End Of Life (Fundamentals 10, Burke 13) Flashcards
Loss
any potential, actual or perceived situation when valued object or person has changed or not accessible.
Maturational
naturally occurs over time. Death due to aging. occurs as person moves from one developmental stage to the next
Situational
in response to external events beyond person’s control
Categories of LOSS
1) significant other
2) aspect of self
3) external object
4) familiar environment (moving)
Grief
- Intense PSYCHOLOGICAL responses that occur after loss
- necessary, normal, natural adaptive responses
Mourning
- Period of TIME in grief.
- Physical outward appearance (cultural aspects, i.e., Italians wear black for ever, Asians where white, Catholics wear veils etc.)
Bereavement
- Period of GRIEF after death of loved one
- emotional aspect of suffering
Stages of Grief
SHOCK: feeling of emotional numbness
REALITY: painful experience after one consciously realizes the loss
ACCEPTANCE/RECOVERY:
Type of Grief
- UNCOMPLICATED: Normal
- ANTICIPATORY: before expected loss (waiting for sick grandma to die)
- DYSFUNCTIONAL: intense, persistent pattern that is not reconciled.
- DISENFRANCHISED: can’t grieve openly (i.e. side chick can’t grieve for married man)
Factors affecting Loss/Grief
- Developmental Stage (teens, toddlers, adult, elderly)
- Religion/Culture
- Relationship w lost object (sentimental value, significant other v acquaintance)
- Cause of death (tragic surprise, long term illness)
Nursing Care to grieving client
- determine personal meaning of loss
- encourage clients to feel it (let it out)
- assess client progress through stage of grief
- renew patients ability to do ADLs alone
Goals for those in Grief
- accept loss
- verbalize feelings of grief **
- share grief w significant others
- renew activities and relationships
Implantation of Goals
- spend time listening
- demonstrate acceptance
- non judgmental attitude
- provide reassurance, support and counseling resources
Death
last stage of life
PSDA
Patient Self Determination Act
Always ask patient about Advanced directives. (i.e. living will, Health care proxy, DNI/DNR)
legal means to specify circumstances under which life sustaining measures should or should not be rendered.
Advance Directives
- written instructions of client wishes
- includes durable POA for health care and living will.
Stages of Death/Dying
Elizabeth Kubler Ross
1) Denial
2) Anger
3) Bargaining
4) Depression **NORMAL in this case
5) Acceptance
EOL care consists of
- control of symptoms (comfortable as possible)
- ID of needs
- promotion of interaction
- facilitation of peaceful death
Palliative Care
relief of symptoms
care delivered by interdisciplinary team to manage psychological, social, spiritual needs
Hospice
- less than 6 months to live
- Death with dignity
- no technology unless it is palliative
- i.e. morphine drip to slow breathing and for pain
2 biggest fears of dying
- dying alone
- dying in pain
How to communication and demonstrate acceptance
hold clients or family hand and say “ I will not leave you” etc.
Physiological Needs of Dying
- Respiration
- fluid/nutrition
- mouth,eyes, nose
- mobility
- skin care
- eliminations
- comfort
- physical environment
Signs of Impending Death
- lungs can’t provide adequate gas diffusion (LOW O2)
- LOW perfusion of heart and vessels (cold hands/feet)
- brain shuts down
- Cheyne Stokes respirations (death rattles, loud breathing)
