Module 11B Flashcards
Chapter43 Sparkle Ppt
Concepts of Loss
Loss occurs when a valued person, object, or situation is
changed or becomes inaccessible such that its value is
diminished or removed.
Actual loss: can be recognized by others
Perceived loss: is felt by person but intangible to others
Physical loss versus psychological loss
Maturational loss: experienced as a result of natural
developmental process
Situational loss: experienced as a result of an unpredictable
event
Anticipatory loss: loss has not yet taken place
Grief:
internal emotional reaction to loss
Bereavement:
state of grieving from loss of a loved one
Mourning:
actions and expressions of grief, including the
symbols and ceremonies that make up outward
expression of grief
Engel’s Six Stages of Grief page 1687
Shock and disbelief Developing awareness Restitution Resolving the loss Idealization Outcome
Definition of Death
Uniform Definition of Death Act: An individual who has
sustained either (1) irreversible cessation of all functions
of circulatory and respiratory functions or (2) irreversible
cessation of all functions of the entire brain, including the
brainstem, is dead.
Medical criteria used to certify a death: cessation of
breathing, no response to deep painful stimuli, and lack
of reflexes (such as the gag or corneal reflex) and
spontaneous movement, flat encephalogram.
Components of a Good Death
Control of symptoms
Preparation for death
Opportunity to have a sense of completion of one’s life
Good relationship with health care professionals
Clinical Signs of Impending Death
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
Kübler-Ross’s Five Stages of Grief page
1687
Denial and isolation Anger Bargaining Depression Acceptance
Advance Directives
Indicate who will make decisions for the patient in case
the patient is unable.
Indicate the kind of medical treatment the patient wants
or doesn’t want.
Indicate how comfortable the patient wants to be.
Indicate how the patient wants to be treated by others.
Indicate what the patient wants loved ones to know.
Special Orders
Allow natural death, do-not-resuscitate, or no-code
orders
Terminal weaning
Voluntary cessation of eating and drinking
Active and passive euthanasia
Palliative sedation
Factors Affecting Grief and Dying
Developmental considerations Family Socioeconomic factors Cultural, gender, and religious influences Cause of death
Needs of Dying Patients
Physiologic needs: physical needs, such as hygiene, pain
control, nutritional needs
Psychological needs: patient needs control over fear of
the unknown, pain, separation, leaving loved ones, loss
of dignity, loss of control, unfinished business, isolation
Needs for intimacy: patient needs ways to be physically
intimate that meets needs of both partners
Spiritual needs: patient needs 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.
Meet family needs.
Providing Postmortem Care
Care of the body Care of the family Discharging legal responsibilities Death certificate issued and signed Labeling body Reviewing organ donation arrangements, if any Care of other patients
Postmortem Care of the Body
Prepare the body for discharge.
Place the body in anatomic position, replace dressings,
and remove tubes (unless there is an autopsy
scheduled).
Place identification tags on the body.
Follow local law if patient died of communicable disease.
Postmortem Care of the Family
Listen to family’s expressions of grief, loss, and
helplessness.
Offer solace and support by being an attentive listener.
Arrange for family members to view the body.
In the case of sudden death, provide a private place for
family to begin grieving.
It is appropriate for the nurse to attend the funeral and
make a follow-up visit to the family.
Care Plan of a patient with Death Anxiety
Focused Assessment Guide 43-1 page 1700
Examples of NANDA-I Nursing Diagnoses (Loss and
Impending Death)
Please read Nursing Care Plan for Mrs. Esposita and
Her Family 43-1
Chapter 46
Three Spiritual Needs (Shelly & Fish.
1988)
Need for meaning and purpose
Need for love and relatedness
Need for forgiveness
Meeting Spiritual Needs
Offering a compassionate presence
Assisting in the struggle to find meaning in the face of
suffering, illness, and death
Fostering relationships that nurture the spirit
Facilitating patient’s expression of religious or spiritual
beliefs and practices
TABLE 46-1 Beliefs and Health Care Practices of Major
Religious Traditions in the United States Page 1796
Concepts Related to Spirituality
Spirituality: anything that pertains to the person’s
relationship with a nonmaterial life force or higher power
Faith: a confident belief in something for which there is
no proof or evidence
Religion: term used to describe cultural or institutional
religion
Hope: ingredient in life responsible for a positive outlook
Love: connectedness with others
Spiritual health and healing: spiritual needs are met
Spirituality and everyday living—in health and illness
Elements of Spirituality
Experienced as a unifying force, life principle, and an
essence of being
Experienced in and through connectedness with nature,
the earth, the environment, and the cosmos
Expressed in and through connectedness with other
people
Shapes the self-becoming and is reflected in one’s being,
knowing, and doing
Provides purpose, meaning, strength, and guidance to
shape the journey
Beliefs Related to Faith
Agnostic: one who holds that nothing can be known
about the existence of a higher power
Atheist: person who denies the existence of a higher
power
Agnostic:
one who holds that nothing can be known
about the existence of a higher power
Atheist:
person who denies the existence of a higher
power
Religious Influences
Life affirming: enhance life, give meaning and purpose to
existence, strengthen self, are health giving and life
sustaining
Life denying: restrict or enclose life patterns, limit
experiences and associations, place burdens of guilt on
individuals, are health denying and life inhibiting
Religious Beliefs
Guide to daily living habits
Source of support
Source of strength and healing
Source of conflict
Factors Affecting Spirituality
Developmental considerations Family Ethnic background Formal religion Life events
A Child’s Perceptions of God
God works through intimacy and the interconnectedness
of lives.
God is involved in self-change and growth and
transformation that make the world fresh, alive, and
meaningful.
God has tremendous power, and children show
considerable anxiety in face of it.
God is an image of light.
Common Characteristics of Religions
Basis of authority or source of power Portion of scripture or sacred word Ethical code defining right or wrong A psychology and identity Aspirations or expectations Some ideas about what follows death
O’Brien’s Spiritual Assessment Guide
Spiritual pain Spiritual alienation Spiritual anxiety Spiritual guilt Spiritual anger Spiritual loss Spiritual despair
Nursing Diagnoses for Spiritual Problems
Readiness for enhanced spiritual well-being
Spiritual distress
Patient Goals/Outcomes
Identify spiritual beliefs that meet needs for meaning and
purpose, love and relatedness, and forgiveness.
Derive strength, hope, and comfort from these beliefs.
Develop spiritual practices that nurture communion with
inner self, God, and the world.
Express satisfaction with compatibility of spiritual beliefs
and everyday living.
Patient Goals/Outcomes:
Spiritual Distress
Explore the origin of spiritual beliefs and practices.
Identify factors in life that challenge spiritual beliefs.
Explore alternatives to these challenges.
Identify spiritual supports.
Report or demonstrate decreased spiritual distress after
intervention.
Please read: Nursing Care plan for Mr.Gargan 46-1 page
1812 (we will discuss in lecture)
Examples of NANDA-I Nursing Diagnoses Page 1806
Implementing Spiritual Care
Offering supportive presence Facilitating patient’s practice of religion Nurturing spirituality Praying with a patient Praying for a patient Counseling the patient spiritually Contacting a spiritual counselor Resolving conflicts between treatment and spiritual activities
Evaluating Expected Outcomes
Identify some spiritual belief that gives meaning and
purpose to life.
Move toward healthy acceptance of the current situation.
Develop mutually caring relationships.
Reconcile interpersonal differences causing anguish.
Verbalize satisfaction with relationship with God.
Express peaceful acceptance of limitations and failings.
Express ability to forgive others and live in the present.
Demonstrate interior state of joy, freedom from anxiety
and guilt.
Facilitating the Practice of Religion
Familiarize the patient with religious services within the
institution.
Respect the patient’s need for privacy during prayer.
Assist the patient to obtain devotional objects and protect
them from loss or damage.
Arrange for the patient to receive sacraments if desired.
Attempt to meet dietary restrictions.
Arrange for a priest, minister, or rabbi to visit if the
patient wishes.
Counseling Patients Spiritually
Have the patient articulate spiritual beliefs.
Explore the origin of the patient’s spiritual beliefs and
practices.
Identify life factors that challenge the patient’s spiritual
beliefs.
Explore alternatives when given these challenges.
Develop spiritual beliefs that meet the need for meaning
and purpose, care and relatedness, and forgiveness.
Room Preparation for Spiritual
Counselor Visit
Make sure the room is orderly and free of unnecessary
equipment.
Provide a seat for the counselor near the patient’s bed.
Clear the top of the bedside table and cover with a clean
white cloth for sacraments.
Draw the bed curtains if the patient cannot be moved to
a private setting.
The end Yayyyy
