Loss, Grief and Dying Flashcards
Actual loss is…
loss that can be identified by others
Physical loss is…
Injuries, loss of body function, removal of body organs or limbs
External loss is…
Actual losses of objects that are important to the person because of their cost or sentimental value
Perceived loss is…
internal,; can only be identified by the person experiencing it
Psychological loss is…
Challenge our belief system; involve sexuality, control, meaning, trust
Internal loss is…
Same as perceived or psychological
John Bowlby stages of grief
Shock and Numbness
Yearning and Searching
Disorganization and Despair
Reorganization
Uncomplicated
natural response to a loss. Certain feeling and behaviors are expected within his culture
Complicated
not adapting in a healthy way to the loss
Complicated Chronic
long-term with little resolution
Complicated Masked
expressing grief through changes in behavior (drinking, isolating oneself, working more to forget)
Complicated Delayed
putting grieving off until later
Disenfranchised
experiencing a loss that is not socially supported or acknowledge by traditional means
Miscarriage, loss of a homosexual partner
Anticipatory
experiencing feelings of grief before the loss actually occurs
Physiological stages of dying
1 to 3 months prior to death Dying person socially withdraws Sleep increases, appetite decreases 1 to 2 weeks prior to death Physical changes occur (decrease BP, temp fluctuates, skin becomes pale, periods of apnea during sleep) Days to hours prior to death Shallow, rapid breathing followed by Cheyne-Stokes respirations Peripheral circulation decreases Body muscles relax Restlessness and agitation Moments prior to death Person cannot be aroused and does not respond to touch or sound
5 Stages of grief
Denial – characterized by shock and disbelief, serves as a buffer to mobilize defense mechanism
Anger- resistance of the loss occurs, anger is typically directed toward others
Bargaining - deals are sought with God or other higher power in an effort to postpone the loss
Depression- loss is realized; may talk openly or withdraw.
Acceptance- recognition of the loss occurs, disinterest may occur; future thinking may occur.
Types of end-of-life care
Palliative
Hospice
Palliative care
Holistic comfort care
Managing the symptoms of the disease process, not the actual disease
Examples:
Administering medicine for pain/nausea
Providing oral care for pt who can no longer eat/drink
NOT the following
Surgical procedures to sustain life such as inserting a gastrostomy tube
Intubating patient and placing on mechanical ventilation
Hospice care
Holistic care of dying clients
Physician has determined the patient will likely not survive past 6 months
Key Points
The quality of life is still VERY important
The dying person should be allowed to face death with dignity and surrounded by those people he cherishes
Assisting the family is an integral part of hospice nursing
Priorities are keeping the patient comfortable (pain meds, oral care) NOT forcing them to do things that will really have no bearing on their prognosis (i.e. getting them out of bed, forcing them to eat, even turning them can cause pain)
Advance directives
Living will
Pt has the right to change this at any time
We do not need a doctor’s order for a Living Will
Durable power of Attorney
DNR
Do not resuscitate
Euthanasia
Active: direct action causes death
Passive: withholding care the patient doesn’t want
Assisted suicide
q
Autopsy
q
Organ donation
q
Assessment for Terminally Ill Client and Family
Knowledge base History of loss Coping abilities and support systems Meaning of the loss/illness Physical assessment Cultural and spiritual assessment
Possible Nursing Dx that could have loss and grieving as the etiology (“related to”)
Anxiety
Fatigue
Imbalanced Nutrition: Less than Body Requirements
Spiritual Distress
