Loss grief and dying PrepU
The experience of parting with an object, person, belief, or relationship that one values is defined as: loss. bereavement. grief. death.
Loss is defined as the experience of parting with an object, person, belief, or relationship that one values; the loss requires a reorganization of one or more aspects of the person's life.
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. Pale, cool skin Regular deep respirations Decreased urine output Irregular heart rate Strong, bounding pulse
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.
The client is terminal and 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 can't 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. 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." Ignore the client's statement, and limit any contact with the client.
The American Nurses Association has issued a statement that assisting in suicide and participating in active euthanasia are in violation of the Code of Nurses. 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.
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: "Why did this have to happen to me?" "I do not believe I have this disease." "I just want to see my son have a family of his own." "I don't care about anything. I have no energy."
The client is expressing anger when displaying a "why me" attitude. The other statements are reflective of other stages of grief.
The nurse is providing care to a group of terminally ill clients. The client who is most likely experiencing the bargaining stage of grief is the one who states: "Why did this have to happen to me?" "I do not believe I have this disease." "I just want to see my son have a family of his own." "I don't care about anything. I have no energy."
The client is expressing the bargaining stage of grief when attempting to barter for more time, as in the statement, "I just want to see my son have a family of his own." The other statements are reflective of other stages of grief.
A nurse caring for a client with a terminal illness understands which statement to be true? Recovery will be slow. Recovery is not expected. Recovery will be longer than 3 months. Recovery is dependent on selected treatment.
A terminal illness is a condition from which recovery is not expected. Clients with terminal illness do not recover from the illness; they may be treated symptomatically and be provided care and comfort. Recovery cannot be based on a time frame such as 3 months. Recovery is not dependent on the selected treatment as it is not expected.
Which stage of the Parkes's model of grief lasts the longest? Numbness Yearning 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.
Which manifestation of grief by the client who lost his wife 3 years earlier is considered abnormal? showing a photograph of the decedent talking about his wife's absent-mindedness 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.
A client is being discharged from the hospital with terminal brain cancer and a life expectancy of 1 month. When planning this client's discharge, it is most important for the nurse to include a referral to which agency? hospice support group home health outpatient rehab
Hospice is care provided for people with limited life expectancy, often in the home. A support group would be appropriate, but not as high in priority as hospice. Home health and outpatient rehab would not be appropriate for this client, as both of these facilities promote care toward independence.
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? "Each stage of dying must be completed prior to moving to the next stage." "The process is the same from person to person." "Sometimes a person returns to a previous stage." "The duration of all stages is a few hours."
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.
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? Denial Anger Bargaining Acceptance
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.
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. Gurgling sounds emanating from the client's throat with each breath Distended abdomen with last bowel movement documented 7 days ago A regular apical pulse of 90 beats/minute Systolic blood pressure which rose from 100 to 110 mm Hg Cyanotic nail beds in hands and feet bilaterally
Correct response: 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 Explanation: Signs of an impending death include noisy respirations, abdominal distention, constipation, and cyanosis of the extremities. The pulse may be slow and/or irregular. The systolic blood pressure would be decreasing, not increasing.
Upon admission, the nurse should give priority to addressing which need of a client who is displaying symptoms of dysfunctional grief? coping strategies self-care activities pain management spiritual distress
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 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 care differs from palliative care in its foundational philosophy. 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 provides physical and psychological support; palliative care provides social and spiritual support.
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.
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? Call a code and begin resuscitating the client. Initiate a slow-code until the physician arrives. Consult with the charge nurse or nurse manager before calling the code. Respect the client's wishes and avoid calling a code.
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.
The husband of a client who has died cannot express his feelings of loss and at times denies them. His bereavement has extended over a lengthy period. What type of grief is the husband experiencing? Anticipatory grief Inhibited grief Normal grief Unresolved grief
In unresolved grief, a person may have trouble expressing feelings of loss, may deny them, and the bereavement may extend over a lengthy period. Anticipatory loss or grief occurs when a person displays loss and grief behaviors for a loss that has yet to take place. Inhibited grief occurs when a person suppresses feelings of grief and may instead manifest somatic (body) symptoms, such as abdominal pain or heart palpitations. Normal expressions of grief may be physical (crying, headaches, difficulty sleeping, fatigue), emotional (feelings of sadness and yearning), social (feeling detached from others and isolating oneself from social contact), and spiritual (questioning the reason for the loss, the purpose of pain and suffering, the purpose of life, and the meaning of death).
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? Encourage discussion between the husband and wife regarding their intimacy needs 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 Suggest other ways the couple can spend time together, such as watching television together
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.
The hospice nurse is visiting a new client. Which assessment questions are appropriate for the nurse to ask a client who has a terminal illness? Select all that apply. "Please describe what you have been told about your condition." "What community resources might be of help to you?" "How well do you think those around you are coping?" "Have you had any previous experiences with the death of someone you love?" "Do you have a will?"
Please describe what you have been told about your condition." "What community resources might be of help to you?" "How well do you think those around you are coping?" "Have you had any previous experiences with the death of someone you love?" Explanation: Focused assessment for those experiencing loss, grief, and dying is directed toward determining the adequacy of the client's and family's knowledge, perceptions, coping strategies, and resources. Interview questions for these areas would include the following: adequacy of knowledge base ("describe your condition"), perceptions ("previous experience with death of someone you loved"), adequacy of resources ("community resources"), and adequacy of coping ("those around you coping"). Determining if a client has a will to distribute personal property is not a priority assessment for the nurse.
The client is a middle-aged female who has been told she has cancer of the plasma. She states to the health care team, "Just keep me alive until I can see my daughter graduate from high school." What stage of dying is this client exhibiting? denial bargaining depression acceptance
The client's statement is reflective of the bargaining stage of dying. In this example, the client is negotiating for more time. In the denial stage, the client would deny the diagnosis or the severity and may state, "No, you are wrong" and/or "No, I can't have cancer." In the depression stage, the client grieves and may cry, not speak much, and withdraw. In the acceptance stage, the client has accepted the reality of the diagnosis and death. The client is prepared to die.
A client at a health care facility has died after a prolonged illness. A nurse is assigned to perform postmortem care for the client. Which intervention should the nurse perform when providing postmortem care? Avoid replacing dentures in the mouth. Place a rolled towel under the head. Cleanse drainage from the skin. Apply hairpins and clips.
The nurse should cleanse secretions and drainage from the skin to ensure delivery of a hygienic body. The dentures should be replaced in the mouth, as they maintain the natural contour of the face. A small rolled towel is placed beneath the chin of the client to close the mouth; it is not placed under the head. The nurse should remove all hairpins or clips to prevent accidental trauma to the client's face.
A nurse has just finished a presentation on hospice and palliative care. Which statement by a participant would indicate a need for further education? "Palliative care provides relief from pain and other distressing symptoms." "Hospice care programs focus on quality rather than length of life." "In hospice care, the nurses make most of the care decisions for the clients." "Palliative care affirms life and regards dying as a normal process."
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.
