Loss, Grief and Dying

Question 1

Name the 5 stages of Kubler Ross’ reaction to dying and give an example of each.

Answer 1

1) Denial - “Maybe they mixed up my EMR with someone else’s
2) Anger - “Why me?”
3) Bargaining - “If I can just make it my son’s graduation I’ll be satisfied”.
4) Depression - “I can’t bear the thought of not being there for my daughter’s wedding”.
5) Acceptance - “I’ve tied up all loose ends, now I can go in peace”.

Question 2

What are the 10 signs of impending death?

Answer 2

1) Difficulty talking or swallowing
2) Nausea, flatus, & abdominal distention
3) Urinary and/or bowel incontenence or constipation
4) Loss of movement, sensation and reflexes
5) ⬇ body temp with cold or clammy skin
6) Weak, slow, or irregular pulse
7) ⬇ BP
8) Noisy Irregular, or Cheyne-Stokes respirations
9) Restlessness and or agitation
10) Cooling, mottling, and cyanosis of extremities and dependent areas

Question 3

What are the 4 medical criteria used to certify death?

Answer 3

1) Cessation of breathing
2) No response to deep painful stimuli
3) Lack of reflexes (such as gagging and corneal reflex)
4) non reversible loss of brain function

Question 4

(T/F) It is the nurse’s responsibility to ensure that the physician has signed the death certificate?

Answer 4

True

Question 5

What three conditions could possibly suspend life processes and give the false appearance of death?

Answer 5

1) Hypothermia
2) Drug intoxication
3) Circulatory shock

Question 6

Describe the two types of Advance Directives

Answer 6

1) Living Wills - Specific instructions on healthcare to be provided in specific situations.
2) Durable Power of Attorney - Given to a person appointed as agent to make healthcare decisions in the event of incapacity.

Question 7

What is the difference between Assisted Suicide and Active Euthanasia?

Answer 7

1) Assisted Suicide - HCP provides patient with the means (drug or equipment) to commit suicide.
2) Active Euthanasia - HCP acts directly to cause the death of the patient (give lethal dose of medication).

Question 8

What is Passive Euthanasia?

Answer 8

When the patient chooses to stop aggressive disease treatment and allow disease progression to death.

Question 9

An Autopsy must be obtained with what types of deaths? Whose consent is needed?

Answer 9

1) Accidental death
2) Suicide
3) Homicide
4) Illegal therapeutic practice
* Must obtain consent of the closest surviving family member