Chapter 42 Loss, Grief, and Dying

5 stages of grief according to Kublar Ross

1) denial, 2) anger, 3) bargaining, 4) depression, 5) acceptance

psychological care of the dying patient includes what?

a fear of isolation, of having to face death alone, is a primary concern of a dying patient, support the patient by indicating your presence, giving full attention, and showing that you care, encourage the presence of family members in the room and sharing of reminiscences,

taking specific steps to cause a patient's death

active euthanasia

can be recognized by others as well as by the person sustaining the loss, for example loss of a limb, a child, a valued object such as money and a job

actual loss

what types of loss exist?

actual loss, perceived loss, anticipatory loss,

focused assessment for those experiencing loss, grief, and dying is directed toward determining the

adequacy of the patient's family's knowledge

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

advance directive

explain factors that affect loss, grief, and dying

age family relationships socioeconomic position cultural and religious influences developmental considerations cause of death

occurs when a person displays loss and grief behaviors for a loss that has yet to take place, such as in families of patients witha serious or life threatening illness

anticipatory loss

in a state of grieving from loss of a loved one

bereaved

in the implementation phase of the nursing process for grieving or dying patients and families,the nurse aims to

care for dying patients and their families which include facilitating coping of the dying person and family and promoting health and preventing illness of the family

when a patient dies what are the nurse's responsibilites when a patient dies?

caring for the patient's body caring for the family discarging specific legal responbilities ensuring that the death certificate is issued and signed, labeling the body, and reviewing organ donation arragnments if any

the ANA issued position statements stating that assisting in suicide and participating in active euthanasia are in violation of the

code for nurses , the ethical traditions and goals of the profession, and its covenent with society.

a person who has sustained either 1) irreversible cessation of all functions of circulatory and respiratory functions or 2) irreversible cessation fo all functions of the entire brain, including the brainstem is ____

death

in the outcome identification and planning stage of the nursing process nursing care should be directed toward acheiving goals such as

demonstrates freedom to express feelings, needs, fears, and concerns identify and use effective coping strategies accept need for help as appropriate and useful available resources make health care decisions reflecting personal values and goals, declare preferences regarding treatment options, report sufficient relief of pain to interact meaningfully with family and to attend everyday concerns experience a dignified and comfortable death resolve grief after a suitable period of mourning

implementation for the grieving or dying patients and families includes

developing a trusting nurse-patient/family relationship explaining the patient's condition and treatment teaching self care and promoting self esteem teaching family members to assist in care meeting the needs of a dying patient meeting the needs of the family providing postmortem care

the data the nurse collects about how a patient or the patient's caregivers are responding to an actual or impending loss or to impending death may support several

different nursing diagnosis

what are the clinical signs of impending death?

difficulty talking or swallowing, nausea, flatus, abdominal distention, urinary/bowel incontinence or constipation, loss of movement, sensation, and reflexes, decreasing body temperature with cold or clammy skin, weak, slow, irregular pulse, decreasing blood pressure, noisy, irregular, or cheyne strokes respirations, restlessness/agitation, cooling, mottling, and cyanosis of the extremeties and dependent areas,

abnormal or distorted, may be either unresolved or inhibited, in unresolved a person may have trouble expressing feelings of loss or may deny them, in unresolved grief thre is a state of bereavement that extends over a lengthy period

dysfunctional grief

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

euthanasia

an internal emotional reaction to loss, occurs with loss caused by separation or by death, normal expressions of ____ may be physical, emotional, or spiritual

grief

how should you address spritual needs of a dying patient?

help obtain the services of clergy or pastoral care workers as the situation indicates,

is care provided for people with limited life expectancy often in the home, focuses on the needs of the dying patient

hospice

comfort measures only order

indicates the goal of treatment is comfortable, dignified death and that further life sustaining measures are no longer indicated

physiologic care of the dying patient includes what?

involves meeting physical needs such as personal hygiene, pain control, nutritional and fluid needs, movement, elimination, and respiratory care, personal hygiene includes cleanliness of the skin, hair, mouth, nose, eyes, frequent baths and linen changes may be necessary

assessment in the nursing process for grieving or dying patients and families includes what

it is directed toward determining the adequacy of the patient's and family's knowledge, perceptions, coping strategies, and resources

what are two types of advanced directive?

living wills and a durable power of attorny

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

loss

the actions and expressions of that grief, including the symbols and ceremonies (funeral) that make up the outward expressions of grief

mourning

what are some components of grief?

mourning, grief reactions (Kublar ross), dysfunctional grief

do not resuscitate order

no attempts are to be made to resuscitate a patient who is breathing or heart stops

what is the role of the nurse when caring for the family of a dying patient?

nurses play an important role in ensuring that timely prognostic information is givent to patients and families so that they can decide hwo to spend their last days together

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

palliative sedation

withdrawing medical treatment with the intention of causing a patients death

passive euthanasia

the physician order for life sustaining treatment form must be completed and signed by a health care professional and cannot be filled out by the patient, these forms are always completed in close consultation with the

patient to ensure that the patient's values and goals are accurately represented

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

perceived loss

medical order indicating a patient's wishes regarding treatments commonly used in medical crisis

physician order for life-sustaining treatment form

in diagnosisng response to a loss can be used as both

problem and etiology

an illness in which death is expected within a limited period of time,

terminal illness

gradual withdrawal of mechanical ventilation from a patient with a terminal illness or an irreversible condition with a poor prognosis

terminal weaning

what happends in kublar ross's stage of dying- anger?

the patient expresss rage and hostility and adopts a "why me" attitude

what happends in kublar ross's stage of dying- acceptance?

the patient feels tranquil, the patient has accepted the reality of death and is prepared to die, the patient will think "I have tied up all of my loose ends made the will, now I can go in peace"

what happends in kublar ross's stage of dying- 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"

what happends in kublar ross's stage of dying- bargaining?

the patient tries to barter for more time, "if i can just make it to my sons graduation" Many patients put their 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 to later stages of dying

what happends in kublar ross's stage of dying denial?

this is the first stage the patient denies the reality of death and may repress what is discussed, the patient may think "they made a mistake in my diagnosis"