mental health Flashcards
S/sx of final days
person starts to withdraw, decrease socialization, decreased LOC, increased sleeping, decreased ability to swallow
physical signs: loss of bladder & bowel, decrease of urine, change in temp, skin appearance and breathing pattern
how to support the family
provide privacy, encourage, accept and allow for expressions of grief and sadness
create peaceful environment (soft lightening, decrease clutter)
signs of impending death
irregular breathing, extremities cool to touch, mottling in color, non responsive to voice and touch
signs of death
absence of breathing & heart rate for 3 minutes, eyes fixed and slightly open, color change
family reactions to a fatal illness
discovery and diagnosis induction and remission maintenance recover relapse terminal stage
care of body after death
avoid using strings (leaves indentations)
use wide gauze to loosely wraparound fingers
don’t use chin strap
put something small under head for normal positioning
do not put body face down
if plastic bags are used keep loose at the head
going through stages of grief before death, preparations
anticipatory grieving
outward expression of our grief, what others see
mourning
out internal suffering, what others don’t see
grief
when dealing with death and dying what must you do
must first examine own mortality, be compassionate and caring and be a good listener
ability to cope is based on what
post experience, methods of coping, support systems and suddenness
Elizabeth Kubler-Ross stages of dying
denial "no, not me" rage/anger "why me" bargaining "yes me, but" depression "yes me" acceptance "its all right"
what are the three cardinal rules for death and dying cultural beliefs and practices
ask the pt about cultural practices
respect values and traditions
accommodate requests whenever possible
Davidson normal grief response
shock and numbness ‘failure to accept reality”
searching and yearning “guilt”
disorientation “ loneliness, isolation”
reorganization “accepts or is resigned to the loss”
normal grief response
is predictable but can dkip, have overlapping and repeats
abnormal grief
if after 3 years…
deceased room and belongings intact, talk about loss as though it has just happened, inability to remember the deceased, preoccupied with thoughts of deceased, talks about deceased as though still alive
nursing dx
anticipatory grief
prolonged grief
no resumption of normal activities of daily living within 4-8 weeks of a loss
when should someone find help
don’t begin to feel better over time
abuse alcohol or meds to help feel better
think about suicide
the persistent effect the birth of a special needs child brings
chronic sorrow
the final stages for chronic grief
restitution (acceptance)
stages of chronic sorrow
defense mechanisms (denial and disbelief) phase of developing awareness, characterized by overwhelming emotion restitution/acceptance
does chronic grief prevent parents from feeling jow, happiness, satisfaction, and accomplishment for the child they love
no it does not
what are the 2 pathological reaction patterns of chronic grief
extreme guilt (look for signs of excessive over protectiveness) parents may be intolerant of the child and deny relationship
the sudden unexpected death of any infant or child typically under two years of age in which an autopsy does not show an explainable cause of death
SIDS
*a syndrome, the 1st sx is death
predisposing factors for SIDS
age 2-4 months, most at 6 months
increased in winter months, SGA, premature, males, after 1st born
SIDS is a Dx of what
exclusion
always assume SIDS not abuse
common finding of SIDS
petechiae on thalamus, lung & brain, pulmonary edema, abnormal thalamus
usually frothy pink mucous coming from mouth and nose
sudden and unexplained death of infant in which cause of death is found later
SUID
what is the triple risk theory for SIDS
vulnerable infant
critical developmental period (0-6 months)
exogenous stressor
children and death
tell the truth immediately, must be told by parent or someone close, be direct and honest, parents should show emotion
childs sadness often short lived but is intermittent
signs of regression
bedwetting, thumb sucking, are often seen byt temporary (NORMAL)
infant understanding of death and their response
unable to conceive death, aware of lack of gratification of needs, react to pain and discomforts
toddler understanding of death and their response
1-3 years
developing awareness of absence “all gone”
talk about person as though still alive, very ritualistic, frequently regress, may display physical aggression
preschool understanding of death and their response
3-5 years
death is perceived as temporary (can die and come back like cartoons)
engage in strange activities (return to pets burial site and dig them up to confirm death)
think their thoughts can cause death
play therapy is very beneficial
may turn to parent of opp. sex for comfort
school age understanding of death and their response
6-12 years
realize the truth about death, know irreversible and universal, personify death (boogyman, ghost) develop rituals to avoid death
preoccupied with details
greatest fear is fear of unknown
plan elaborate funerals for pets
adolescent understanding of death and their response
13-19 years
mature concept and understanding of death
attitudes about death formed by parents, religion and peers
tempt fate to prove immorality
may reject funeral customs with exception of when a classmate or friends die
desire to protect parents (usually send parents away when know death is near)
greatest fear is loss of body image
when an individual can look back on a relationship with the lost entity and accept both the pleasures and the disappointments
resolution
bereavement overload
may not be able to complete one grieving process before another loss occurs
is there an increased risk of suicide in the elderly
yes when related to unresolved grief and loneliness
drug therapy for elderly
should only be used short term and with the smallest effective dose possible
should not exceed 3 weeks
what is the key variable to aid in recovery for the elderly
social support
concept of caring
provide emotional, physical, supportive and finical assistance to terminal patients and families
hospice
nationally available program for dealing with the needs of the newly widowed
widowed persons service
peer support group for families experiencing the death of a child through miscarriage, ectopic pregnancy, stillbirth, or neonatal death
bayside helping hands
peer support group for parents who have experienced the loss of a child of any age
compassionate friends
directory listing of multiple bereavement support groups located through the state
directory of bereavement resources (Delaware grief awareness)
the risk of complicated grief increases with what
the death of a spouse, death of a child, death by suicide, or sudden unexpected death
the risk of dysfunctional grief is highest when what
a person has had a previous unresolved grief or has inadequate support
Nursing Dx for grief
delayed or inhibited grief: don’t deal with reality of loss
prolonged greif: no resumption of normal ADLs within 4-8 weeks
exaggerated grief response: Sx of grief are exaggerated (anger turned inward on self = depression)
