Nursing FUNdamentals final Flashcards
What are John Bowlby’s stages of grief?
- Shock and numbness
- Yearning and searching
- Disorganization and despair
- Reorganization
What is a/the grieving process?
Grief is the physical, psychological, and spiritual responses to loss. ???
affected by the significance and circumstance of the loss, the timeliness of the death, the amount of support for the bereaved, spiritual beliefs, cultural values, developmental stage, and conflicts at time of death.
What are the types of grief?
Uncomplicated
Complicated
Chronic
Masked
Delayed
Disenfranchised
AnticipatoryWhat is uncomplicated grief?
natural response to a loss. Certain feeling and behaviors are expected within his culture
What is complicated grief?
not adapting in a healthy way to the loss
What is chronic grief?
long-term grief with little resolution
What is masked grief?
expressing grief through changes in behavior (drinking, isolating oneself, working more to forget)
What is delayed grief?
putting grieving off until later
What is disenfranchised grief?
experiencing a loss that is not socially supported or acknowledged by traditional means
Miscarriage, loss of a homosexual partner
What is anticipatory grief?
experiencing feelings of grief before the loss actually occurs
What is the definition of death established in the Uniform Determination of Death Act of 1981?
Either irreversible cessation of circulatory and respiratory functions OR irreversible cessation of all functions of the entire brain, including the brainstem
Hospice care with interventions
-Priorities are keeping the patient comfortable (pain meds, oral care) NOT forcing them to do things that will really have no bearing on their prognosis (i.e. getting them out of bed, forcing them to eat, even turning them can cause pain)
Interventions Chosen based on the etiology of the problem Therapeutic communication is important Helping families with grieving End-of –life care
death r\t pt activity
1 to 3 months prior to death
Dying person socially withdraws
Sleep increases, appetite decreases
1 to 2 weeks prior to death
Physical changes occur (decrease BP, temp fluctuates, skin becomes pale, periods of apnea during sleep)
Days to hours prior to death Shallow, rapid breathing followed by Cheyne-Stokes respirations Peripheral circulation decreases Body muscles relax Restlessness and agitation
Moments prior to death
Person cannot be aroused and does not respond to touch or sound
advance directives
-Living will - states what medical desired (or not) in event
of pt being unable to make the decision
-Durable power of attorney (healthcare proxy) - pt names
another person to make healthcare decisions under
certain conditions (irreversible coma, terminal illness)
living will r/t changes
can be changed at any time by the pt.
heart rhythm r/t death
blood pressure decreases and may be hard to detect.
r/t dehydration
leads to decreased blood volume
decreased circulation to peripherals, kidneys
postmortem care
Initially, family should be comforted. Care of the body will come soon after
Rigor mortis typically sets in 2-4 hours after death
Important to place dentures and close eyes and mouth before rigor mortis makes it difficult
Make body presentable if family wants to spend time with the deceased
Allow them the time they need
death r/t nurse responses & interventions
a
palliative care & interventions
Managing the symptoms of the disease process, not the actual disease
Examples:
-Administering medicine for pain/nausea
-Providing oral care for pt who can no longer eat/drink
NOT the following
-Surgical procedures to sustain life such as inserting a
gastrostomy tube
-Intubating patient and placing on mechanical ventilation
Rando’s grieving phases
Recognize the loss React to the separation Recollect memories Relinquish old attachments Readjust to the new environment Reinvest in oneself
death rattle r/t nursing interventions
Turn the patient on his side, and elevate the HOB
administer antispasmodic and anticholinergic medications if necessary
CA pain control
make comfortable
pt losses
Physical (fatigue, dec energy & appetite)
Emotional (anger, guilt, fear, sadness)
Behaviors (withdrawn, insomnia, crying)
Cognitions (forgetfulness, confusion, questioning spiritual beliefs, dec. concentration)
dabda ?? denial, anger, bargaining, depression, a
death r/t ND
fatigue r/t care
death r/t nurse responses and interventions
Meeting physiological needs
Mobility (ROM), oxygenation, pain control, fluids, safety, personal hygiene
Meeting psychological needs
Silence may cause unnecessary anxiety
Allow family and pt to talk about prognosis, desires, fears
Addressing spiritual needs
It is ok to pray with a patient, but make sure this is something he wants
Contact pt’s own clergy if that is his wish
Addressing cultural needs
Make certain you assess each individual’s cultural needs
pt denial
a
grief r/t depression
a
pt reactions to losses
Loss of aspects of self
Physical losses: body organs, disfigurement, loss of body
functions
Psychological: loss of hope or faith, losses related to
aging process
Environmental loss
Changes in the familiar: moving to new home, going to
college, elderly client moving into nursing home
Loss of significant relationships
Actual loss of people through divorce, death, separation
Cardinal signs of inflammation
redness increased heat tumor/edema pain loss of function
