Exam4- Loss, Grief, and Dying

Question 1

what is loss?

Answer 1

the undesired changed or removal of a valued object, person, or situation

Question 2

type of losses

Answer 2

• necessary loss
• actual loss
• perceived loss
• maturational or developmental loss
• situational loss
• anticipatory loss

Question 3

a loss related to change that is part of the cycle of life that is anticipated but still can be intensely felt

Answer 3

necessary loss

Question 4

any loss of a valued person, item, or status, such as loss of a job that can be recognized by others

Answer 4

actual loss

Question 5

any loss defined by the person experiencing the loss and is not obvious to others (rejection, status)

Answer 5

perceived loss

Question 6

any loss normally expected due to the developmental processing of life

Answer 6

maturational loss

Question 7

any unanticipated loss caused by an external event (family loses home during tornado)

Answer 7

situational loss

Question 8

experienced before the loss happens

Answer 8

anticipatory loss

Question 9

what is grief?

Answer 9

physical, psychological, and spiritual responses to a loss

Question 10

what is mourning?

Answer 10

action associated with grief

Question 11

what is bereavement?

Answer 11

mourning and adjustment time following a loss

Question 12

5 stages of grief (Kubler-Ross theory)

Answer 12

denial
anger
bargaining
depression
acceptance

Question 13

what are the factors influencing loss and grief?

Answer 13

• current stages of development
• gender
• interpersonal relationships
• social support networks
• type and significance of loss
• culture and ethnicity
• spiritual and religious beliefs and practices
• prior experience with loss
• socioeconomic status

Question 14

factors increasing risk for dysfunctional grieving

Answer 14

• being exceptionally dependent upon the deceased
• a person dying unexpectedly at a young age
• a person dying through violence
• inadequate coping skills
• lack of support systems
• lack of hope or preexisting mental health issues (depression or substance abuse)
• unresolved conflilct
• circumstances of the loss (guilt); suicide, homelessness

Question 15

types of grief

Answer 15

• uncomplicated or normal
• anticipatory
• complicated- unresolved or chronic grief (feels stuck/can’t move on)
• disenfranchised- grief can’t be shared publicly (suicide, abortion)

Question 16

ways to facilitate mourning

Answer 16

• grant time for the grieving process
• use therapeutic communication
• use active listening
• open-ended questions
• silence
• provide continuing support
• provide available community resources
• initiate referrals

Question 17

palliative care (end-of-life care)

Answer 17

• planned holistic comfort care
• patient does NOT necessarily have to be “actively dying” but they’re also not getting better
• slow progressive disease

Question 18

hospice care (end-of-life care)

Answer 18

-holistic care of dying pts
-MD certifies that pt is likely to die within 6 months
(eligibility for hospice insurance benefits)
-pt is terminal and chooses to end treatment
-focus is to support client toward a peaceful and dignified death

Question 19

legal and ethical considerations

Answer 19

• advance directives
• DNR
• assisted suicide
• autopsy
• organ donation

Question 20

power of attorney vs durable power of attorney

Answer 20

power of attorney does NOT give rights for healthcare decisions while durable power of attorney does

Question 21

T/F: hearing is diminished when pt is approaching death

Answer 21

false; hearing is NOT diminished

touch can be diminished

Question 22

signs of approaching death

Answer 22

• decreased LOC
• muscle relaxation of face
• inability to swallow
• labored breathing (Cheyne-Stokes)
• incontinence of bowel/bladder
• mottling
• decreased pulse and BP
• cool extremities
• pupils no longer reactive to light
• decreased urine output

Question 23

care of the dying person

Answer 23

• meeting physiological needs (nutrition, oxygen, fluids, hygiene, control pain and nausea)
• meeting psychological needs
• addressing spiritual and cultural needs

Question 24

historical definition of death

Answer 24

-cessation of flow/vital bodily fluids

Question 25

heart-lung death

Answer 25

irreversible cessation of breathing and circulation

Question 26

whole-brain death

Answer 26

brain stem is not functioning

Question 27

higher-brain death

Answer 27

still have brain stem function; can have respiratory effort (vegetative state)

Question 28

providing postmortem care

Answer 28

care of the body: follow agency policies and respect cultural and spiritual preferences

nurses follow federal and state laws:

• organ/tissue donation
• obtaining permission for autopsy
• appropriate documentation of death
• providing postmortem care

Question 29

rigor mortis

Answer 29

• stiffening of the body after death
• contraction of muscles from lack of ATP
• begins in heart and proceeds to head, neck, trunk, and extremities

Question 30

when does rigor mortis occur

Answer 30

2-4hrs after death
(place dentures and close pts eyes after death before rigor mortis occurs)

disappears about 96hrs after death

Question 31

preparing body for viewing

Answer 31

-maintain privacy
-remove all tubes (except for organ donation or medical examiner case)
-remove personal belongings and give to family
-cleanse and align body
-apply fresh linens
-brush/comb hair
-

Question 32

postviewing

Answer 32

• apply identification tags according to facility policy
• complete documentation
• remain aware of visitor and staff during transport to morgue or funeral home

Question 33

what nurses can do after a loss of a patient

Answer 33

• cry with family
• go to pt’s funeral
• communicate in writing to the family
• attend debriefing sessions with colleagues
• use stress management techniques
• talk with a professional counselor