Dementia and loss

The adult children of a dying patient, who is alert and oriented, disagree on the patient's choice of a do-not- resuscitate order. The children ask the opinion of the nurse, who has cared for this patient over an extended period. How should the nurse respond to this question about the patient's dying request?

Listen to the children's concerns and encourage them to talk to their parent.

A 77-year-old patient has been admitted with pneumonia. Her husband asks the nurse about the living will. Which statement is correct about living wills?

Living wills allow individuals to express their wishes regarding care.

situational loss

Loss of a person, thing, or quality resulting from a change in a life situation, including changes related to illness, body image, environment, and death. promote emotional growth and coping skills but you have to get through the process. Sometimes we need to remind patients at some point once acceptance is hit

maturational loss

Loss, usually of an aspect of self, resulting from the normal changes of growth and development. loss of childhood dreams leaving family and going to college - empty nest

Loss is a natural part of our lives. What is the loss that is felt when one leaves home for college?

Maturational loss

Dementia

Neuro - brain cognitive - knowledge ease - disease affecting that area mild or major major - multiple types and can be associated with other diseases

dementia

Not a disease but a clinical syndrome; a collection of symptoms that can occur with many types of diseases

Loss

Not all losses are obvious or immediate obvious losses not-so-obvious losses maturational loss situational loss personal loss

What type of care allows a patient to make more informed choices, achieve better alleviation of symptoms, and have more opportunity to work on issues such as closure?

Palliative care

The physical needs of the dying patient should be of utmost importance to the nurse giving care. Which patient descriptions would require an intervention?

Patient is soiled and needs clothing changed.

The home health nurse is visiting an older patient who had an exacerbation of chronic obstructive pulmonary disease (COPD). Which finding best supports the nurse's analysis of dysfunctional grieving?

Patient ruminates over loss of health and vigor that started years ago

SPECIAL SUPPORTIVE CARE:

Perinatal death pediatric death suicide gerontologic death sudden or unexpected death

A teenager brought by ambulance to the Emergency Room from the scene of a motor vehicular accident is pronounced dead upon arrival. The family is notified of the death and request to see their child before the funeral home picks up the body. Which actions by the nurse are most respectful when caring for the patient and family during a sudden death? (Select all that apply.)

Preparing the body to look as clean and natural as possible-Allowing the parents to spend as much time as possible with the body-Offering to call the pastor of the family's church while the family is viewing the body

What is the purpose of palliative care for a patient with a terminal illness?

Provide prevention, relief, reduction, or soothing of symptoms of a disease without providing a cure.

Signs and symptoms of imminent (impending) death

Pupils dilated and fixed (pen light shines - not reacting to light) cheyne-stokes respirations (irregular breathing patterns) shallow or big, intermixed with partial, some fast, some slow pulse weaker and more rapid (the further from our hearts and the smaller the artery, the more quickly those pulses will disappear - pedial pulse first to shut down), to feel pulse you need to get a larger pulse like carotid blood pressure continues to fall - fall to point to get accurate reading (body closing down) skin cool and clammy profuse diaphoresis - sweating death rattle: noisy respirations

The patient's daughter remained at the bedside of her dying mother throughout the night. When her mother died the following morning, the daughter cried out angrily at the nurse and the physician. Which is the most appropriate action by the nurse?

Remain with the daughter and listen to what she is saying.

A bereaved widow of 3 months tells the nurse she has smelled her deceased husband's aftershave scent clearly as she sat in church recently. She questions if she might be "going crazy." What is the widow experiencing?

Sense of presence

The nurse is caring for a dying patient and is showing attentiveness both verbally and nonverbally. What is the best intervention to demonstrate attentiveness?

Sitting in a chair close to the bed, facing the patient

After the death of a patient, the nurse leaves the room quickly; she is found sobbing in the utility room. Which action is the most supportive to the nurse?

Sitting with her and allowing her to express herself

The nurse is caring for a dying patient. Which vital signs are most indicative of end of life?

Slow, weak, and thready pulse; lowered blood pressure; rapid, shallow, irregular respirations.

The grieving family

Support the needs of the grieving family and significant others should be met by a caring, compassionate healthcare provider Resolution of grief Begins when the grieving person can complete the following tasks: have positive interactions participate in support groups establish goals and work to achieve them discuss the meaning of the loss and its effect

Brain tumor (adults)

Supratentorial: metastasis, glioblastoma multiforme (astrocytoma), meningioma (benign), schwannoma *MGM Studios*

Neurosyphilis

Symptomatic patients may have aseptic meningitis, tabes dorsalis, general paresis, or meningovascular disease. Imaging is usually normal in tabes dorsalis, rarely gummas are found: small enhancing nodules on brain surface with adjacent meningeal enhancement. Meningovascular syphilis thickening of meninges and medium to large vessel arteritis.

Subdural Hematoma (SDH)

Tearing of the bridging vessels between the brain and the dura occurring over the surface of the brain.

Loss, grief, dying, & death Mortality

The condition of being subject to death

Factor that influence loss

The following factors may affect the nature, intensity, and duration of grief: The relationship a grieving person had with the person who died. The cause of death. For example, the grieving process may differ depending on whether the person died suddenly or was ill for a long time. The grieving person's age and gender. The life history of the person who is grieving, including past experiences with loss. The grieving person's personality and coping style. The support available from friends and family. The grieving person's customs and religious or spiritual beliefs. The grieving process is often harder when the person has unresolved feelings towards or conflicts with the person who has died. People who are struggling with complicated grief may find it helpful to talk with a counselor. This may include a clinical social worker, psychologist, or spiritual counselor.

Clinical signs of death

Unresponsiveness No movement or breathing No reflexes Flat encephalogram Absence of apical pulse Cessation of respirations

A healthy 25-year-old who sustained a head injury during a motor vehicle accident is in the emergency department. The patient has no brain activity and is on life support. The family has expressed an interest in organ donation. What should the nurse know about organ donations?

Vital organs, such as the heart and pancreas, must be harvested while the patient remains on the ventilator.

The dying patient asks to nurse to assist him to say goodbye to his son, who is 4 years old. Which suggestion by the nurse is age appropriate for the 4-year-old?

You could write him a letter that he can read when he gets older.

Which person is most likely to suffer from a maturational loss?

a college students who has never been away from home goes to Europe to study

Alzheimer's disease

a progressive and irreversible brain disorder characterized by gradual deterioration of memory, reasoning, language, and, finally, physical functioning

Loss, grief, dying, & death Grief work

adaption process of mourning a loss

Grief work

adaption process of mourning a loss How we work through the grieving process

Dementia

also known as neurocognitive disorder two classifications: mild or major major has multiple types and can be associated with other disorders/diseases

Loss, grief, dying, & death loss

an aspect of self no longer available to a person

loss

an aspect of self no longer available to a person could be person, item - house, car - car theft, something can't physically hold - position at work or on a sport team Key - something so important its part of your self - your identity Nurse needs to realize that it is important to that patient

DNR (do not resuscitate)

an order that tells medical professionals not to perform CPR. Allow themselves to die naturally AND same as DNR

Nursing process

assess assign some type of diagnosis plan what we are going to do with that implement some interaction/treatment evaluation ADPIE impaired ADLs - might not be able hold their toothbrush, swallow inadequate nutrition - forget to eat - can set alarms, label food - socializing big because they what others are doing sleep disturbance - minimize noise, calming routines, minimizing nighttime interaction as a nurse potential for injury - falls - keep aisles clear clutter, regular toileting, night light, bathroom lights, no drinking before bed, bedside commode, do not take to many pills, aspirate risks - finger foods, soft foods, calorie shakes behavior disturbances - quick appropriate corrective action v. important - keep calm inability to communicate effectively - taking your time. Might need to board with pictures, try not to speak for them, give yes and no questions. The more they see you get impatient the more they will get impatient

The nurse enters the room and the family is standing around the dying patient loudly praying and chanting. The wife invites the nurse to join in. What should the nurse do first?

assess effects of the activity on the patient

The UAP tells the nurse that the dying patient's family keeps calling for assistance with minor tasks that that could easily do for the patient. What should the nurse do?

assess the family's desire and ability to participate in the care of the patient

Which nursing action is most likely to be affected by the patient's advance directives?

assisting the provider to intubate for respiratory arrest

On seeing the body of his little brother who just died from cancer, a 10-year-old sibling screams, "I won't go to the funeral!" I won't go!" The mother is sobbing and the father begins to yell. What should the nurse do first?

calmly close the door and stay with the family while they express themselves

hospice

can be part of palliative care - usually at end comprehensive care delivered in a variety of settings, and can be implemented when a client is not expected to live longer than 6 months. Further medical care in toward a cure is stopped and the focus becomes enhancing quality of life and supporting the client toward a peaceful and dignified death hospice no longer treats illness where palliative care gets treated usually at home but can be in a nursing care facilities which deals specifically with hospice patients

stattons

can brake down muscle tissue - poisonous to kidneys

postmortem care

care of the body after death The body should be cared for as soon as possible after death to prevent tissue damage or disfigurement offer the family the opportunity to view the body before the family views the body, prepare it, and the room to minimize the stress of the experience. The body should be made to look as natural and comfortable as possible

Loss, grief, dying, & death Death

cessation of life

Types of complicated grief

chronic delayed exaggerated masked

Major dementia

chronic and irreversible memory impairment and many other cognitive deficits might start showing - assess orientation: name, DOB, location time, which situation brought them there oriented x 3 or x 4 need document which one they didn't know - not oriented to..... impaired intellectual function, problem solving ability, judgment, memory and orientation and inappropriate behavior - if they were cooking they wouldn't comprehend how to put a fire out if something went wrong. They could go into the wrong house. Walk into the wrong bed. Inappropriate behavior - assess family - hitting, scratching, yelling, spitting - weighs heavy on staff - can't let it affect our ability to take care or take personality but for family member it can be too much so need to carer some home help, social worker, respite care.

major neurocognitive disorder

chronic and irreversible (as opposed to delirium, which is short-term and reversible) memory impairment and many other cognitive deficits impaired intellectual function, problem-solving ability, judgment, memory, and orientation, and inappropriate behavior

Types of complicated grief

chronic: active acute mourning characterized by normal grief reactions that do not decrease but persist over long periods. People verbalize an inability to get past the grief. Delayed: characterized by normal grief reactions that are suppressed or postponed. The survivor consciously or unconsciously avoids the pain of the loss. Active grieving is held back, only to resurface later, usually in response to a trivial loss or upset. For example, a wife only grieves a few weeks after the death of her spouse, only to become hysterical and sad a year later when she loses her car keys. The extreme sadness is a delayed response to the death of her husband. Exaggerated grief: people become overwhelmed by grief, and they cannot function. This is reflected in the form of severe phobias or self destructive behaviors such as alcoholism, substance abuse, or suicide. Masked grief: survivors are not aware that behaviors that interfere with normal functioning are a result of their loss. For example, a person who has lost a pet has changes in sleeping or eating patterns develop.

The patient is sobbing. When the nurse tries to find out what is wrong, the patient angrily says, "I'm dying! I have pain! My children are losing their mother! We are in debt up to our eyeballs! And God seems to be on a coffee break!" What does the nurse do first to identify and prioritize the patient's problems?

collect additional data about each concern and consult with the RN

bereavement

common depressed reaction to death of a loved one

Hospice care

comprehensive care delivered in a variety of settings, and can be implemented when a client is not expected to live longer than 6 months. Further medical care in toward a cure is stopped and the focus becomes enhancing quality of life and supporting the client toward a peaceful and dignified death

The terminally ill patient has been experiencing severe pain and has requested that the physician assist her to end her suffering. What should the nurse do if the physician prescribes a morphine dosage that could cause respiratory depression and respiratory arrest?

consult the nursing supervisor for advice

Which nursing action demonstrates that the nurse is performing his/her responsibilities according to the National Organ Transplantation Act (Public Law 98-507, 10-14, 1984) and the Uniform Anatomic Gift Act?

contacts a qualified health care professional to ask family about organ donation

nursing interventions for mild dementia

coping with impaired memory brain stimulating activities

vascular dementia

damage to brain cells caused lack of oxygen to brain from stroke, narrowing of arteries which ends up with dementia

The nurse is teaching the entire family, which includes a preschooler and a school-aged child, about how to care and interact with older member of the family who is dying and being cared for at home. Which activities would be best to suggest to the preschooler and school-aged child, respectively?

draw a picture for grandma and organize her photo album

As the nurse is performing medication teaching, the older woman begins to cry. "My grandson got into my pills and overdosed. He didn't die, but my daughter won't even speak to me." What is the most therapeutic response?

every time you look at your medicine, you think about your family

chronic grief

excessive in duration and never comes to a satisfactory conclusion

palliative care interventions

focus on the relief of physical manifestations (pain) as well as addressing spiritual, emotional, and psychosocial aspects of the client's life. and inter-professional team of physicians, nurses, social workers, physical therapist, occupational therapists, spiritual supports, and others provide palliative care

vascular dementia

form of dementia caused by a stroke or other restriction of the flow of blood to the brain

acquired immunodeficiency syndrome (AIDS)

group of clinical signs and symptoms associated with suppression of the immune system and marked by opportunistic infections, secondary neoplasms, and neurologic problems

Nurses grief and survival strategies for nurses

heightened empathy for patients which can lead to burn out, breaking down - having to go through that process. Some have to build up a tough skin - hard to get balance. Box 25.2 survival skills for nurses - personal spiritual beliefs - will help when you speak to others regular breaks and vacation days identify specific stressful patients so you can prepare yourself

The hospice nurse is visiting a family of a deceased patient. During the visit, the son displays symptoms of a grief attack. Which intervention would the nurse use?

help the son recognized that the attack is a type of grief response

Which nursing action supports the structure and process of care and represents one of the eight domains established by the National Consensus Project for Quality Palliative Care?

helps the patient to identify previously used coping strategies and develop new ones

Huntington disease (Huntington chorea)

hereditary disorder marked by degenerative changes in the cerebrum leading to abrupt involuntary movements and mental deterioration

conditions associated with dementia

hydrocelphalus, subdural hematoma, brain tumors, neurosphilis and aids - can get dementia

organ donations

if you can't save me, donate organs to someone who needs them. Easy to sign up

Nursing care for neurocognitive disorders

impaired ADLs inadequate nutrition sleep disturbance potential for injury behavioral disturbances inability to communicate effectively

age related influence on the concept of death

infancy to 5 years Does not understand concept of death infant's sense of separation forms basis for later understanding of loss and death believes death is reversible, a temporary departure or sleep 5 - 9 yr understands that death is final believes own death can be avoided associates death with aggression or violence believes wishes or unrelated actions can be responsible for death 9 - 12 years understands death as the inevitable end of life begins to understand own mortality concept of death expressed as interest in afterlife or as fear of death 12 to 18 Fears a lingering death may fantasize that death can be defied, acting out defiance through reckless behaviors seldom thinks about death, but views it in religious and philosophic terms may seem to reach adult perception of death but is emotionally unable to accept it 18 - 45 years has attitude toward death influenced by religious and cultural beliefs 45 - 65 Accepts own mortality encounters death of parents and some peers experiences peaks of death anxiety death anxiety diminishes with emotional well being 65+ fears prolonged illness encounters death of family members and peers sees death as having multiple meanings e.g. freedom from pain, reunion with already deceased family members)

delayed grief

inhibited, suppressed or postponed response to a loss

Dementia

is not a disease but a clinical syndrome collection of symtoms that can occur with many types of diseases

1960s

kubler-ross 5 stages of grieving/death behavior orientated theory that includes five stages: Denial: individual acts as though nothing has happened and may refuse to believe or understand loss have occurred Anger: individual resists the loss and may strike out at everyone and everything. Bargaining: individual postpones awareness of reality of the loss and may try to deal in a subtle or overt way as though the loss can be prevented. Depression: individual feels overwhelmingly lony and withdraws from interpersonal interaction. Acceptance: individual accepts the loss and looks to the future.

Pick disease (frontotemporal dementia)

language, behavior, memory

Rights of dying patient

list from book dying patient rights

The nurse is caring for hospice patient who has frequently experiencing episodes of pain and dyspnea. The family is devoted and frequently visits, but today the patient is difficult to arouse, and they cause the nurse of over medicating patient. What should the nurse do first?

listen to their concerns and clarify their goals for the patient

Advance directives

livings wills and durable power of attorney living wills - contains tube feedings, certain types of meds, pacemaking. If unable to communicate - unconscious - legal document durable power of attorney DPOA - this person can make all of those decisions on my behalf if I am incapacitated.

On assessing the dying patient, the nurse notes that the pulse rate is 30/min, the respiratory rate is 8/min, and the systolic blood pressure is palpated at 60. The patient has a Do Not Resuscitate (DNR) order. What should the nurse do first?

make the patient comfortable

mild neurocognitive disorder

modest decline in cognitive function individual functions well enough to live independently may exhibit apathy, sleep disturbances, hallucinations, anxiety Nursing interventions: focused on coping with impaired memory

mild neurocognitive disorder

modest decline in cognitive function - age and cognition do not go hand in hand so gets mis-diagnosed - could be something much biggest and needs further evaluation individual function well enough to live independently - can drive. May not be reversible but definitely slow process like keeping brain active - stimulate brain slows progression but need to get evaluated or assessed they may exhibit apathy sleep disturbance (stress/coffee or sign of mild dementia) hallucinations anxiety

Which statement by the family member of dying patient best indicates a healthy retention of hope?

my sister is coming from California next week, I know he wants to see her

uncomplicated grief

normal grief, natural response to a loss

Conditions associated with dementia

normal pressure hydrocephalus subdural hematoma brain tumors neurosyphilis acquired immunodeficiency syndrome (AIDS)

complicated grief

not normal grief a type of grief that impedes a person's future life, usually because the person clings to sorrow or is buffeted by contradictory emotions importance of grief work cannot be overstated. Indicative of unresolved grief - dysfunctional grieving stuck in the grief/pattern unable to express feelings cannot find anyone in their lives to act as a listener loss may resurface other losses - will compound whole process lack of reassurance and support - nothing works - stuck - given up on it

Loss

obvious losses - death of a loved one, divorce, break up - obvious because you can see those things not so obvious - aging, illness, defects of birth, changes in schools, jobs, moving (not want to - missing old home).

exaggerated grief

often exhibits self-destructive or maladaptive behavior, obsessions, or psychiatric disorders. Suicide is a risk for these people.

Alheimer's disease

organic condition that results in the progressive destruction of brain cells might actually caused by a specific infection caused by dentition

Huntington's disease

passed genetically - dementia and muscular decline - loss control of your body functions ethical - would you want to know or get tested if your parent had it. Will always carry gene 50/50 chance of giving it to a child

Which outcome statement best indicates that one of the primary goals of palliative care has been met?

patient reports relief from pain and nausea

Loss, grief, dying, & death Grief

pattern of physical and emotional responses to bereavement

Grief

pattern of physical and emotional responses to bereavement grief is physical, emotional, it happens whenever we lose something - a pattern which is different for different people

special supportive care

perinatal death - death of baby - parents need to say goodbye, need to bond with baby. Lock of hair, footprints, angel boxes. pediatric death - special skills, understand views of child, children need reassurance and parents, have to talk about their mortality - all frightened. Suicide - average 121 per day. Survivors of someone who committed suicide - guilt and shame, anger See counselling Gerontologic death - older adults often assumed to have some understanding of death process. Individual process who needs assessment of their own needs: physical changes loss of employment self care capabilities loss of control sense of fulfillment personality traits feelings of self worth degree to which functional ability is retained sudden or unexpected death: some sort of violent act or car crash - surprise/shock. If you are nurse caring for that person and family come. Family think you are working on them, they do not realize how serious - very emotional

Creutzfeldt-Jakob disease (CJD)

progressive, incurable, neurologic disease caused by infectious prions

Creutzfeldt-Jakob disease

protein that has grown abnormally - most common mad cow's disease human version of mad cow's disease spontaneously change - universally fatal. can get by infected surgical instruments being used on you

signs and symptoms of imminent death

pupils dilated and fixed Cheyne-Stokes respirations pulse weaker and more rapid blood pressure continues to fall skin cool and clammy profuse diaphoresis death rattle: noisy respirations

mourning

reaction activated by a person to assist in overcoming a great personal loss. refers to culturally defined patterns of grief - funerals, wakes, memorials

A student who normally gets "As" receives a "Cs" on her project and experiences a loss of confidence. Which behavior best indicates that the student is achieving growth because of this situation loss?

requests a review of the project's strengths and weaknesses against the criteria

Vascular dementia

results in damage to brain cells caused by inadequate blood supply

personal loss

sense of loss occurs - dog dies

A nurse is talking to a 63-year-old woman who underweight grief therapy for unresolved grief related to the death of her husband. Which behavior best indicates that the therapy is helping?

she talks about things they used to enjoyed

Delirium

short term confusional state with sudden onset; typically reversible characterized by disturbances in consciousness that impairs a person's awareness of the environment may have difficulty focusing or paying attention, so easily distracted impaired with recent memory is common, along with disorientation and language problems

Which action is the best indicator that an older widow is moving through grief towards closure?

sorts through husband's belongings and saves some items for grandchildren and donates the rest

fraudulent methods of treatment

special diets enemas unproven drugs nurse can help patient sort out - people trying to profit

grief

subjective response to loss. depends on who you are - some cultural / religious components to it. when grief allowed to operate normally it can lead to resolution of the hurt and the reestablishment of one's life. accepting reality of loss experiencing the pain of grief adjusting to environment that no longer includes the lost person, object or aspect of self reinvesting emotional energy to new relationships successful completion of these tasks results in resolution - healthy adjustment to loss Nurse's role is to help patient and family to complete these tasks as they can negatively affect your outcome, how you are in future relationships if death expected - anticipatory grief - so we can prepare for it. cry together - enjoy mutual affection - will easy pain of that loss

The nurse has good relationship with an older man who was recently placed on hospice care. He speaks fondly about his adult children but admits to being very rough on them while they were growing up. What should the nurse do first to facilitate anticipatory grieving for the man and his family?

talk to the man about his perception of his current relationship with his children

euthanasia

the act of painlessly killing a suffering person or animal; mercy killing

mortality

the condition of being subject to death. We are all subject to death Know how you view your mortality is important to know so you can understand all of the facets that go into that. you help someone else go through that process

The patient tells the nurse that he has a durable power of attorney for health care and medical treatment. What is the most important information to obtain from the patient?

the name and phone number of the person who will make health care decisions

Grieving family

the needs of the grieving family and significant others should be met by a caring, compasionate health care provider Resolution of grief begins when the grieving person can complete the following tasks; have positive interactions, participate in support groups, establish goals and work to achieve them, discuss the meaning of the loss and its effect

palliative care

the nurse serves as an advocate for the clients sense of dignity and self esteem Learn to live fully with an incurable condition. incurable but still treating it. improves quality of life for clients and their families facing end of life issues palliative care interventions - relief of physical manifestations pain, as well as addressing spiritual emotional and psychosocial aspects of the client's life. and inter-professional team of physicians, nurses social workers physical therapist, occupational therapists, spiritual support and others provide palliative care trying to prolong life and get treatments usually at home but can be in skilled nursing facility or hospital

communicating with dying patients

therapeutic communication - expresses respect, realistic hope and offers appropriate reassurance and support careful attention to what the patient expresses verbally and nonverbally is required if patient do not wish to communicate at a particular time, they need to know that this is acceptable and will be respected assisting the patient in saying goodbye. They don't to leave their family in a hard say so you need to help walk them through the process.

Clinical signs of death

unresponsiveness - ABC - chest rise, no posturing, no movement, no reflexes - poke at eyeball to see if body will react to that no movement or breathing no reflexes flat electroencephalogram - measure brain waves - none brain dead absence of apical pulse - left side, below nipple, apex of heart, listen for 1 minute (have already tried carotid) cessation of respirations - no breathing

physician's order

usually only for that hospital stay

delirium

when pt is delirious they may see what you see but they are comprehending a completely different environment easily distracted need to re-orientated frequently - safety issue impaired recent memory impaired recent memory is common - very difficulty to work with patient can be combative (do not judge caused by delirium)

For which patient should the nurse design and implement interventions to facilitate anticipatory grief?

young athlete is informed that he needs a below-the-knee amputation due to osteosarcoma

The nurse is conducting an assessment on the dying patient. Which statement by the patient would indicate the patient is experiencing the stage of acceptance by Kübler-Ross?

"I am helping my spouse plan my obituary and funeral."

The community hospice nurse is conducting a follow-up visit with the family 3 months after the death of a loved one. Which statement by the family member indicates that she is experiencing grief?

"I really miss Charlie; it is hard to accept that he is gone."

Which comment is most likely to help grieving family members express themselves more easily? (Select all that apply.)

"Tell me how you're feeling." "I hear you saying that you miss your loved one very much."

Following the death of her husband, a wife feels that he still with her. She also reports having dreams and vivid memories of him. Which question should the nurse ask to assess the sense of presence that the wife has described?

"how do you feel about these dreams and experiences"

Nurses care for all types of patients with various conditions, including those with a terminal illness. Which statement is true about terminal illnesses?

'An illness is terminal when no reasonable hope of recovery exists.

A young mother has just given birth to a boy born with severe birth defects. She states, "I feel so sad i wanted a normal child. I do not want to see the babu. Which type of loss is the mother experiencing?

'Situational loss

A nurse is preparing to care for a dying patient, and several family members are at the bedside. Select the therapeutic techniques that the nurse uses when communicating the family. (Select all that apply.)

-Be honest and truthful and let the patient and family know that the nurse will not abandon them. -Explain everything that is happening to all family members. Encourage expression of feelings, concerns, and fears.-Extend touch and hold the patient's or family member's hand appropriate.

The nurse is providing postmortem care for a patient. Which interventions are appropriate before allowing the family to visit? (Select all that apply.)

-Prepare the body to look as clean and natural as, possible.-Remove the external tubes and drains if there is no autopsy required.-Call the health care provider to obtain an order to release the body to the mortician.

In the care of dying patient, which tasks can be delegated to the unlicensed assistive personnel (UAP)? select all that apply

-assist the patient into a position of comfort-assist the patient with taking oral fluids-ensure that patient is clean and dry, and linens are changed as needed

When talking with a patient what would be considered a therapeutic communication technique? (Select all that apply.)

-encouraging family members to share their feelings-Sitting at the same level of the patient when conversing with them.

What signs and symptoms would the nurse expect to observe in the patient who is nearing death? select all that apply

-lowered blood pressure-irregular respiratory pattern-mouth-breathing with dry mucous membranes

Which actions indicate that the health care team is fulfilling the Dying Person's Bill of Rights? select all that apply

-nurse assesses pain and administers pain-patient's choice of spiritual leader is contacted and rituals are allowed-nurse gives comfort measures and talks to patient who is in a coma-patient is allowed to make decisions, even though she seems indecisive

What is most likely to be included in postmortem care? select all that apply

-wash hands and don gloves-care for valuables and personal belongings-close patient's eyes and mouth if needed-place patient supine with arms at the sides

Kubler-Ross's stages of dying

1. Denial 2. Anger 3. Bargaining 4. Depression 5. Acceptance normal grieving process

conditions associated with dementia normal pressure hydrocephalus

Chronic, low-level form of hydrocephalus. Clinical triad: Dementia, gait disturbance, and urinary incontinence. CSF pressure is within normal limits. Slight gradient exists between ventricular system and subarachnoid space due to incomplete subarachnoid CSF block. Commonly results from prior subarachnoid hemorrhage or meningitis. Diffuse ventriculomegaly out of proportion to sulcal prominence. Early entry of radiotracer into lateral ventricles, with persistence at 24 and 48 hours. Delay ascent to parasagittal region.

Nursing care

Assessment (physical, emotional, intellectual, sociocultural, spiratual) Patient problem - Box 25.7 (complex grief, fear of dying, insufficient nutrition) Outcomes & planning Implementation evaluation

Nursing care

Assessment (physical, emotional, intellectual, sociocultural, spiritual) - may have problems with one or all of these P.740 Assessing - ADL, mobility, meds, nutrition, sleeping patterns intervention: energy conservation, pain reduction, promotion of sleep and rest, Emotional assessment - endeavor filled with anxiety, guilt, anger, acceptance open ended questions Interventions: encouragement, allowing for open space to talk and share, offering encouragement and support "permission to die" by assisting patient in saying goodbye. outcomes and planning implementation evaluation intellectual level of family family member - let them know what they can do spiritual assessment - question usually upon admission "any religious or spiritual beliefs that would impact your care. religions/cultural deal with death in different ways Interventions - healthcare, clergy, belief systems nursing interventions actual or potential lack of resolution loss of significant other fear of dying or death insufficient nutrition impaired family process despair impaired belief system nursing diagnosis gives you baseline on how you are going intervene. Outcomes and goals: grief - encourage talking, listening and allow for silence, eye contact if culture ok, empathy and sympathy but not about you - about them. Bringing family insufficient nutrition: smaller meals, nutritional supplements, food preferences, - family could bring in favorite food, advocate for patient

A nurse is assigned to a patient who recently was diagnosed with a terminal illness. While the nurse was assisting her with morning care, the patient asked about organ donation. Which nursing action is most appropriate?

Assist her in obtaining the necessary information to make this decision.

Changes in healthcare relating to dying and death

Before 1950s, it was common for patients to die at home in their own beds with family present From 1950s to 1980s, the health care system became highly mechanized and dying occurred mostly in institutions By the early 1980s, when diagnosis related groups (DRGs) came into play, this trend changed Currently, the recuperating or terminally ill patient is often discharged to home, a convalescent home, or a nursing home

A newly licensed nurse is assigned to his first dying patient. When he is caring for a dying patient, what best prepares the nurse?

Being aware of his own thoughts and feelings toward death

The nurse is caring for a dying mother of a 6-year-old child. Based on the developmental age of the child, what beliefs might the child be feeling?

Believes wishes can be responsible for death.

The nurse is working in a pediatric outpatient clinic. There is an 8-year-old child whose grandfather has just died. Based on the developmental level of the child, what type of response would the nurse anticipate?

I was bad at school and talked back to Mom. That's why Grandpa died

A patient has been diagnosed with lung cancer and is undergoing treatments. Based on the importance of providing physical care, which patient problem would be of highest priority?

Imbalanced nutrition: less than body requirements

steps for post mortem care

1. gather equipment: disposable gloves, gown, and other protective clothing plastic bag for hazardous waste disposal washbasin, washcloth, warm water, bath towel Clean gown or disposable gown for body absorbant pads body bag or shroud kit suitable receptacle for patient's belongings and other items to be returned to family valuables envelope identification tags, as required by agency policy 2. Wash hands (reduces spread of microorganisms 3. Don clean gloves (Protects nurse from contamination) 4. Close patient's eyes and mouth if needed (provides a more normal appearance) A rolled towel placed under the chin is helpful to keep the mouth closed. 5. Remove all tubing and other devices from the patient's body (Make patient look more peaceful) 6. Place patient in supine position (allows access for procedures) Elevate the head (prevents discoloration). Do not place one hand on top of the other (this can lead to discoloration). 7. Replace soiled dressings with clean ones (prevents odor) 8. Bath patient as necessary (reduces odor) 9. Brush or comb hair (gives more normal appearance) 10. Apply clean gown (prepares body for viewing) 11. Care for valuables and personal belongs (for legal considerations) if wedding band is to remain on the deceased, secure ring to finger with a small strip of tape over ring (prevents loss and protects jewellery) 12. Allow family to view body and remain in room for as much time as needed (Provide emotional support for the family wishes). A sheet or light blanket is placed over the body with on the head and upper shoulders exposed maintaining dignity and respect for the deceased. Remove unneeded equipment from the room. Provide soft lighting and offer chairs (demonstrates respect for significant others). 13. After the family has left the room attach identification per hospital policy. Attach special label if patient had a contagious disease (protects those who handle the body). 14. Close door to room (prevents exposure to patients and visitors) 15. Await arrival of ambulance or transfer to morgue. (Out of respect for patient) (Some agencies use a shroud to enclose the body before transfer to the morgue). 16. Document procedure and disposition of patient's body and of belongings and valuables (For legal purposes).

Historical overview

1906s, Pioneers in death and dying theory such as Kubler-Ross, Glasssner, and Strauss produced works that stimulated the health care industry to research topics about death and dying

Historical overview

1970s - Hospices became recognized as health care delivery systems

Hospices v. palliative care

1970s hospice became recognized as health care delivery systems

Historical overview

1980s grief therapy was introduced when Benoliel and Martocchio added new insights into the needs and care of the dying patient

changes in healthcare related to dying and death

50s die at home 1950s to 1980s healthcare system became more of a machine and hospitals became places for treatment and dying 1980s when diagnosis related groups (DRGs) came into play trend changed to treatment more than deaths currently, the recuperating or terminally ill patient is often discharged to home, a convalescent home or a nursing home.

Which statement describes a person experiencing anticipatory grief?

A person faces the possibility of losing a loved one.

masked grief

A type of grief reaction when the person experiences symptoms and behavior which causes them difficulty, but they do not see or recognize the fact that these are related to the loss

The nurse is caring for a dying patient. What are clinical signs of death? (Select all that apply.)

Absence of apical pulse Cessation of respirations Flat encephalogram

Which of the following helps family members make difficult decisions?

Addressing one matter at a time, giving them adequate time to discuss each issue

A patient is being cared for in the hospital and had the opportunity to formulate a Living Will and Durable Power of Attorney for Healthcare. These are examples of what type of documents?

Advanced directives

major neurocognitive disorder types of dementia

Alzheimer's disease vascular dementia Pick disease Huntington disease Creutzfeldt-Jakob disease

The nurse is working in a long-term care facility taking care of an 87-year-old male patient. The patient states "All my friends have passed on; guess I'm next." The nurse knows that patient is experiencing what type of grief?

Anticipatory

Types of advance directives include

DNR, Living will, and power of attorney ABandC

Pick disease

Degenerative disease of frontal (behavior) and temporal (language), sparing parietal and occipital lobes

Which of the following is most therapeutic when talking with family members with an unresolved issue?

Encourage them to verbalize their thoughts and felings to the loved one.

issues related to dying and death

Euthanasia do not resuscitate (DNR) advance directives organ donations rights of dying patients fraudulent methods of treatment

grief and grieving

Grief bereavement mourning tasks of grief to facilitate healthy adjustment to loss these tasks are not sequential nurse's role anticipatory grief sense of presence grief attacks nurses grief and survival strategies for nurses kubler-ross stages of dying complicated grief

Patient problem statements related to grieving

Grief, related: Potential loss of significant other potential loss of physiopsychosocial well being Complex grief or potential for complex grief, related to: Actual or potential object loss Absence of anticipatory grieving Lack of resolution of previous grieving response Loss of significant other Thwarted grieving responses to a loss Fear of Dying relating to: anticipation of pain, suffering of terminal disease discussions on the topic of death uncertainty about the after life following death Insufficient nutrition related to: depressed grief response loss of significant other change in social status situational transition or crisis Impaired family processes related to: Situational transition or crisis Despair related to: failing or deteriorating physiologic condition Impaired belief system or potential for impaired belief system, related to: Separation from religious and cultural ties situational transition or crisis Potential for impaired human dignity, related to: Compromised maintenance of health Impaired decision-making ability

sense of presence

The illusion that a virtual experience is real. See hear the person. Sees something that reminds them of that person. Smells and knew they were there. vary from general feelings of the deceased's prescence to actual sensory experiences - dreams/halluicinations

grief attack

The involuntary and unexpected reappearance of emotions and behaviors associated with grief can have triggers but doesn't have to have specific trigger

Palliative care

The nurse serves as an advocate for the client's sense of dignity and self esteem the goal is to learn to live fully with an incurable condition palliative care improves the quality of life for clients and their families facing end of life issues

nursing interventions for dementia

The nursing interventions for a dementia client are: Orient client. Frequently orient client to reality and surroundings. ... Encourage caregivers about patient reorientation. ... Enforce with positive feedback. ... Explain simply. ... Discourage suspiciousness of others. ... Avoid cultivation of false ideas. ... Observe client closely.

Communicating with dying patients

Therapeutic communication expresses respect for the patients, maintains realistic hope, and offers appropriate reassurance and support careful attention to what the patient expresses verbally and nonverbally is required if patients do not wish to communicate at particular time, they need to know that this is acceptable and will be respected assisting the patient in saying goodbye

postmortem care

This care of the patient's body after death P.754 the body should be cared for as soon as possible after death to prevent tissue damage or disfigurement - eyes closed, arms straight to sides offer the family the opportunity to view the body. Bed bath before family comes in, wash eyes and face, new brief, sheets If coroner's case you need to leave all tubes in place DO NOT REMOVE Make body look as natural as possible. brings chairs and kleenex, dim lights - depends on situation can call to cafe - they can bring coffee/water/cookies for family Postmortem body bag/shroud - identification toe tag, needs to be placed on body. valuables need to go home with and CHART with whom they went home with. Organ donor may have to be put on rescusitation to keep organ viable (organ service will give directions).