Loss Grief and Dying

Question 1

Plan of care (written or oral) stating the client’s wishes regarding how he/she receives healthcare services in the event they become incapacitated or unable to make decisions.

Answer 1

Advance Directives

Question 2

Two type of advance directives

Answer 2

Living will

Durable Power of attorney

Question 3

specific instructions the client wishes related to healthcare delivery

Answer 3

living will

Question 4

designated person to make healthcare wishes in the event a client is unable to make those decisions.

Answer 4

Durable Power of Attorney

Question 5

Components of Spirituality

Answer 5

Faith, hope, love

Question 6

An evolving pattern of believing that guides and grounds us and helps us make sense of the world and confront the challenges.

Answer 6

faith

Question 7

A positive expectation and desire for future things to happen. Includes our basic human need to achieve, create, and to shape something of our life that will endure

Answer 7

hope

Question 8

Kubler- Ross Stages of Grief

Answer 8

Denial
Anger
Bargaining
Depression
Acceptance

Question 9

Engel Stages of Grief

Answer 9

Shock and disbelief
Developing awareness of the loss
Restitution and Recovery

Question 10

Worden Stages of Grief

Answer 10

Accepting the reality of the loss
Working through the pain and grief
Adjusting to the environment in which the deceased is missing
Emotionally relocating the deceased and moving on with life

Question 11

Taking care of the whole person mind, body, spirit, heart, and soul.
Focuses on quality of life
Appropriate for many illnesses and settings.

Answer 11

Palliative Care

Question 12

A form of palliative care for patients with a short life expectancy
Focus is on the need of the dying
Care may be at home

Answer 12

Hospice Care

Question 13

Culture should be considered

Remember an individual’s culture can influence decision making regarding end of life care.

Answer 13

Culturally Competent Care

Question 14

Clinical Manifestations of Impending Death

Answer 14

Difficulty talking or swallowing
Nausea, flatus, abdominal distention
Urinary and/or bowel incontinence or constipation
Loss of movement, sensation, and reflexes
Decreasing body temperature, with cold or clammy skin
Weak, slow, or irregular pulse
Decreasing blood pressure
Noisy, irregular, or Cheyne-Stokes respirations
Restlessness and/or agitation
Cooling, mottling, and cyanosis of the extremities and dependent areas

Question 15

must be ordered by the provider, after conferring with patient and/or family.

Answer 15

Do Not Resuscitate (Allow Natural Death)

Question 16

requires signed permission from the next of kin except if required by law (suspicious or unwitnessed deaths).

Answer 16

Autopsy

Question 17

Call _______ for every death

Answer 17

KODA

Question 18

Why is it important to position the body with a pillow under the head and shoulders soon after death?

Answer 18

To prevent discoloration from blood settling in these areas, which would be upsetting to the family.

Question 19

Why is it important to close the eyes and mouth of the deceased and position the body within at least 2 to 4 hours after death?

Answer 19

Rigor mortis occurs about 2 to 4 hours after death. It does not disappear until about 96 hours after death. You would not be able to do these things after the body becomes rigid.

Question 20

is the natural response to the loss of a person or object. The bereaved person experiences the expected feelings, behaviors, and cognitions. Emotions are intense but gradually diminish over time (several months to several years). Some emotions will always be present, but the intensity will change.

Answer 20

Uncomplicated Grief (normal grief)

Question 21

is characterized by intensity of emotions and length of time. The person’s responses are maladaptive, dysfunctional, unusually prolonged, or overwhelming. For example, the bereaved may become severely depressed, violent, or suicidal; become a “workaholic”; become socially isolated; or demonstrate addictive behavior. After several years the person may still be experiencing as much pain and disruption as in the first months after the loss.

Answer 21

Complicated Grief, also known as prolonged acute grief,

Question 22

A nurse is caring for a client recently diagnosed with advanced cancer. Which client statement reflects the Kübler-Ross stage of denial in the grief process? Select all that apply.

1. _____ “Why did this have to happen to me now?”
2. _____ “How could this happen when I quit smoking cigarettes?”
3. _____ “Maybe they mixed up my records with someone else’s records.”
4. _____ “I probably will not live long enough to see my children married.”
5. _____ “What’s the point in doing anything? They tell me I am going to die soon anyway.”

Answer 22

3. This statement characterizes the denial stage of the grieving process. When in denial, a client may identify reasons why the diagnosis is not possible.