Death & Grief Flashcards by Alicia Daum

Define Bereavement

Situation in which someone who is close dies

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Define Grief

natural response to bereavement

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Define Complicated Grief

Form of acute grief that is usually prolonged, intense, and disabling

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Define Mourning

Process of adapting to a loss & integrating grief

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Hallmark of Grief

Intense focus on thoughts & memories of the deceased person, accompanied by sadness and yearning

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Non-bereavement Losses

Separation through divorce
Pet
Job
Property 
Community

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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

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Symptoms of Grief due to a Trauma/Stress Reaction

Disbelief & shock
Numbness
Impaired attention, concentration, or memory

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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

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Grief Course

Time-limited
Adapting occurs within 6 months
Restoration of ongoing life within 6-12 months
Can return for “big” events

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Types of Bereavement Loss

Type of relationship lost (survival guilt)
Sudden lost (homicide/suicide)
Chronic illness
Terminal illness

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Associated Psychotherapy to Bereavement

Major depression
Anxiety disorder
PTSD
Suicidality
Other mental disorders (sleep, somatoform, substance, eating)
Complicated grief

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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

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Risk Factors for Complicated Grief

Older age (>61)
Female
Low SES
Non-Caucasion
Prior psych history
Death of spouse, child, young person
Sudden death

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Acute Grief Clinical Features

Separation distress
Inhibition exploration of the world
Traumatic distress

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Complicated Grief Clinical Features

Maladaptive rumination about circumstances of the death
Intense emotional and/or physical reactions
Dysfunctional behaviors
Inadequate regulation of emotions

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Most Common Symptoms of Complicated Grief

Yearning

Feeling upset by memories of deceased

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Risk of Suicidality in Complicated Grief

Greater number of years elapsed since death

Depression & anxiety

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Adverse Consequences of Complicated Grief

Increase use of ETOH & tobacco
Poor QOL
General medical illness & suicide

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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&amp;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