Chapter 44 - Loss Grief and Dying

‭Types of Loss‬ ‭●‬ ‭Actual loss:‬‭Can be recognized by others‬ ‭●‬ ‭Perceived loss:‬‭Is felt by person but intangible to‬‭others‬ ‭●‬ ‭Physical loss vs. psychological loss‬ ‭●‬ ‭Maturational loss:‬‭Experienced as a result of a natural‬‭developmental process‬ ‭●‬ ‭Situational loss:‬‭Experienced as a result of an unpredictable‬‭event‬ ‭●‬ ‭Anticipatory loss:‬‭Loss has not yet taken place‬ ‭Definitions‬ ‭●‬ ‭Grief:‬‭Internal emotional reaction to loss‬ ‭●‬ ‭Bereavement:‬‭State of grieving from loss of a loved‬‭one‬ ‭●‬ ‭Mourning:‬‭Actions and expressions of grief that make‬‭up outward expression of grief‬ ‭Engel’s Six Stages of Grief‬ ‭●‬ ‭Shock and disbelief:‬‭To protect oneself‬ ‭●‬ ‭Developing awareness:‬‭Emptiness, self-blame‬ ‭●‬ ‭Restitution:‬‭Mourning, initiating recovery‬ ‭●‬ ‭Resolving the loss:‬‭Reflection, viewing loss ideally‬ ‭●‬ ‭Idealization:‬‭Thinking about positive traits of what‬‭was lost‬ ‭●‬ ‭Outcome‬ ‭ uestion:‬‭A person who exaggerates the good qualities‬‭of his recently deceased father is‬ Q ‭experiencing what stage of Engel’s grief?‬ ‭a.‬ ‭Shock and disbelief‬ ‭b.‬ ‭Restitution‬ ‭c.‬ ‭Idealization‬ ‭d.‬ ‭Outcome‬ ‭Medical Criteria of Death‬ ‭●‬ ‭Cessation of breathing‬ ‭●‬ ‭Flat encephalogram (brain waves)‬ ‭●‬ ‭No response to deep painful stimuli‬ ‭●‬ ‭Lack of reflexes and spontaneous movement‬ ‭○‬ ‭Ex. gag or corneal reflex‬ ‭Components of a Good Death‬ ‭●‬ ‭Control of symptoms‬ ‭●‬ ‭Opportunity to have a sense of completion of one’s life‬ ‭●‬ ‭Preparation of death‬ ‭●‬ ‭Good relationship with healthcare professional‬ ‭Clinical Signs of Impending Death‬ ‭●‬ ‭Difficulty talking or swallowing‬ ‭●‬ ‭Nausea, flatus, or abdominal distention‬ ‭●‬ ‭Urinary and/or bowel incontinence or constipation‬ ‭●‬ ‭Restlessness and/or agitation‬ ‭●‬ ‭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 ‭●‬ ‭Cooling, mottling, and cyanosis of the extremities and dependent areas‬ ‭Kubler-Ross’s Five Stages of Dying‬ ‭●‬ ‭Denial and isolation‬ ‭●‬ ‭Anger‬ ‭●‬ ‭Bargaining‬ ‭●‬ ‭Depression‬ ‭●‬ ‭Acceptance‬ ‭Advance Directives‬ ‭●‬ ‭A living will‬ ‭○‬ ‭The kind of medical treatment I want or don’t want‬ ‭●‬ ‭A durable power of attorney for healthcare‬ ‭○‬ ‭The person I want to make care decisions for me when I can’t‬ ‭Special Orders‬ ‭●‬ ‭Do-not-resuscitate (DNR)‬ ‭●‬ ‭Allow natural death (AND)‬ ‭●‬ ‭No-code‬ ‭●‬ ‭Terminal weaning: Gradually reduces mechanical ventilation support‬ ‭●‬ ‭Voluntary cessation of eating and drinking‬ ‭●‬ ‭Active and passive euthanasia‬ ‭●‬ ‭Palliative sedation‬ ‭Palliative vs. Hospice Care‬ ‭●‬ ‭Palliative: Aggressive management of symptoms‬ ‭●‬ ‭Hospice:‬ ‭○‬ ‭Usually must be considered to be terminal within 6 months‬ ‭○‬ ‭Includes palliative care as well as physical, emotional, and spiritual needs‬ ‭○‬ ‭Forego extensive life-prolonging treatment; focus on achieving comfort‬ ‭ uestion:‬‭The goal of palliative care is to give patients with life-threatening illnesses the best‬ Q ‭quality of life they can have by the aggressive treatment of symptoms.‬ ‭a.‬ ‭True‬ ‭b.‬ ‭False‬ ‭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, and nutritional needs‬ ‭●‬ ‭Psychological needs:‬‭Patient needs control over fear‬‭of the unknown, pain, separation,‬ ‭leaving loved ones, loss of dignity, loss of control, unfinished business, isolation‬ ‭●‬ ‭Needs for intimacy:‬‭Patient needs physical intimacy‬‭meeting needs of both partners‬ ‭●‬ ‭Spiritual needs:‬‭Patient needs meaning/purpose, love/relatedness,‬‭forgiveness/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 need‬ ‭Providing Post-Mortem Care‬ ‭●‬ ‭Care of the body‬ ‭●‬ ‭Labeling of body‬ ‭●‬ ‭Care of the family‬ ‭●‬ ‭Death certificate issued and signed‬ ‭●‬ ‭Reviewing organ donation arrangements (if any)‬ ‭●‬ ‭Care of other patients‬