Taylor Fundamentals of Nursing Chapter 43- Loss, Grief, and Dying

Anticipatory loss

condition in which a person displays loss and grief behaviors for a loss that has yet to take place

A client's son is named to make decisions for his mother in the event she cannot speak for herself. This is an example of a(an): significant power. exemplary representative. durable power of attorney. advance estate director.

durable power of attourney A durable power of attorney allows clients to designate another person to make decisions if they become incapacitated and cannot make decisions independently. Advanced estate planning typically involves estate tax reduction, Medicaid planning and/or special needs trust planning is for a client with a large estate. Exemplary representative and significant power are not related to health care.

The nurse is caring for a client who has just died after a long diagnosis of dementia. Which nursing assessment is the priority for documentation? "No breathing and no pulse at 0840." "Notified the client's daughter." "Postmortem care completed." "Body transported to morgue."

"No breathing and no pulse at 0840." The priority documentation is the assessment that indicates the client is dead. The other items can occur and will be documented after establishing that death has occurred.

The nurse is providing care to a group of terminally ill clients. The client who is most likely experiencing the anger stage of grief is the one who states: "I just want to see my son have a family of his own." "I don't care about anything. I have no energy." "Why did this have to happen to me?" "I do not believe I have this disease."

"Why did this have to happen to me?" The client is expressing anger when displaying a "why me" attitude. The other statements are reflective of other stages of grief.

Kubler-Ross stages of dying

1. Denial 2. Anger 3. Bargaining 4. Depression 5. Acceptance

Dysfunctional Grief

Distorted or abnormal grief response, including inhibited grief (suppression of grief reaction) and unresolved grief (lengthy or denied grief reaction) Grief that falls outside normal parameters; may manifest as absence of, delayed, exaggerated, or prolonged grief

Grief

Emotional response to loss.

Common reactions to Denial

The patient denies the reality of death and may repress what is discussed. The patient may think, "They made a mistake in the diagnosis. Maybe they mixed up my records with someone else's."

Dysfunctional grief

abnormal or distorted grief that may be either unresolved or inhibited

A client has recently lost a parent. The client spent about 6 months deeply mourning the loss and is just now able to function at the pre-loss level. During this process, a strong social support network was able to assist the client. What developmental stage of life does the nurse identify the client is in? adult toddler school-aged child infant

adult Adults tend to grieve more intensely and more continuously, but for a relatively shorter period of time than children. Having a good social network helps with this process, as well as having a stable lifestyle.

heart-lung death

cessation of apical pulse, respirations, and blood pressure

The nurse is taking care of a client recently involved in a motor vehicle accident during which a pet was thrown from the vehicle and died. The client states, "My heart aches and I can't eat or sleep." According to Kübler-Ross, what stage of grief is the client experiencing? acceptance denial and isolation depression bargaining

depression According to Kübler-Ross (1969), the client would be in the depression stage, as evidenced by the loss of sleep and appetite. The other stages do not apply to this client according to the statements made.

In the Parkes model, a person uses denial as a psychological defense in the stage of: yearning. reorganization. disorganization. numbness.

numbness In the numbness stage, which is usually brief, trauma so overwhelms the bereaved survivor that he or she must use denial as a psychological defense.

Mourning

period during which a person learns to accept grief

Active euthanasia

someone other than the patient commits an action with the intent to end the patient's life, for example, injecting the patient with a lethal dose of a drug

Bereavement

state of grieving or going through the grief process

Palliative sedation

the lowering of patient consciousness with medication for the express purpose of limiting the patient's awareness of suffering that is intractable and intolerable

cerebral or higher brain death

when the cerebral cortex is irreversibly destroyed

Advance Directive

written directive that allows people to state in advance what their choices for health care would be if certain circumstances should develop

A middle-age client is caring for an older adult parent who has end-stage renal disease. Which statement by the client indicates to the nurse that the client is experiencing anticipatory loss? "I know my parent will not be with me forever." "I know that my parent has end-stage renal disease." "I am feeling so sad when I should be enjoying the time I have left with my parent." "My parent and I watch TV together as often as we can."

"I am feeling so sad when I should be enjoying the time I have left with my parent." Anticipatory loss occurs when a person displays loss and grief behaviors for a loss that has yet to take place. Anticipatory loss is often seen in the families of clients with serious and life-threatening illnesses and may lessen the effect of the actual loss of the family member. Feeling sad at the impending death of a parent would be an example of anticipatory loss. The other statements are simply statements of fact. -The parent does have end-stage renal disease. -Watching TV together is an activity that allows shared time. -The child understands that the parent will not be with them forever; this is fact, not a symptom of anticipatory grieving.

A nurse has just finished a presentation on hospice and palliative care. Which statement by a participant would indicate a need for further education? "In hospice care, the nurses make most of the care decisions for the clients." "Palliative care provides relief from pain and other distressing symptoms." "Hospice care programs focus on quality rather than length of life." "Palliative care affirms life and regards dying as a normal process."

"In hospice care, the nurses make most of the care decisions for the clients." The philosophy of hospice is that clients and families are empowered to achieve as much control over their lives as possible. Hospice focuses on relieving symptoms and supporting clients with a life expectancy of 6 months or less, rather than years, and their families. However, palliative care may be given at any time during a client's illness, from diagnosis to end of life.

The nurse is caring for a client who recently found out he has a terminal illness. The nurse notes that the client is hostile and yelling. Which statement by the nurse shows that she has understanding of the Kübler-Ross emotional responses to impending death? "Sometimes a person returns to a previous stage." "The process is the same from person to person." "The duration of all stages is a few hours." "Each stage of dying must be completed prior to moving to the next stage."

"Sometimes a person returns to a previous stage." Kübler-Ross (1969) studied the responses to death and dying. Her findings are as follows: Sometimes a person returns to a previous stage; the stages of dying may overlap; the duration of any stage may range from as little as a few hours to as long as months; the process varies from person to person.

Death

(1) irreversible cessation of all functions of circulatory and respiratory functions; (2) irreversible cessation of all functions of the entire brain, including the brainstem; (3) termination of life

Engel's Six Stages of Grief

1. Shock and disbelief 2. Developing awareness 3. Restitution 4. Resolving the loss 5. Idealization 6. Outcome

Which assessment finding would best support a nursing concern of disordered grieving? A client blames themself for not doing more to make their spouses's recent death more comfortable. A client cries frequently and loudly in the weeks following their child's death in an accident. A client has been experiencing chronic insomnia since their parent's death earlier this year. A client is unable to return to work after their sibling's death 18 months ago.

A client is unable to return to work after their sibling's death 18 months ago. An inability to return to normal activities 18 months after a sibling's death is suggestive (though not definitive) of disordered grieving. Crying and having difficulties sleeping are not unusual and will often accompany healthy grieving. A feeling of "not doing enough" is common during grief and would only be considered disordered if this became a long-term and all-encompassing belief.

What is a good death?

A good death is one that allows a person to die on his or her own terms, relatively free of pain, and with dignity. It is free from avoidable distress and suffering for patients, families, and caregivers; in general accord with patients' families' wishes; and reasonably consistent with clinical, cultural, and ethical standards

Which priority intervention should the nurse plan to implement to reduce a client's discomfort during terminal weaning? Provide an explanation of the process. Have the client's family remain at the bedside. Offer emotional support to the family. Administer sedation and analgesia.

Administer sedation and analgesia. Terminal weaning is the gradual withdrawal of mechanical ventilation from a client with a terminal illness. Providing sedation and analgesia is the best way to reduce the client's discomfort during the process. The nurse participates in the process by educating the client and family about the burdens and benefits of continued ventilation and what to expect when terminal weaning is initiated. -Supporting the family and having the family remain at the bedside are important roles of the nurse during terminal weaning, but do not directly affect discomfort as much as sedation and analgesia.

A client states, "My children still need me. Why did I get cancer? I am only 30." This client is exhibiting which stage, according to Kübler-Ross? Acceptance Anger Bargaining Denial

Anger Anger is the second stage and is exhibited by statement similar to "Why me?" -Denial occurs when the person refuses to believe certain information. -Bargaining is an attempt to postpone death. -During the acceptance stage, the dying clients accept their fate and make peace spiritually and with those to whom they are close.

A client with a diagnosis of lung cancer is seen in the clinic for follow-up care. Which nursing interventions are essential to include in this client's plan of care to address grief? Select all that apply. Urge the client to continue a usual routine. Promote good nutrition and sleep habits. Help the client establish coping strategies. Encourage participation in religious rituals. Assist the client to form a support system.

Assist the client to form a support system. Help the client establish coping strategies. Promote good nutrition and sleep habits. Encourage participation in religious rituals. Nursing interventions used to help clients move through grief include helping the client mobilize a support system. The nurse can also help the client establish coping behaviors used in the past. Other interventions to include when helping clients move through grief are promoting good nutrition and sleep habits. The nurse should encourage the client to participate in religious rituals that are important to him. -The nurse should not urge the client to continue his usual routine because it may not include healthy behaviors. For example, the nurse should not encourage use of alcohol, drugs, and caffeine during the grief process.

Which statement regarding perceptions of death by children is accurate? Preschool-age children view death as a spiritual release. Adolescents tend to respond better than adults with death. Toddlers perceive death as irreversible and unnatural. At about age 9, the child perceives death as irreversible.

At about age 9, the child perceives death as irreversible. At about 9 years of age, the child's concept of death matures, and the child perceives death realistically as irreversible, universal, inevitable, and natural.

Medical criteria used to certify a death

Cessation of breathing No response to deep painful stimuli Lack of reflexes (such as the gag or corneal reflex) and spontaneous movement Flat encephalogram (brain waves)

The hospice nurse is caring for several clients on the unit. Which client is exhibiting signs or symptoms of impending death? Client with end-stage emphysema and a respiratory rate of 32 breaths/min at rest Client with pancreatic cancer and a blood glucose level of 350 mg/dl (19.43 mmol/l) Client with circumoral cyanosis and abdominal mottling Client with end-stage cardiac disease experiencing chest pain while ambulating

Client with circumoral cyanosis and abdominal mottling The client with circumoral cyanosis and abdominal mottling indicates poor oxygenated perfusion and impending death. Other signs include alterations in vital signs, decreasing urinary output, incontinence, difficulty swallowing, and decreased responsiveness. -Abnormal glucose levels occur in clients with pancreatic dysfunction and may not indicate impending death. -A resting respiratory rate of 32 breaths/min may be normal for a client with end-stage emphysema—steadily decreasing respirations and somnolence would indicate impending death. -Clients with end-stage cardiac disease often experience chest pain with activity, but it does not necessarily mean impending death.

The nurse enters a client's room and finds the client curled up in bed and crying. The client states, "My life is so good, and now I have cancer. Why me? I have tried to be a good person." The nurse recognizes the client as exhibiting signs of which stage of Engel's model of grief? Shock and disbelief Idealization Restitution Developing awareness

Developing awareness The client is exhibiting signs of developing awareness when demonstrating anger, feelings of emptiness, and crying "Why me?" -Shock and disbelief are usually defined as refusal to accept the fact of loss, followed by a stunned and numb response. -Restitution involves rituals surrounding loss. -Idealization is the exaggeration of the good qualities that the person or object had, followed by acceptance of the loss and a lessened need to focus on it.

The clinical signs of impending or approaching death include:

Difficulty talking or swallowing Nausea, flatus, abdominal distention Urinary or bowel incontinence or constipation 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 Restlessness or agitation Cooling, mottling, and cyanosis of the extremities and dependent areas

The husband of a client with terminal cancer is afraid of hurting his wife during sexual intercourse. Which action by the nurse is likely to be most helpful in reducing this client's fears? Reassure the client's husband that he cannot hurt the client during sexual intercourse Inform the client's husband that the client cannot have sexual intercourse due to fatigue Encourage discussion between the husband and wife regarding their intimacy needs Suggest other ways the couple can spend time together, such as watching television together

Encourage discussion between the husband and wife regarding their intimacy needs Partners of terminally ill clients may wish to be physically intimate with the dying person but are afraid of "hurting" him or her and may also be afraid that an open expression of sexuality is somehow "inappropriate" when someone is dying. Encourage discussion and suggest ways to be physically intimate that will meet the needs of both partners, such as a foot massage or embrace, and not just watching TV. -Telling the client that he cannot have relations based on the fatigue of the client's spouse is not appropriate. -Reassuring the client that he will not cause pain is incorrect.

A nurse is preparing a presentation for a family support group for cancer. The nurse is planning to describe grieving and the various terms associated with this concept. Which term would the nurse use to describe the entire range of responses to the loss of a valued object, person, belief, or relationship? Grief Bereavement Mourning Loss

Grief Grief is person centered and encompasses the entire range of physical, psychological, cognitive, and behavioral responses to a loss of an object, person, belief, or relationship that one values. -Bereavement is a state of desolation that occurs as the result of a loss, particularly the death of a significant other. -Mourning encompasses the socially prescribed behaviors after the death of a significant other.

The nurse is receiving a change of shift report on a client who has a terminal illness and has exhibited a slow and progressive decline in the health status over the past several days. Which data supports the client's impending death? Select all that apply. Systolic blood pressure which rose from 100 to 110 mm Hg A regular apical pulse of 90 beats/minute Cyanotic nail beds in hands and feet bilaterally Distended abdomen with last bowel movement documented 7 days ago Gurgling sounds emanating from the client's throat with each breath

Gurgling sounds emanating from the client's throat with each breath Distended abdomen with last bowel movement documented 7 days ago Cyanotic nail beds in hands and feet bilaterally

Palliative care

Hospice care; taking care of the whole person—body, mind, spirit, heart, and soul—with the goal of giving patients with life-threatening illnesses the best quality of life they can have through the aggressive management of symptoms

After the death of a terminally ill spouse, a client reports frequent headaches and loss of appetite. The client states, "How am I going to live without him?" What type of grief is the client experiencing? Inhibited grief Anticipatory grief Unresolved grief Abbreviated grief

Inhibited grief With inhibited grief, a person suppresses feelings of grief and may instead manifest somatic (body) symptoms, such as abdominal pain or heart palpitations. -Abbreviated grief is not a common classification of grief. -Anticipatory loss or grief occurs when a person displays loss and grief behaviors for a loss that has yet to take place. In unresolved grief, a person may have trouble expressing feelings of loss, may deny them, and the bereavement may extend over a lengthy period.

When preparing for the death of a client, the nurse should provide the client's family with which interventions? Select all that apply. Explain the dying process and allow grieving. Utilize therapeutic communication techniques. Listen to concerns, fears, and worries. Suggest that the family doesn't leave the bedside. Encourage rest and proper nutrition.

Listen to concerns, fears, and worries. Encourage rest and proper nutrition. Explain the dying process and allow grieving. Utilize therapeutic communication techniques.

When does loss occur?

Loss occurs when a valued person, object, or situation is changed or becomes inaccessible such that its value is diminished or removed.

Which signs assessed in a dying client would the nurse recognize as signs of death? Select all that apply. Increased body temperature Increased blood pressure Loss of movement, sensation, and reflexes Cheyne-Stokes respirations Nausea, flatus, abdominal distention Racing pulse

Nausea, flatus, abdominal distention Cheyne-Stokes respirations Loss of movement, sensation, and reflexes Signs of impending death include nausea, flatus, abdominal distention, Cheyne-Stokes respirations, and loss of movement, sensation, and reflexes. The body temperature decreases, pulse decreases, and blood pressure decreases.

When assessing a person who is grieving using the grief cycle model, which concept would be most important for the nurse to keep in mind? Select all that apply. People vary widely in their responses to loss. Some people actually skip some stages of grief altogether. The stages are relatively discrete and identifiable. Stages occur at varying rates among people. The stages of grief occur linearly and are static.

People vary widely in their responses to loss. Stages occur at varying rates among people. Some people actually skip some stages of grief altogether In reality, the stages of the grief cycle model are not as discrete as the model indicates. However, it is helpful to use the model as a general guide, while keeping in mind that people may vary greatly in their responses to loss and still fall within the normal response range. Grieving persons may go through the stages at varying rates, go back and forth between stages, or skip stages.

The nurse is preparing the body of a client who was killed in a car accident for the family to view. Which step would be contraindicated? Remove all the IVs and other medical tubing. Clean, position, and cover the client with a sheet, exposing only the head and a hand. Respect all religious and cultural practices of the family. Inform the family that they can have as much time alone with the client as they wish.

Remove all the IVs and other medical tubing In an effort to limit exposure to the disturbing sight of equipment and medical supplies, the nurse should, if possible, remove unneeded items and clean, position, and cover the client. However, under some circumstances (such as an unexpected death), intravenous and other lines and tubes should not be removed, as the body may need to be examined by a medical examiner. Having time alone with the client is an important step for some families, whereas others appreciate the presence of a nurse, a spiritual leader, or friends. Religious and cultural beliefs and customs should be observed as much as possible.

Abbreviated grief

Short but genuine grief reaction

The client who is terminally ill has unrelieved and intractable pain. The nurse is administering hydromorphone intravenously. The client states, "I want you to give me additional medication so I will die. I cannot go on any longer." What action would the nurse take? Contact the health care provider to request additional intravenous medication to honor the client's request. Ignore the client's statement, and limit any contact with the client. State, "This is not something I or any of the nurses can do." Obtain additional medication from the automated medication system that would hasten the client's death.

State, "This is not something I or any of the nurses can do." The ANA Code for Ethics states that the nurse "should provide interventions to relieve pain and other symptoms in the dying client consistent with palliative care practice standards and may not act with the sole intent to end life. The best option is for the nurse to say, "This is not something I or any of the nurses can do." The nurse should then explore the meaning of the client's request, seek other measures to relieve the client's pain, and provide end-of-life counseling services. -The nurse does not participate in active euthanasia, which includes contacting the health care provider to obtain a prescription for additional intravenous medication to honor the client's request, and obtaining additional medication from the automated medication system that would hasten the client's death. -The nurse would be negligent in client care by limiting contact with the client due to this request.

Which does not coincide with Kübler-Ross's stages related to a dying client? The dying client usually exhibits anger first. The client may be in several stages at once. Clients don't always follow the stages in order. Some client regress, then move forward again.

The dying client usually exhibits anger first. The dying client does not usually exhibit anger first. The client may be in several stages at once, clients don't always follow the stages in order, and some regress and then move forward.

Common reactions to Bargaining

The patient tries to barter for more time: "If I can just make it to my son's graduation, I'll be satisfied. Just let me live until then." Many patients put their personal affairs in order, make wills, and fulfill last wishes, such as trips, visiting relatives, and so forth. It is important to meet these wishes, if possible, because bargaining helps patients move into later stages of dying.

The nurse is caring for a client with terminal illness. Which should the nurse teach the family about physiological signs of imminent death? Most clients are wide awake when they pass. You may notice confusion and disorientation. Everyone is different, so there is no way to predict imminent death. There will be changes in vital signs, skin color, and responsiveness.

There will be changes in vital signs, skin color, and responsiveness. Teaching family members about physiological changes that occur during imminent death should be done with short, simple, and honest explanations. The nurse will inform the family that there will be changes in vital signs (e.g., decreased blood pressure/increased or decreased pulse), skin color (i.e., pale or blue, cool skin), and decrease in responsiveness are expected. -The nurse will avoid using clinical terms because family members may not understand the terminology. -Most clients gradually lose consciousness as they pass and are not wide awake. -Confusion and disorientation may occur well before death is imminent. -Although variations may occur during death, the nurse should relay the most general findings that occur.

clinical signs of heart-lung death & cerebral/higher brain death may be confirmed by:

These clinical signs may be further confirmed by an electroencephalogram or cerebral blood flow study.

The hospice nurse is caring for a client with allow natural death (AND) orders. The nurse assesses that the client has a slow, irregular heart rate, has cooling of the extremities, and is agitated. Which interventions can the nurse implement? Select all that apply. Do not perform cardiopulmonary resuscitation. Administer a lethal dose of barbiturates. Allow the client to stop drinking fluids. Implement a slow code in the case of cardiopulmonary or respiratory arrest. Use medication to lower client consciousness to limit awareness of suffering.

Use medication to lower client consciousness to limit awareness of suffering. Allow the client to stop drinking fluids. Do not perform cardiopulmonary resuscitation. A client with signs of a slow, irregular heart rate, cooling of the extremities, and restlessness is showing signs of impending death. The health care provider has written AND orders for this client, so cardiopulmonary resuscitation should not be implemented, including a slow code. When clients who are imminently dying have pain and suffering, palliative sedation (using medication to lower client consciousness) may be utilized to limit awareness of suffering. Allowing the client to stop drinking fluids would be a type of passive euthanasia. -Administering a lethal dose of barbiturates, or active euthanasia, is immoral and illegal.

Allow Natural Death (AND) order

an order that no attempts are to be made to resuscitate a patient who stops breathing or whose heart stops beating

Comfort Measures Only order

an order written to indicate that the goal of treatment is a comfortable, dignified death and that further life-sustaining measures are no longer indicated

A widow develops cancer within 6 months of her husband's death. This may be a result of: social isolation. alcohol intake. multiple losses. bereavement.

bereavement Physical health and psychosocial adjustment are intricately intertwined. The bereaved are known to be at greater risk for mortality and morbidity than are comparable non-bereaved people.

Upon admission, the nurse should give priority to addressing which need of a client who is displaying symptoms of dysfunctional grief? coping strategies spiritual distress self-care activities pain management

coping strategies Dysfunctional grief can be unresolved or inhibited. In unresolved grief, a person may have trouble expressing feelings of loss or may deny them. Unresolved grief also describes a state of bereavement that extends over a lengthy period. With inhibited grief, a person suppresses feelings of grief and may instead manifest somatic (body) symptoms. Coping strategies are necessary in the grieving process and for resolution of grief. Many times individuals experiencing dysfunctional grief have difficulty with self-care activities; however, the individual should be encouraged to perform these activities independently. -Pain management is usually not necessary in the management of dysfunctional grief. The spiritual needs of the client are important as well and should be considered after coping strategies have been addressed.

The nurse is taking care of a client recently involved in a motor vehicle accident during which a pet was thrown from the vehicle and died. The client states, "My heart aches and I can't eat or sleep." According to Kübler-Ross, what stage of grief is the client experiencing? depression denial and isolation bargaining acceptance

depression According to Kübler-Ross (1969), the client would be in the depression stage, as evidenced by the loss of sleep and appetite. The other stages do not apply to this client according to the statements made.

A terminally ill client is being cared for at home and receiving hospice care. The hospice nurse is helping the family cope with the client's deteriorating condition, educating them on the signs of approaching death. Which sign would the nurse include in this education plan? increased sensory stimulation increased urinary output difficulty swallowing decreased pain

difficulty swallowing A sign that death is approaching is the client's difficulty in swallowing. People who are dying do not experience decreased pain. They may not be in a position to report pain; therefore, the caregiver should observe the client closely. Urinary output decreases when a person is approaching death due to system failure and limited intake. The client approaching death has decreased sensory stimulation.

Perceived loss

loss of youth, of financial independence, and of a valued environment experienced by a person, but intangible to others

Euthanasia

mercy killing; the deliberate termination of the life of a person

Advance care planning (ACP)

process of planning for future care in the event a person becomes unable to make his or her own decisions

Which care environment would the nurse suggest to a client with no family nearby who is diagnosed with end-stage lung disease? residential care respite care home care acute care

residential care Nursing homes or long-term care facilities are the usual settings for long-term subacute care. These facilities provide around-the-clock nursing care for clients who cannot live independently or do not have family that can provide home care. -Acute care is not appropriate, as the client's condition is known and is not unstable. -Respite care is used to provide rest for caregivers.

The children of a male client with late-stage Alzheimer disease have informed the nurse on the unit that their father possesses a living will. The nurse should recognize that this document is most likely to: dictate how the client wants his estate handled after his death, and by whom. specify the treatment measures that the client wants and does not want. make legal provisions for active euthanasia. give permission for organ donation.

specify the treatment measures that the client wants and does not want Living wills provide instructions about the kinds of health care that should be used or rejected under specific circumstances. -The management of an individual's estate is specified in a will, not a living will. -It is not legal for a living will to make provisions for active euthanasia. -A living will may or may not include reference to organ donation, but normally this is addressed in a separate, specific consent card or document.

MOLST form

stands for Medical Order for Life-Sustaining Treatment, a medical order indicating a patient's wishes regarding treatments commonly used in a medical crisis

POLST form

stands for Physician Order for Life-Sustaining Treatment, a medical order indicating a patient's wishes regarding treatments commonly used in a medical crisis; must be completed and signed by a health care professional, not the patient

Terminal weaning

withdrawal of life-sustaining therapy with the understanding that death may result, generally after a decision is made that the therapy in question is medically futile or disproportionately burdensome

The condition of a client with a traumatic brain injury continues to deteriorate despite medical efforts. The decision is made to terminally wean the client from mechanical ventilation. Which statement by the nurse is most significant in educating the family regarding terminal weaning? "Your loved one will not feel or be aware of anything that is happening once the breathing tube is removed." "If you change your mind after we remove the breathing tube, just tell us and it will be reinserted." "All efforts will be taken to make sure your loved one is comfortable and out of pain." "Once the endotracheal tube is removed, your loved one will no longer be able to breathe."

"All efforts will be taken to make sure your loved one is comfortable and out of pain." A common and valid concern of families during terminal weaning is to make sure the client is not suffering. As such, the nurse's role is to educate the family regarding comfort measures, such as pain medication and additional sedation. -It is inaccurate to tell the family that the client will no longer be able to breathe once the tube is removed. The client may continue breathing for several hours to days. -When a decision is made to terminate mechanical ventilation, it should be clear that reintubation is no longer an option and death is inevitable. -The nurse must be honest with the family, as the client may be aware of loved ones in the room and talking to the client is encouraged.

A client has been receiving dialysis for years and now states, "I have been thinking about this for a long time. I no longer wish to continue dialysis. I just want to die." What is the most appropriate statement by the nurse? "Can you tell me about why you've made this decision?" "Once you've started treatment, it's important to continue." "Have you discussed this with your health care provider?" "Does your family agree with this decision?"

"Can you tell me about why you've made this decision?" Having the client explain his decision-making process is open-ended and allows exploration of the client's feelings. A competent client is not required to continue with treatment that has been initiated. -The other options are closed-ended and stop any further conversation.

The caregiver of a client who is terminally ill is becoming short tempered with the client and states, "I just can't take this anymore." Which nursing response is most appropriate? "Have you considered respite care so that you can rest for a few days?" "It is hard to care for someone who is ill." "It won't help for you to be intolerant of the client." "Have you considered residential care so you don't have to care for your loved one?"

"Have you considered respite care so that you can rest for a few days?" Respite care (relief for the caregiver by a surrogate) is important because it gives the caregiver an opportunity to enjoy brief periods away from home. Short-term respite care can be arranged in an inpatient facility and would allow the caregiver time to rest. -A residential home (long-term care facility) may not be warranted. -Being critical of the caregiver is not helpful and while it is important to be empathetic, it is imperative to provide options that may be helpful, such as respite care. -The focus of support may shift back and forth between the client and the caregiver.

A nurse is caring for a client whose spouse died more than 4 years ago. What assessment question will the nurse ask to determine if the client is experiencing abnormal grief? "Do you cry on the anniversary of your spouse's death?" "Can you remember the good times together with your spouse?" "Have you gone through and donated your spouse's clothing?" "Do you keep photos of your spouse on your bedside table?"

"Have you gone through and donated your spouse's clothing?" Abnormal grief responses present beyond 3 years after a loss. The nurse can identify if a client suffers from abnormal grief through questions aimed at learning if the client has left the deceased's room and belongings intact, has reported physical symptoms similar to those the deceased had before death, and has talked about the deceased as if the individual were still alive. -Remembering good times and keeping photos of loved ones are part of reminiscing and a healthy form of grieving. -Crying on the anniversary of a loved one's death is part of the normal grieving response.

When reviewing a client's chart, the nurse notes that the client is in the disorganization stage of grief. Which assessment finding would support this diagnosis? "I feel like I have absolutely no idea what to do next." "I had a good time at my class reunion. It was nice to be out with other people again." "A lot of the time I'm terrified that I'm going to die the same way." "I haven't let my children out of my sight. I am afraid something will happen to them."

"I feel like I have absolutely no idea what to do next." In the disorganization stage of grief, the client may exhibit difficulty making decisions, aimlessness, decreased resistance to illness, and loss of interest in people, work, and usual activities. -In the protest stage of grief, the client may exhibit preoccupation with thoughts of the deceased, searching for the deceased, dreams/nightmares, hallucinations, and concerns about others' health and safety. -In the shock stage, the client may exhibit slowed and disorganized thinking, blocking of thoughts, neglect of appearance, and wish to join the deceased. -In the reorganization stage of grief, the client may exhibit a realistic memory of the deceased, be comfortable when remembering the deceased, and return to previous level of ability.

During an interview of the client at the community clinic, the nurse finds that the client is providing care for a parent, who is terminally ill. Which statement by the client indicates anticipatory grieving? "I do not think my parent really has cancer. I think my parent needs to get a third opinion." "My parent is suffering with cancer and death will be a relief of the pain." "It is fine if my parent dies. We have not been close for years." "There is no way I can stay in the hospital because my parent is sick."

"My parent is suffering with cancer and death will be a relief of the pain." Anticipatory grief is the characteristic pattern of psychological and physiologic responses a person makes to the impending loss of a significant person. The client's statement, "My parent is suffering with cancer and death will be a relief of the pain," is an example of anticipatory grief and is intended to facilitate coping when death occurs. -The client's statement, "There is no way I can stay in the hospital because my parent is sick" demonstrates empathy for the parent and denial of a personal need for treatment. Denial is apparent when the client suggests the parent's diagnosis is incorrect. Denial is also apparent when the client relates it is "fine" if the mother expires because they were not close.

The nurse is caring for a client who recently lost an older adult parent. Which client statement alerts the nurse that the stage of depression may have started within the grief process? "It is all my fault! I did not see the signs." "This does not seem real to me." "Please go away; I just want to be left alone." "What am I going to do now that my parent is gone?"

"Please go away; I just want to be left alone." The clinical definition of depression is anxiety and hostility turned inward. The statement asking the nurse to go away and a desire to be "left alone" indicates withdrawal, which is a characteristic of depression. -"This does not seem real to me" indicates the client is in denial. Blaming oneself for the loss is an expression of guilt that may occur in the anger phase of grieving. Feeling uncertain about the future may occur as the grieving person accepts that the loved one is deceased and life will be different.

The psychologist is teaching students about the factors that affect a person's reaction to grief. Which statements by the students about developmental considerations are accurate? Select all that apply. "Children do not need to go through the same grief reactions as adults." "Children understand death on the same level as adults." "Terminally ill children normally do not ask questions about death." "Sense of loss for a child is just as great as it is for an adult." "Death of a parent can delay a child's development."

"Sense of loss for a child is just as great as it is for an adult." "Death of a parent can delay a child's development." Children do not understand death on the same level as adults, but their sense of loss is just as great. Death of a parent or another significant person can delay a child's development. Both terminally ill children and their siblings are likely to talk and ask questions about death. Children need to go through the same grief reactions as adults.

Which stage of the Parkes's model of grief lasts the longest? Yearning Numbness Reorganization Disorganization

Reorganization According to Parkes, progression through the four stages of grief normally takes 2 years or longer. The last stage, reorganization, usually begins 6 to 9 months after the loss and lasts the duration.

The new hospice nurse is reviewing the concepts of loss and grief with the preceptor. Which statement leads the preceptor to believe that the nurse has an understanding of grief and loss? "People only experience grief when someone dies." "Older adult clients who are lamenting their loss of youth are demonstrating actual loss." "Clients can experience a sense of loss when their child leaves for college. This is a type of situational loss." "The client who is isolating himself from social contact after the death of his spouse is demonstrating a social expression of grief."

"The client who is isolating himself from social contact after the death of his spouse is demonstrating a social expression of grief." Normal expressions of grief may be physical, emotional, social (feeling detached from others and isolating oneself from social contact), and spiritual. Grief is an internal emotional reaction to loss and occurs with loss caused by separation (e.g., divorce) or by death. Clients lamenting their loss of youth are demonstrating a type of perceived loss, which is intangible to others. Situational losses are experienced as a result of unpredictable events; a child going to college would be a maturational loss for the parent.

When preparing for palliative care with the dying client, the nurse should provide the family with which explanation? "The client will have to go to an inpatient hospice unit in order to receive palliative care." "Palliative care is the gradual withdrawal of mechanical ventilation from a client with terminal illness and poor prognosis." "In palliative care, no attempts are to be made to resuscitate a client whose breathing or heart stops." "The goal of palliative care is to give clients the best quality of life by the aggressive management of symptoms."

"The goal of palliative care is to give clients the best quality of life by the aggressive management of symptoms." Palliative care involves taking care of the body, mind, spirit, heart, and soul. It views dying as something natural and personal. The goal of palliative care is to give clients with life-threatening illnesses the best quality of life they can have by the aggressive management of symptoms. -A do-not-resuscitate order means that no attempts are to be made to resuscitate a client whose breathing or heart stops. -Gradual withdrawal of mechanical ventilation from a client with a terminal illness and poor prognosis is called terminal weaning. -Clients do not have to be in an inpatient hospice unit to receive palliative care.

"My father has been dead for over a year and my mother still can't talk about him without crying. Is that normal?" What is the best response by the nurse? "In fact, the more that someone cries about a loss, the better they're dealing with it." "The inability to talk about your dad without crying, even after a year, is still considered normal." "Did your mother cry a lot before your father died?" "It is not normal. Your mother needs to see a therapist about her grief."

"The inability to talk about your dad without crying, even after a year, is still considered normal." Normal responses to bereavement after 1 year include the inability to speak of the deceased without intense emotion, clinical signs of depression, and feelings of meaninglessness. Increased crying does not necessarily signal increased coping, however.

When a client with end-stage renal failure states, "I am not ready to die," what is the appropriate nursing response?

"This must be very difficult for you." The nurse should use statements with broad openings, such as "This must be difficult for you," to allow the client to continue expressing concerns and to acknowledge the client's feelings. This facilitates communication and allows the client to choose the topic or manner of response during this stage of the grieving process. Assuming the client is angry and sad or indicating that this is "a terrible diagnosis" is not an appropriate way to promote coping. The nurse should automatically assume a spiritual leader is desired.

A client has responded to a recent diagnosis of lung cancer by making extensive plans for overseas travel with family, despite the extremely poor prognosis. The client is adamant about not discussing cancer and is identified by the nurse as experiencing the denial stage of grief. How can the nurse best facilitate the client's healthy grieving? Restate the client's situation in more specific and detailed terms. Enlist the assistance of another nurse to help the client face the reality of the situation. Supplement conversations with the client by using written material about the diagnosis. Address the client's diagnosis and prognosis at a later time or date.

Address the client's diagnosis and prognosis at a later time or date. In the absence of the client's readiness to become more aware of the situation, the nurse should respect the client's current position and revisit the matter when the client is more ready. It is disrespectful, and likely counterproductive, to have others reiterate the message, to provide written material, or to increase the amount of detail if the client is not ready to engage at this time.

Assisted suicide is expressly prohibited under statutory or common law in the overwhelming majority of states. Yet public support for assisted suicide has resulted in a number of state ballot initiatives. The issue of assisted suicide is opposed by nursing and medical organizations as a violation of the ethical traditions of nursing and medicine. Which scenario would be an example of assisted suicide? Neglecting to resuscitate a client with a "do not resuscitate" status Administering a morphine infusion Administering a lethal dose of medication Granting a client's request not to initiate enteral feeding when the client is unable to eat

Administering a lethal dose of medication Assisted suicide refers to providing another person the means to end his or her own life, such as administering a lethal dose of a medication. This is not to be confused with the ethically and legally supported practices of withholding or withdrawing medical treatment in accordance with the wishes of the terminally ill individual. -Administering a morphine infusion may be used to assist with a client's pain near the end of life. -Granting a client's request not to initiate enteral feeding when the client is unable to eat is an example of wishes of a terminally ill client, and the agreed-upon measures near the end of life. -Neglecting to resuscitate a client with a "do not resuscitate" status is following the prescribed, mutually agreed-upon decisions about care.

An appropriate nursing diagnosis for the family of a client dying of cancer, whose members have expressed sorrow over the forthcoming loss, would be: Dysfunctional Grieving related to the loss of family member, as manifested by behaviors indicating anxiety. Anticipatory Grieving related to loss of family member, as evidenced by sorrow. Dysfunctional Grieving related to future loss of family member, manifested by family's developmental regression. Potential for Grieving related to loss of family member and sorrow.

Anticipatory Grieving related to loss of family member, as evidenced by sorrow. Anticipatory grieving comprises the intellectual and emotional responses and behaviors by which individuals, families, and communities work through the process of modifying self-concept based on the perception of loss.

A graduate nurse enters a client's room and finds the client unresponsive, not breathing, and without a carotid pulse. The graduate nurse is aware that the client has mentioned that he does not wish to be resuscitated, but there is no DNR order on the client's chart. What is the nurse's best action? Initiate a slow-code until the health care provider arrives. Consult with the charge nurse or nurse manager before calling the code. Respect the client's wishes and avoid calling a code. Call a code and begin resuscitating the client.

Call a code and begin resuscitating the client If there is no DNR order to the contrary, the standard of care obligates professionals to attempt resuscitation if a client stops breathing or his or her heart stops. It is important for nurses to clarify a client's code status if the nurse has reason to believe a client would not want to be resuscitated. It is imperative that the client's wishes are documented in a formal document in the health record for all to view. -Slow-codes are never good practice, and the nurse could be charged with negligence in the event of a slow-code and resultant client death. -Calling the charge nurse or nurse manager is not appropriate because it can delay emergency care, which could result in negligence and client death.

A client has been declared brain dead following a fall from a roof. The client's advance directives state they do not wish to have prolonged life measures, and that only the heart, kidneys, and liver should be donated. The client's spouse wants to also donate the client's corneas. What is the appropriate nursing action? Contact the organ procurement team to discuss organ donation with the spouse. Discontinue life support in keeping with the client's wishes. Explain that organ harvesting requires that the client donate all organs or none. Prepare for harvesting of the client's heart, kidneys, liver, and corneas.

Contact the organ procurement team to discuss organ donation with the spouse. The organ procurement team should be contacted as soon as possible to talk with the client's spouse. This discussion cannot wait, as the fragility of organs increases as time passes. While it is important to honor a client's wishes, life support cannot be withdrawn until the potential for organ donation is determined. The organ procurement team is specially trained to have these kinds of conversations.

The hospice nurse is visiting the wife of a client who died 10 months ago. The wife states, "My life is meaningless since my husband died." The nurse recognizes that the client is in which stage of grief? Protest Reorganization Shock Disorganization

Disorganization In the disorganization stage of grief, the client may exhibit difficulty making decisions, aimlessness, and loss of interest in people, work, and usual activities. -In the protest stage of grief, the client may exhibit preoccupation with thoughts of the deceased, searching for the deceased, dreams/nightmares, hallucinations, and concerns about others' health and safety. =In the shock stage, the client may exhibit slowed and disorganized thinking, blocking of thoughts, and wish to join the deceased. -In the reorganization stage of grief, the client may exhibit a realistic memory of deceased, be comfortable when remembering the deceased, and return to previous level of ability.

The hospice nurse is visiting the wife of a client who died 10 months ago. The wife states, "My life is meaningless since my husband died." The nurse recognizes that the client is in which stage of grief? Protest Disorganization Shock Reorganization

Disorganization In the disorganization stage of grief, the client may exhibit difficulty making decisions, aimlessness, and loss of interest in people, work, and usual activities. -In the protest stage of grief, the client may exhibit preoccupation with thoughts of the deceased, searching for the deceased, dreams/nightmares, hallucinations, and concerns about others' health and safety. -In the shock stage, the client may exhibit slowed and disorganized thinking, blocking of thoughts, and wish to join the deceased. -In the reorganization stage of grief, the client may exhibit a realistic memory of deceased, be comfortable when remembering the deceased, and return to previous level of ability.

The wife of a client who has been diagnosed with a terminal illness asks the nurse about the differences between palliative care and hospice care. Which information would the nurse most likely include in the response? Hospice provides physical and psychological support; palliative care provides social and spiritual support. Hospice care focuses on quality of life while palliative care focuses on length of life. Hospice care is provided for clients who have 6 months or less to live; palliative care is provided at any time during illness. Hospice care differs from palliative care in its foundational philosophy.

Hospice care is provided for clients who have 6 months or less to live; palliative care is provided at any time during illness. Hospice programs, which, in effect, are a type of insurance benefit, focus on relieving symptoms and supporting clients with a life expectancy of 6 months or less, and their families. Palliative care, on the other hand, may be given at any time during a client's illness, from diagnosis to end of life. Hospice and palliative care programs provide care that focuses on quality rather than length of life. Both hospice and palliative care share a similar foundation. Hospice and palliative care provide physical, social, psychological, and spiritual support through a team of health care professionals and lay volunteers.

Loss

Inaccessibility or change in a valued person, object, or situation. -Actual loss: loss tangible to both the person sustaining the loss and to others. -Perceived loss: loss tangible only to the person sustaining it. -Physical loss: loss of life, limb, an object, person, pet, or job. -Psychological loss: loss that affects a person's self-image. Anticipatory loss: loss behaviors displayed before the actual loss occurs.

A home hospice client who has Medicare is experiencing extreme pain at home and is refusing to receive inpatient care due to concerns over the cost of inpatient care. What teaching will the nurse include in the plan of care? Worry about payment should not be a concern for the client. Inpatient pain management for hospice clients is covered by Medicare. Medicare does not cover pain control in the home; it must be in the inpatient care. Medicare does not cover costs that are not directly related to the diagnosis.

Inpatient pain management for hospice clients is covered by Medicare. Inpatient pain management is covered by Medicare as are any other Medicare-covered services needed to manage pain and other symptoms as recommended by the hospice team. Medicare will cover pain control in the home as well, but for extreme pain, hospitalization may be required. -Telling a client not to worry about payment does not educate about what services are available.

A nurse is conducting grief resolution for a client who lost his wife in a motor vehicle accident in which he was the driver. Which interventions best accomplish this goal? Select all that apply. Include significant others in discussions and decisions as appropriate. Encourage the client's desire to keep silent about the event. Communicate acceptance of discussing the loss. Avoid identification of fears regarding the loss. Avoid making empathetic statements about the client's grief. Listen to expressions of grief.

Listen to expressions of grief. Include significant others in discussions and decisions as appropriate. Communicate acceptance of discussing the loss. Grief resolution involves dealing with the loss. Listening to the client's expressions of grief, including significant others in discussions, and communicating acceptance helps the client deal effectively with the loss. Encouraging the client to keep silent about the event, not being empathetic, and avoiding identification of fears does not help the client in dealing with the loss.

The nurse is caring for a client who has terminal lung cancer and is unconscious. What assessment would indicate to the nurse that the client's death is imminent? Pursed lip breathing Slow, steady pulse Mottling of the lower limbs Increased swallowing

Mottling of the lower limbs The time of death is generally preceded by a period of gradual diminishing of bodily functions. During this time, the nurse may observe increased intervals between respirations, weakened and irregular pulse, and skin color may change or become mottled. The client will not be able to swallow secretions, so suctioning, frequent and gentle mouth care, and possibly the administration of a transdermal anticholinergic drug may be required.

A nurse is providing care to a terminally ill client. Which finding would alert the nurse to the fact that the client is dying? Select all that apply. Irregular heart rate Regular deep respirations Strong, bounding pulse Pale, cool skin Decreased urine output

Pale, cool skin Decreased urine output Irregular heart rate Signs of dying include extremely pale, cyanotic, jaundiced, mottled or cool skin; irregular heart rate; weak, rapid, irregular pulse; shallow, labored, faster, slower, or irregular respirations; and decreased urine output.

With the help of the nurse, the parents of an infant who died shortly after birth arrange for a funeral service. Which stage of grief, according to Engel, involves the rituals surrounding loss, including funeral services? Shock and disbelief Developing awareness Restitution Resolving the loss

Restitution Restitution is the stage of grief that involves the rituals surrounding loss; with death, it includes religious, cultural, or social expressions of mourning, such as funeral services. Shock and disbelief involve the person being in denial or having a numbed response to the death. Developing awareness is characterized by physical and emotional responses such as anger, emptiness, and crying. Resolving the loss involves dealing with the void left by the loss.

The nurse is caring for an older adult client admitted with a terminal illness. The client's chart indicates do not resuscitate (DNR) status. Which communication technique will facilitate a trusting nurse-client relationship? Ask if the client wants to speak with the hospital chaplain. Provide a pamphlet to the client's spouse about death and dying. Speak in a well-modulated voice and listen carefully to what the client says. Offer to phone the client's attorney so final arrangements can be made.

Speak in a well-modulated voice and listen carefully to what the client says It is important for the nurse to get to know the client by presenting oneself in a professional manner and by speaking in a well-modulated voice and listening carefully to what the client is saying. -Providing a pamphlet about death and dying may be helpful to the spouse; however, it is not addressing the client's individual needs. -Offering to phone an attorney is not appropriate, as the client may not have one, may not want one, or may not trust the nurse yet. -Asking if the client would like to speak with the hospital chaplain is not appropriate until the nurse assesses the client's spirituality needs.

A nurse at the health care facility cares for several clients. Some of the clients may require end-of-life care. Which case may require the service of a coroner? The client was being administered oxygen therapy. The client was diagnosed with acute kidney failure. The client did not have any recent medical consultation. The client is an older adult with a history of hypertension.

The client did not have any recent medical consultation The services of a coroner may be needed in a case where the client did not have any recent medical consultation. A coroner is a person legally designated to investigate deaths that may not be the result of natural causes. Death following a diagnosis of acute kidney injury, administration of oxygen therapy, or a history of hypertension does not call for the services of a coroner.

A client severely injured in a motor vehicle accident is rushed to the health care facility with severe head injuries and profuse loss of blood. Which sign indicates approaching death? The client's breathing becomes noisy. The arms and legs are warm to touch. The client is calm and peaceful. The frequency of urination decreases.

The client's breathing becomes noisy Noisy breathing, or death rattle, is common during the final stages of dying because of the accumulation of secretions in the lungs. -Reduced urination is not seen during the final stages of dying. Instead, the client develops loss of control over bladder and bowels due to loss of neurological control. -The peripheral parts of the client's body such as the arms and the legs are cold to touch (not warm) because the circulation is directed away from the periphery and toward the core of the body. -Clients in the last stages of dying are usually not calm and peaceful; they occasionally exhibit sudden restlessness due to hunger for oxygen.

Common reactions to Anger

The patient expresses rage and hostility and adopts a "why me?" attitude: "Why me? I quit smoking and I watched what I ate. Why did this happen to me?"

Common reactions to Depression

The patient goes through a period of grief before death. The grief is often characterized by crying and not speaking much: "I waited all these years to see my daughter get married. And now I may not be here to see her walk down the aisle. I can't bear the thought of not being there for the wedding—and of not seeing my grandchildren."

Anticipatory grief

a syndrome characterized by the presence of grief in anticipation of death or loss; the actual death comes as a confirmation of knowledge of a life-limiting condition

Hospice care

a type of end-of-life care for persons who are terminally ill, characterized by the following: (1) patients are kept as free of pain as possible so that they may die comfortably and with dignity; (2) patients receive continuity of care, are not abandoned, and do not lose personal identity; (3) patients retain as much control as possible over decisions regarding their care and are allowed to refuse further life-prolonging technologic interventions; and (4) patients are viewed as individuals with personal fears, thoughts, feelings, values, and hopes

Common reactions to Acceptance

When the stage of acceptance is reached, the patient feels tranquil. The patient has accepted the reality of death and is prepared to die. The patient may think, "I've tied up all the loose ends: made the will, made arrangements for my daughter to live with her grandparents. Now I can go in peace knowing everyone will be fine."

A hospice nurse has developed a care plan for a client with liver cancer. The care plan focuses on providing palliative care for this client. The goal of palliative care is best described as providing clients with life-threatening illnesses a dignified quality of life through which means? eliminating all forms of medical and nursing care treatment of the disease process providing counseling related to the stages of death and dying aggressive management of symptoms

aggressive management of symptoms The goal of palliative care is to provide clients with life-threatening illnesses the best quality of life they can have by the aggressive management of symptoms. There is no treatment goal for the life-threatening illness for palliative care. Aggressive management of symptoms includes medical and nursing care for the client. Providing counseling related to the stages of death and dying is pursued after aggressive management of symptoms.

Do Not Resuscitate (DNR) order

an order specifying that there be no attempt to resuscitate a patient in the event of cardiopulmonary arrest

The spouse of a recently deceased client states, "I just can't believe he left me. He swore he would never leave me and I feel betrayed!" Using Kübler-Ross stages of grief, what stage does the nurse identify the client is experiencing? bargaining denial and isolation acceptance anger

anger The client is identified as being in the anger stage of the grieving process. The client has accepted the fact that the spouse is gone but is angry and betrayed at the departure from life. The client has yet to accept this death and may have some overlapping with depression as well.

What is Kübler-Ross's third stage of grief? anger denial bargaining depression

bargaining Her proposed stages of grief are denial, anger, bargaining, depression, and acceptance.

When preparing the care plan for a dying client, it is important for the nurse to include a goal that addresses which needs? Select all that apply. expression of feelings use of coping strategies urinary elimination management of pain nutritional therapy

expression of feelings management of pain use of coping strategies Nursing care for the dying client should be directed toward the achievement of several goals, including demonstration of the ability to express feelings, fears, and concerns. The client's pain should be managed effectively to allow the client to interact meaningfully with family. The client should also be able to identify and utilize effective coping strategies such as deep breathing, talking with family members, and rest periods. -Nutritional therapy and urinary elimination are not specific to the dying client, and more assessment would be needed to determine if these are viable needs for the client.

A client diagnosed with liver failure in hospice care died 10 hours ago. The client's spouse is having difficulty leaving the room and is crying uncontrollably. What situation does the nurse identify is happening with this client's spouse? pathologic grief anticipatory grief bargaining grief grief reaction

grief reaction The client's spouse is demonstrating behaviors related to a grief reaction. The anticipatory grief occurs prior to the death. The client's spouse has not had enough of a length of time to determine if the grief is pathologic. The spouse is experiencing the denial stage of grief and not the bargaining stage.

Terminal illness

illness from which there is no reasonable expectation of recovery or cure

Which manifestation of grief by the client who lost his wife 3 years earlier is considered abnormal? talking about his wife's absent-mindedness showing a photograph of the decedent leaving the wife's room and belongings intact telling the nurse how his life has changed

leaving the wife's room and belongings intact Bereavement experts reported that they considered almost all bereavement manifestations to be normal during the early stages of grief, but considered most of the manifestations to be abnormal if they continue beyond 3 years.

Actual loss

loss that can be recognized by others as well as by the person sustaining the loss, such as loss of a limb or a spouse