S3 M8/9 Grief/End of Life Flashcards
Grief
Multifaceted
Reaction to loss, real or perceived
3 types of loss
Actual
Perceived
Anticipatory
Kubler Ross
Stages of grief
test
Denial Anger Bargaining Depression Acceptance
Acceptance should happen within _ months
6
Maladaptive grief
Distorted or exaggerated
Chronic or prolonged
Delayed
Anticipatory grief
anticipating a negative circumstance
Nursing interventions for grief
Understand process
Develop Therapeutic communication
Active listening
Be non-judgmental
Most important part of moving through grief stages
Be open and communicative
Are grief stages definite
NO
pt can spend different amounts of time and go back and forth between stages
3 Assessments of client
Perception
Support
Coping
Still birth
Loss up to 1 month old
With still birth provide memories
lock of hair photograph (ask parent first) name band encourage hold/tough dress infant
With still birth pt may
have misplaced anger
need time
not want contact
be open minded
Amputation may lead to
grief
With amputations encourage contact with
residual limb
To facilitate amputations ID
PT strengths and resources
Goal of assistive devices
Independent function
Goal with amputation patients and overall grief
Acceptance
Myocardial infarctions and grief
Diet
Lifestyle
Life meds
pt stuck in unexpected changes
realization of mortality
Associated problems with MI grief
Fears Loss of employment Strain on marriage Hostility toward changes Fear of another MI
Terminal illness grief
Anticipatory and mourning
Normal emotions of terminal grief
Denial Sadness Anger Fear Anxiety
With terminal illness _ is not always reached
Acceptance
Emotions in terminal illness _ daily
fluctuate
Nursing with terminal illness
support family unit
encourage meaningful interactions
professional support (Chaplin, grief counselor)
Defined recommendations to improve end of life care
coverage
communication
planning
education
DNR/POLST
DNR only good in hospital
POLST out of hospital DNR
Advanced directive
Umbrella term for legal documents
Living will
written while in good health
outlines medical care to be given
Proxy directive
person authorized to make medical decision on your behalf when you cant
Durable power of attorney
IDs the proxy decision maker for financial/general decisions
sometimes medical but not always
recommended to have a separate medical
Assisted suicide legislation
10 states in the US
Palliative
comprehensive symptom management of illness
Hospice
Prep for death
4 levels of hospice
routine home care - routine visits
inpatient respite care - spend short times in hospice facility, gives fam a break
continuous care - hospice providers provide 24h care
general inpatient care - pt moved to impatient care till symptoms are managed
Hospice care principles
acceptance of death
pt and fam viewed as a single unit
pain and symptoms managed for pt
bereavement managed for fam
Nursing management at end of life
COMMUNICATION is center
Develop comfort in communication about death Tailor understanding to values of pt/fam Time arrangements Create right setting Seat all at eye level
Effective listening
Allow for silence
Ask if pt needs time
Assess understanding
Things to avoid with comms
Distractions
Impulse to give advice
Canner responses “I know how you feel”
Focus of End of Life
Pain
assess pain level
Manage Break through pain
Rescue dosing
Hospice analgesics are given
Around the clock
not PRN
End of life physiological changes
Dyspnea
Anorexia/Cachexia
Excess secretions
Emotional fall throughs in end of life
Agitation
Delirium
Anxiety
Preactive phase of dying
restless confusion withdrawal lack of appetite breathing changes
Active phase of dying
sleep
anger, laughing, agitation
pill rolling
breathing problems
Death breathing
Chayne stokes pattern
Body deterioration
dark urine BP drop cold/numb extremities body rigid jaw drop
Death
Cessation of resp
Cessation of cardio
HEARD
Grief vs mourning
Feeling
expression of it
Bereavement
Time for grieving
