Nursing FUNdamentals final

Question 1

What are John Bowlby’s stages of grief?

Answer 1

1. Shock and numbness
2. Yearning and searching
3. Disorganization and despair
4. Reorganization

Question 2

What is a/the grieving process?

Answer 2

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.

Question 3

What are the types of grief?

Answer 3

Uncomplicated
Complicated
     Chronic
     Masked 
     Delayed
Disenfranchised
Anticipatory

Question 4

What is uncomplicated grief?

Answer 4

natural response to a loss. Certain feeling and behaviors are expected within his culture

Question 5

What is complicated grief?

Answer 5

not adapting in a healthy way to the loss

Question 6

What is chronic grief?

Answer 6

long-term grief with little resolution

Question 7

What is masked grief?

Answer 7

expressing grief through changes in behavior (drinking, isolating oneself, working more to forget)

Question 8

What is delayed grief?

Answer 8

putting grieving off until later

Question 9

What is disenfranchised grief?

Answer 9

experiencing a loss that is not socially supported or acknowledged by traditional means
Miscarriage, loss of a homosexual partner

Question 10

What is anticipatory grief?

Answer 10

experiencing feelings of grief before the loss actually occurs

Question 11

What is the definition of death established in the Uniform Determination of Death Act of 1981?

Answer 11

Either irreversible cessation of circulatory and respiratory functions OR irreversible cessation of all functions of the entire brain, including the brainstem

Question 12

Hospice care with interventions

Answer 12

-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

Question 13

death r\t pt activity

Answer 13

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

Question 14

advance directives

Answer 14

-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)

Question 15

living will r/t changes

Answer 15

can be changed at any time by the pt.

Question 16

heart rhythm r/t death

Answer 16

blood pressure decreases and may be hard to detect.

r/t dehydration
leads to decreased blood volume
decreased circulation to peripherals, kidneys

Question 17

postmortem care

Answer 17

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

Question 18

death r/t nurse responses & interventions

Answer 18

a

Question 19

palliative care & interventions

Answer 19

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

Question 20

Rando’s grieving phases

Answer 20

Recognize the loss 
React to the separation 
Recollect memories
Relinquish old attachments
Readjust to the new environment
Reinvest in oneself

Question 21

death rattle r/t nursing interventions

Answer 21

Turn the patient on his side, and elevate the HOB

administer antispasmodic and anticholinergic medications if necessary

Question 22

CA pain control

Answer 22

make comfortable

Question 23

pt losses

Answer 23

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

Question 24

death r/t ND

Answer 24

fatigue r/t care

Question 25

death r/t nurse responses and interventions

Answer 25

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

Question 26

pt denial

Answer 26

a

Question 27

grief r/t depression

Answer 27

a

Question 28

pt reactions to losses

Answer 28

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

Question 29

Cardinal signs of inflammation

Answer 29

redness
increased heat
tumor/edema
pain
loss of function