Loss, Grief, Death Flashcards
Loss
When something of value is no longer accessible
Types of loss
Actual Perceived Physical Psychological Maturational Situational Anticipatory
Actual loss
Can be recognized by others as well as by the person sustaining the loss
Perceived loss
Such as loss of youth, financial independence, or a valued environment is experienced by the person but is intangible to others
Anticipatory loss
Occurs when a person displays loss and grief behaviors for a loss that has yet to take place
Situational loss
occurs when an unexpected and traumatic life event takes place. These types of losses are not only limited to those resulting from death but can also happen as a result of changes in one’s life circumstances.
Maturational loss
are losses that predictably occur during the life cycle
Grief
Internal emotional reaction to loss
Mourning
Actions and expressions of grief including the symbols and ceremonies that make up the outward expressions of grief
Bereavement
State of grieving due to loss of a loved one
Engels six stages of grief
1- shock and disbelief 2- developing awareness 3- restitution 4- resolving the loss 5- idealization 6- outcome
Shock and disbelief
Are usually defined as a refusal to except the fact of loss
Developing awareness
Physical and emotional response such as anger, feeling empty, crying
Restitution
Ritual surrounding loss
Example with death includes religious, cultural, social expressions of mourning such as funeral services
Resolving the loss
Involves dealing with the void left by the loss
Idealization
Exaggeration of the good qualities of the person or object followed by acceptance of the loss in a lesson need to focus on it
Outcome of loss
Final resolution of the grief process, includes dealing with loss as a common life occurrence
Dysfunctional grief
that is abnormal or unresolved
Person has trouble expressing their feelings
May deny their feelings
Extended period of bereavement
Somatic symptoms may develop( Abnormal pain or heart palioitations)
Death
1-Irreversible secession of all functions of circulatory and respiratory functions
2- irreversible cessation Of all functions of the entire brain, including the brain stem
Medical criteria used to certify a death
Succession of breathing, no response to deep painful stimuli, lack of reflexes and spontaneous movement, flat encephalogram
Signs of impending death
- difficulty talking or swallowing
- nausea, flatus, abdominal distention
- Urinary/bowel incontinence or constipation
- loss of movement, sensation, reflexes
- decreased body temperature, cold or clammy skin
- Weak, slow, irregular pulse
- decreased blood pressure
- noisy, irregular, Cheyenne stokes reparations
- restlessness/ agitation
- cooling, mottling, cyanosis of extremities and dependent areas
Kubler Ross’s five stages of dying
1- denial 2- anger 3- bargaining 4- depression 5- acceptance
Denial
Patient denies the reality of death and may repress what is discussed
Patient may think they made a mistake in the diagnosis maybe they make that my record with someone else’s
Anger
Patient expresses rage and hostility and adapts a “why me” attitude
Bargaining
Patient tries to barter for more time
“ if I can just make it to my grandson‘s graduation I’ll be satisfied just let me live until then”
Depression
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 cannot bear the thought of not being there for the wedding and not seeing my grandchildren”
Acceptance
The patient feels tranquil
Patient has excepted the reality of death and is prepared to die
“ i’ve tied up all loose ends made the wheel made arrangements for my daughter to live with her grandparents now I can go in peace knowing everyone will be fine”
Palliative care
Holistic care- Taking care of the whole person, body, mind, spirit, heart and soul
Goal: improve quality of life of terminally ill patients or those with life-threatening diseases
Terminal illness
In which death is expected within a limited period of time
Hospice care
Service provider for those with a life expectancy of six months or less typically in their home
Indicators for hospice care
Poor performance, declining cognition, advanced age, poor nutritional intake, pressure ulcers, comorbidities, acute decompensation
Ethical and legal dimensions
Conflict between promoting life or needlessly prolonging the dying process
Advanced directive
- living will
- durable power of attorney for health care
- provides instructions for future treatment
- nurses should ask about these documents upon admission
Physician order for life sustaining treatments (POLST) form
- provides medial orders for current treatment
- applicable in hospitals, LTC facilities and for EMS
Code status
- DNR= do not resuscitate
- AND = allow natural death
- DNI= do not intubate
Needs of dying patients
- Physiologic= hygiene, pain, nutritional
- Psychological= Control over fear of the unknown, pain, separation, leaving loved ones, loss of dignity, loss of control, unfinished business, isolation
- Intimacy= Ways to be physically intimate that needs needs of both partners
- Spiritual= meaning And purpose, love and relatedness, forgiveness and hope
Developing a trusting nurse patient relationship
- Explain The patient’s condition and treatment
- Teach self-care and promoting self-esteem
- Teach Family members to assist in care
- Meet The needs of the dying patient
- Explain the grieving process
- Communicate and listen
Providing postmortem care
Care of body:
- place in supine position, tubes removed
- washing may be done by family or forbidden in some cultures
- if autopsy is to be done, tubes remain in place
- identification placed on body, shroud, clothing, belongings etc
Providing postmortem care for the family
Reviewing organ donation arrangements if any
