Loss, Grief, Death

Question 1

Loss

Answer 1

When something of value is no longer accessible

Question 2

Types of loss

Answer 2

Actual
Perceived 
Physical 
Psychological 
Maturational 
Situational 
Anticipatory

Question 3

Actual loss

Answer 3

Can be recognized by others as well as by the person sustaining the loss

Question 4

Perceived loss

Answer 4

Such as loss of youth, financial independence, or a valued environment is experienced by the person but is intangible to others

Question 5

Anticipatory loss

Answer 5

Occurs when a person displays loss and grief behaviors for a loss that has yet to take place

Question 6

Situational loss

Answer 6

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.

Question 7

Maturational loss

Answer 7

are losses that predictably occur during the life cycle

Question 8

Grief

Answer 8

Internal emotional reaction to loss

Question 9

Mourning

Answer 9

Actions and expressions of grief including the symbols and ceremonies that make up the outward expressions of grief

Question 10

Bereavement

Answer 10

State of grieving due to loss of a loved one

Question 11

Engels six stages of grief

Answer 11

1- shock and disbelief 
2- developing awareness
3- restitution 
4- resolving the loss
5- idealization 
6- outcome

Question 12

Shock and disbelief

Answer 12

Are usually defined as a refusal to except the fact of loss

Question 13

Developing awareness

Answer 13

Physical and emotional response such as anger, feeling empty, crying

Question 14

Restitution

Answer 14

Ritual surrounding loss

Example with death includes religious, cultural, social expressions of mourning such as funeral services

Question 15

Resolving the loss

Answer 15

Involves dealing with the void left by the loss

Question 16

Idealization

Answer 16

Exaggeration of the good qualities of the person or object followed by acceptance of the loss in a lesson need to focus on it

Question 17

Outcome of loss

Answer 17

Final resolution of the grief process, includes dealing with loss as a common life occurrence

Question 18

Dysfunctional grief

Answer 18

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)

Question 19

Death

Answer 19

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

Question 20

Medical criteria used to certify a death

Answer 20

Succession of breathing, no response to deep painful stimuli, lack of reflexes and spontaneous movement, flat encephalogram

Question 21

Signs of impending death

Answer 21

• 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

Question 22

Kubler Ross’s five stages of dying

Answer 22

1- denial
2- anger
3- bargaining 
4- depression
5- acceptance

Question 23

Denial

Answer 23

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

Question 24

Anger

Answer 24

Patient expresses rage and hostility and adapts a “why me” attitude

Question 25

Bargaining

Answer 25

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”

Question 26

Depression

Answer 26

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”

Question 27

Acceptance

Answer 27

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”

Question 28

Palliative care

Answer 28

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

Question 29

Terminal illness

Answer 29

In which death is expected within a limited period of time

Question 30

Hospice care

Answer 30

Service provider for those with a life expectancy of six months or less typically in their home

Question 31

Indicators for hospice care

Answer 31

Poor performance, declining cognition, advanced age, poor nutritional intake, pressure ulcers, comorbidities, acute decompensation

Question 32

Ethical and legal dimensions

Answer 32

Conflict between promoting life or needlessly prolonging the dying process

Question 33

Advanced directive

Answer 33

• living will
• durable power of attorney for health care
• provides instructions for future treatment
• nurses should ask about these documents upon admission

Question 34

Physician order for life sustaining treatments (POLST) form

Answer 34

• provides medial orders for current treatment

- applicable in hospitals, LTC facilities and for EMS

Question 35

Code status

Answer 35

• DNR= do not resuscitate
• AND = allow natural death
• DNI= do not intubate

Question 36

Needs of dying patients

Answer 36

• 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

Question 37

Developing a trusting nurse patient relationship

Answer 37

• 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

Question 38

Providing postmortem care

Answer 38

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

Question 39

Providing postmortem care for the family

Answer 39

Reviewing organ donation arrangements if any