Death & Grief Flashcards
Define Bereavement
Situation in which someone who is close dies
Define Grief
natural response to bereavement
Define Complicated Grief
Form of acute grief that is usually prolonged, intense, and disabling
Define Mourning
Process of adapting to a loss & integrating grief
Hallmark of Grief
Intense focus on thoughts & memories of the deceased person, accompanied by sadness and yearning
Non-bereavement Losses
Separation through divorce Pet Job Property Community
Symptoms of Grief due to Separation Distress
Yearning for & seeking proximity to the deceased
Loneliness
Crying, sadness, and other painful emotion
Somatic symptoms
Hallucinations of deceased person
Symptoms of Grief due to a Trauma/Stress Reaction
Disbelief & shock
Numbness
Impaired attention, concentration, or memory
Other Symptoms of Grief
Difficult to feel connected & withdraw
Transiently wish they had died with their loved one or instead of deceased
Thoughts & images of the deceased occur frequently
Grief Course
Time-limited
Adapting occurs within 6 months
Restoration of ongoing life within 6-12 months
Can return for “big” events
Types of Bereavement Loss
Type of relationship lost (survival guilt)
Sudden lost (homicide/suicide)
Chronic illness
Terminal illness
Associated Psychotherapy to Bereavement
Major depression Anxiety disorder PTSD Suicidality Other mental disorders (sleep, somatoform, substance, eating) Complicated grief
Management of Grief & Bereavement
Summon families prior to expected death
Grief counseling
Support from family, friends, & clergy
Remind family to maintain regular patterns of activity, sleep, exercise, & nutrition
Send condolence letter
Risk Factors for Complicated Grief
Older age (>61) Female Low SES Non-Caucasion Prior psych history Death of spouse, child, young person Sudden death
Acute Grief Clinical Features
Separation distress
Inhibition exploration of the world
Traumatic distress
Complicated Grief Clinical Features
Maladaptive rumination about circumstances of the death
Intense emotional and/or physical reactions
Dysfunctional behaviors
Inadequate regulation of emotions
Most Common Symptoms of Complicated Grief
Yearning
Feeling upset by memories of deceased
Risk of Suicidality in Complicated Grief
Greater number of years elapsed since death
Depression & anxiety
Adverse Consequences of Complicated Grief
Increase use of ETOH & tobacco
Poor QOL
General medical illness & suicide
Course of Complicated Grief
Symptoms last at least 1 month after 6 months of bereavement who are significantly & functionally impaired
Seek treatment on average 2-4 years after loss
Assessment of Complicated Grief
H&P Mental status exam Labs: CBC, CMP, UA, TSH Address suicide risk Brief Grief Questionnaire
Diagnostic Criteria for Complicated Grief
Experience death of loved on for >6 months
Persistent, intense yearning for deceased
Frequent preoccupying thoughts about deceased
Frequent intense feelings of loneliness or that life is meaningless without deceased
Recurrent thought that it is unfair to live without deceased; urge to join deceased
Frequent troubling rumination about circumstances of death
Recurrent disbelief or inability to accept death
Persistently feeling shocked, stunned, dazed, or numb since death
Anger or bitterness about death
Intense emotional or physiologic reactions to reminders of loss
Marked change in behavior
Goals of Management of Complicated Grief
Relief of rumination, excessive proximity seeking & avoidance behavior
Improve emotion regulation
Accepting finality
Feeling of enduring connection to deceased
Ability to envision life with the possibility of happiness
Engagement satisfying activities & relationships
Treatment for Complicated Grief
CBT
Define Death
Absolute cessation of vital functions
Signs of Death
Cessation of breathing Cardiac arrest Palor mortis: paleness Livor mortis: blood settles to dependent parts Algo mortis: decrease in body temp Rigor mortis: limbs become stiff Decomposition
Define Terminal State
Disease felt to be fatal
Life expectancy
Physiologic Changes While Dying
Increasing weakness, fatigue
Decreasing appetite/food intake
Decreasing blood perfusion
Neurologic dysfunction
Signs of Increasing Weakness & Fatigue
Decreased ability to move
Increased risk of pressure ulcers & need for care
Signs of Decreasing Appetite & Food Intake
Fear of giving in & starving
Food nauseating
Aspiration
Signs of Decreasing Blood Perfusion
Tachycardia Hypotension Peripheral cooling Cyanosis Mottling of skin Diminished urine output
Signs of Neurologic Dysfunction
Decreasing level of consciousness Terminal delirium Changes in respiration Inability to swallow Sphincter control lost
Signs of Active Dying
No intake of food or water Sunken cheeks Respiratory mandibular movement Dramatic skin color changes Rattles in chest
Signs in the Last 48 Hours
Orderly loss of senses Noisy, moist breathing Urinary incontinence or retention Pain Dyspnea Restlessness & agitation Twitching of body N/V Sweating
Hospice Care
Focuses on caring, not curing
Services Provided by Hospice Care
Manages patient’s pain & symptoms
Assists patient with emotional, psychological, & spiritual aspect of dying
Provide needed drugs, medical supplies, & equipment
Guidelines for the Family When A Patient is Dying
Signs of increasing Pain
Close to death do not feel hungry or thirsty
Breathing may become noisy & congested
Hearing is last sense to go
Children
Separation similar to sleep
5-10 Year Olds Attitude Towards Death
Sense of inevitable human mortality
Fear that parents will die & they will be abandoned
Adolescents Attitude Towards Death
Death is inevitable & final
Broad range of emotions
Adults Attitude Towards Death
Accept their time has come
Talk/joke openly about dying
Sense of integrity or despair
How to Convey Bad News
Prepare
Be calm & clear
Arrange follow-up for family members
5 Stages of Grief
Denial Anger Bargaining Depression Acceptance
Stages of Grief: Denial
Normal reaction to overwhelming emotions
Defense mechanism
Stages of Grief: Anger
Reality & pain re-emerge
Intense emotion deflected from vulnerable core & expressed as anger
Know person isn’t to blame but resent person causing pain or leaving
Stages of Grief: Bargaining
Normal reaction to feelings of helplessness & vulnerability to gain control
Make deal with God or higher power to postpone the inevitable
Stages of Grief: Depression
Feel like we don’t care about anything & wish life would hurry and pass on by
2 Types of Depression with Grief
Reaction to practical implications relating to the loss
Quiet preparation to separate & bid loved one farewell
Stages of Grief: Acceptance
Withdrawal & calm
Ready to move on
