Fun Ch. 43 Loss, Grief, and Dying Flashcards
loss that can be recognized by others as well as by the person sustaining the loss, such as loss of a limb or a spouse
actual loss
process of planning for future care in the event a person becomes unable to make his or her own decisions
advance care planning (ACP)
written directive that allows people to state in advance what their choices for health care would be if certain circumstances should develop
advance directive
an order that no attempts are to be made to resuscitate a patient who stops breathing or whose heart stops beating
Allow Natural Death (AND) order
condition in which a person displays loss and grief behaviors for a loss that has yet to take place
anticipatory loss
state of grieving or going through the grief process
bereavement
an order written to indicate that the goal of treatment is a comfortable, dignified death and that further life-sustaining measures are no longer indicated
Comfort Measures Only order
an order specifying that there be no attempt to resuscitate a patient in the event of cardiopulmonary arrest
Do Not Resuscitate (DNR) order
abnormal or distorted grief that may be either unresolved or inhibited
dysfunctional grief
3 definitions of death
(1) irreversible cessation of all functions of circulatory and respiratory functions;
(2) irreversible cessation of all functions of the entire brain, including the brainstem;
(3) termination of life
emotional response to loss.
grief
person suppresses feelings of grief and may instead manifest somatic (body) symptoms, such as abdominal pain or heart palpitations
inhibited grief
lengthy or denied grief reaction
unresolved grief
short but genuine grief reaction
Abbreviated grief
grief reaction before actual loss
Anticipatory grief
care provided for people with limited life expectancy, often in the home.
hospice care
inaccessibility or change in a valued person, object, or situation.
loss
loss tangible to both the person sustaining the loss and to others.
Actual loss
loss tangible only to the person sustaining it.
Perceived loss
loss of life, limb, an object, person, pet, or job.
Physical loss
loss that affects a person’s self-image.
Psychological loss
loss behaviors displayed before the actual loss occurs.
Anticipatory loss
MOLST
stands for Medical Order for Life-Sustaining Treatment, a medical order indicating a patient’s wishes regarding treatments commonly used in a medical crisis
period during which a person learns to accept grief
mourning
hospice care; taking care of the whole person—body, mind, spirit, heart, and soul—with the goal of giving patients with life-threatening illnesses the best quality of life they can have through the aggressive management of symptoms
palliative care
the lowering of patient consciousness with medication for the express purpose of limiting the patient’s awareness of suffering that is intractable and intolerable
palliative sedation
loss of youth, of financial independence, and of a valued environment experienced by a person, but intangible to others
perceived loss
POLST
stands for Physician Order for Life-Sustaining Treatment, a medical order indicating a patient’s wishes regarding treatments commonly used in a medical crisis; must be completed and signed by a health care professional, not the patient
illness from which there is no reasonable expectation of recovery or cure
terminal illness
withdrawal of life-sustaining therapy with the understanding that death may result, generally after a decision is made that the therapy in question is medically futile or disproportionately burdensome
terminal weaning
Engel’s six stages of grief
(1) shock and disbelief,
(2) developing awareness, (
3) restitution,
(4) resolving the loss,
(5) idealization, and
(6) outcome
Stage of grief defined as refusal to accept the fact of loss, followed by a stunned or numb response: “No, not me.”
Shock and disbelief
Stage of grief characterized by physical and emotional responses such as anger, feeling empty, and crying: “Why me?”
Developing awareness
involves the rituals surrounding loss; with death, it includes religious, cultural, or social expressions of mourning, such as funeral services.
Restitution
Stage of grief; involves dealing with the void left by the loss. Idealization is the exaggeration of the good qualities of the person or object, followed by acceptance of the loss and a lessened need to focus on it.
Resolving the loss
Stage of grief; the final resolution of the grief process, includes dealing with loss as a common life occurrence.
Outcome
Kübler-Ross 5 stages of grief and death reactions
(1) denial and isolation,
(2) anger,
(3) bargaining,
(4) depression, and
(5) acceptance
The medical criteria used to certify a death are as follows:
- Cessation of breathing
- No response to deep painful stimuli
- Lack of reflexes (such as the gag or corneal reflex) and spontaneous movement
- Flat encephalogram (brain waves)
heart–lung death
cessation of the apical pulse, respirations, and blood pressure.
cerebral or higher brain death
when the cerebral cortex is irreversibly destroyed.
Characteristics of a Good Death
A good death is one that allows a person to die on his or her own terms, relatively free of pain, with dignity, and free from avoidable distress and suffering for patients, families, and caregivers.
Kübler-Ross 5 stages of grief and death reactions: The patient expresses rage and hostility and adopts a “why me?” attitude: “Why me? I quit smoking and I watched what I ate. Why did this happen to me?”
Anger
Kübler-Ross 5 stages of grief and death reactions: The patient goes through a period of grief before death. The grief is often characterized by crying and not speaking much: “I waited all these years to see my daughter get married. And now I may not be here to see her walk down the aisle. I can’t bear the thought of not being there for the wedding—and of not seeing my grandchildren.”
Depression
Kübler-Ross 5 stages of grief and death reactions: the patient feels tranquil. The patient has accepted the reality of death and is prepared to die. The patient may think, “I’ve tied up all the loose ends: made the will, made arrangements for my daughter to live with her grandparents. Now I can go in peace knowing everyone will be fine.”
Acceptance
Kübler-Ross 5 stages of grief and death reactions: The patient tries to barter for more time: “If I can just make it to my son’s graduation, I’ll be satisfied. Just let me live until then.” Many patients put their personal affairs in order, make wills, and fulfill last wishes, such as trips, visiting relatives, and so forth.
Bargaining
Kübler-Ross 5 stages of grief and death reactions: The patient denies the reality of death and may repress what is discussed. The patient may think, “They made a mistake in the diagnosis. Maybe they mixed up my records with someone else’s.”
Denial
How may children respond to death of a loved one?
- delay development
- regress development
How do older adults respond to death of a loved one?
- reminisce about life,
- put their lives and the purpose of living in perspective, and
- prepare themselves for their own inevitable death.
Focused assessment for those experiencing loss, grief, and dying
- determining the adequacy of the patient’s and family’s knowledge,
- perceptions,
- coping strategies, and
- resources.
