Pwrpnts Flashcards
Types of loss (5)
1) Actual loss
2) Perceived loss
3) Anticipatory loss
4) Maturational loss
5) Situational loss
Actual Loss
Loss of a person or an object that can’t be experienced anymore seen or felt anymore. Easily identified with others outside the loss. Spouse, home, object, home,
Maturational loss
Any changes in developmental process that is normally expected in a lifetime. “Child 1 st day of school” “ Retirement”
Situational loss
Sudden unpredictable loss. ex) typhoon-car accident can have multiple losses “limb–>health–>job–>loved one”
Perceived loss
Internal– ex) loss of self-esteem- loss of confidence-loss of position or status
They need same kind of care as other losses
Anticipatory loss
Deal with a loss before it actual happens.
Start processing loss before it happens.
Bereavement
combination of grief and mourning
Grief
total response to the Emotional response to loss.
Thoughts, feeling, behaviors–>crying~anger
Mourning
Outward social expression of a loss. Behavioral process through which grief is eventually resolved.
Often influenced by culture and custom, and can often last a year or more.
Grief process can take an average of 2 years.
Theories of grief (3)
1) Kubler- Ross- stages of dying (most common)
2) Bowlby- phases of mourning
3) Worden- tasks of mourning
Kubler-Ross
5 Stages of Dying
Stage 1- Denial Stage 2- Anger Stage 3- Bargaining Stage 4- Depression Stage 5- Acceptance
Bowlby’s Theory (4)
1) Phase of numbing (like denial)
2) Phase of yearning and searching (sobbing~painful~tightness in the throat)
3) Phase of disorganization and despair~ (leads to acceptance)
4) Phase or reorganization
Worden’s Theory
!) To accept the reality of the loss
2) To work through the pain of grief
3) To adjust to the environment in which the deceased is missing
4) To emotionally relocate the deceased and move on with life
Types of grief (3)
1) Normal grief~ crying-sobbing
2) Anticipatory grief~ before loss actually occurs(Alzheimer’s, terminal cancer)
3) Complicated grief~can become dysfunctional (sudden death- can’t view the remains)
a) chronic grief~ person can’t move on.
b) delayed grief~ suppressed or
postponed.
c) exaggerated grief~ so overwhelmed
can’t function
d) masked grief~ behaves in ways
that interfere with
normal functioning
but is unaware of it.
Factors influencing loss and grief (6)
1) Significance of the loss
2) Culture
3) Spiritual belief
4) Sex role
5) Socioeconomic status
6) Age
Part 2 of influencing loss and grief (7)
1) Human development
2) Personal relationship
3) Nature of loss
4) Coping strategies
5) Socioeconomic status
6) Culture and ethnicity
7) Spiritual & religious beliefs
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Assessment
1) Type and stage of grief
2) Grief reaction
3) Factors that affect grief
4) End-of-life decisions
5) Nurses experience with grief
6) Client expectations
Concept of Death Based on Developmental Level (7)
Infancy- 5 y/o~ does not understand concept of death
5 yrs~ 9 yrs~ Understands that death is final.
Believes own death can be avoided
9-12 y/o- Understands death as inevitable and unavoidable~ begins to recognize own mortality
12-18 y/o~ Fear of lingering death.
May fantasize that death can be defied
18-45 y/o~ Attitude influenced by religious and cultural beliefs
45-65 y/o~ Experiences death of parents and peers.
Death anxiety.
Fears prolonged illness
65 and over~ Sees death as having multiple meanings.
Death of family members and peers experienced
Signs of impending death
- Loss of muscle tone
- Slowing circulation
- Changes in vital signs
- Sensory impairment
Care of dying patient
1) Assist in peaceful death
2) Meet physiological needs
3) Client bill of rights
4) Hospice and home care
5) Spiritual support
Body changes after death (3)
1) Rigor mortis
2) Algor mortis
3) Livor mortis
Care of the body after death
1) Make environment clean and body appear comfortable
2) Remove all equipment and supplies
3) Remove soiled linens
4) Place the body in the supine position
5) One pillow under head and shoulders
6) Close eyelids
7) Insert dentures, close mouth
8) Clean gown, comb hair
9) Remove jewelry
10) Pull top bedding to shoulders
11) Organize clothing and valuables to take home
Sympathoadrenal Response to pain
- Increased pulses rate
- Increased systolic B/P
- Increase respiratory rate
- Diaphoresis
- Increased muscle tension
- Pallor
- Pupil dilation
- Rapid speech/ elevated pitch
- Increased alertness
Parasympathetic Response to pain
- Decreased pulse rate
- Decreased systolic B/P
- Syncope
- Nausea/ Vomiting
- Warm dry skin
- Prostration
- Pupil constriction
- Slow, monotonous speech
- Withdrawal
Behavioral Responses
- Immobility
- Withdrawal
- Rubbing body part
- Grimacing
- Restlessness
- Writhing
- Unusual postures
- Extreme quietness
- Groaning, crying
Affective (feeling) Response
- Fear/ Flight
- Anxiety
- Depression
- Anger
- Hopelessness
- Powerlessness
- Fatigue/ exhaustion
- Feeling of being punished
Acute pain
- Follows normal nociceptor activation pathway to the brain
- cause is known and treatable.
- Origin is tissue Trauma
- Temporary- rapid onset, short duration
- Pain is specific and localized
- Serves as a warning of tissue damage and subsides with healing
- Behavior and physiologic signs:
~Rubbing
~guarding
~grimacing
~brow wrinkling
~ lip biting
~ change in HR, RR, BP
Chronic Pain
- Most is neuropathic; it follows an abnormal pathway for pain that results from nerve damage from anatomic and physiologic conditions and underlying diseases
- Cause may be unknown; treatment may not be helpful
- Develops slowly; discomfort lasts longer than 6 months
- Pain is nonspecific and generalized
- Behavioral and Physiological signs include unusual sensations such as:
~burning
~Shooting pain
~Abnormal sensations that occur when there
is no painful stimulus present
Pain is the?
5th vital sign
