Concept of grief and loss

Which intervention should the nurse include in the plan of care for a child who is dying?

Allowing the parents to assist with the child's care The nurse should always allow the parents to participate in the care of their own child, no matter what the stage of life or dying is. The nurse should not suggest that the parents hospitalize the child, because care can be managed well in the child's home. The parents should decide if they want live-in assistance. The nurse does not need to limit the number of visitors, because it should be up to the patient and family.

The nurse working in a bereavement center is developing a plan of care for a parent who lost a child a month ago due to an act of violence. Which intervention should the nurse include for this parent to help facilitate the grieving process?

Assessing for signs of unhealthy coping mechanisms The parent lost their child in a violent and sudden manner and did not have any way to prepare for the death. Therefore, the parent is at a higher risk for maladaptive grieving behaviors. The use of antidepressants after a death would not be used for long-term coping. The nurse should not ask the parent about the legal case involving the attacker. While it is important for the nurse to suggest a good night's sleep, sleeping 10-12 hours every night is not conducive to healing and may be too much sleep.

A 6-year-old child tells the school nurse that their stepfather, who was physically abusive, has died. The child reports being confused that they are both happy and sad that their stepfather died. The nurse should document that the child is experiencing which type of grief reaction?

Complicated grief reaction The child is experiencing differing emotions, because they are sad that a person close to their life has died, but happy that they will no longer be a victim of abuse. This is a complicated grief response. Disenfranchised grief would be from a loss that the person cannot share, such as an abortion. Anticipatory grief would be grief that a person experiences knowing that someone will soon die. Childhood traumatic grief occurs when a child witnesses the traumatic death of a person.

The nurse is caring for a patient who experienced a miscarriage at 17 weeks of gestation. Which type of grief should the nurse assess for during the 2-week follow-up visit?

Disenfranchised Disenfranchised grief occurs when the person feels marginalized or forgotten by support persons or society. Perinatal loss is not usually recognized by society. Bittersweet grief occurs in response to memories that linger after the loss. The person may have processed the loss, but at certain times the feelings of grief may return. Anticipatory grieving occurs when there is foreknowledge of an impending loss. Dysfunctional grieving manifests as prolonged or exaggerated grief.

The nurse is planning care for a patient who is experiencing overwhelming grief and loss after the death of a parent. Which nursing intervention may help reduce this patient's anxiety?

Referring the patient to a grief therapist, group therapy, or a bereavement group A referral to an individual or group that can provide expert guidance about coping with loss and assistance with linking with additional resources will help this patient begin to process grief and help reduce anxiety. Teaching about medications and side effects is appropriate only when the patient is prescribed antianxiety or other medications to treat stress. Sometimes, brief courses of anxiolytics are prescribed to assist grieving patients. If signs of depression are present, the patient may be prescribed an antidepressant. Teaching family members to encourage the patient's expressions of grief and encouraging the patient to resume activities when ready are appropriate interventions to facilitate the patient's grief work.

The nurse is working with a family who sustained the loss of a parent. The child is having a difficult time coping with the loss. The parent asks about antidepressants. Which information is most important for the nurse to provide about the use of antidepressant medications in children?

Risk of suicidal ideations Antidepressants increase the risk of suicidal ideations, especially in children. Therefore, the nurse would educate the parent about signs to observe for in the child. Antidepressants typically increase, not decrease, appetite. While antidepressants can have diverse effects on sleep depending on classification, it is not as important as the safety risk for suicidal ideations. Counseling should be continued while the patient is receiving antidepressants.

The nurse is caring for a patient who sustained a limb loss from military combat. Which assessment finding indicates that the patient is recovering from his loss?

Runs a half marathon with a limb prosthesis When the patient uses the new limb prosthesis and runs a half marathon, this indicates acceptance of the loss. Staying in their room during activities could indicate depression. Using the wheelchair instead of the prosthesis could indicate despair. Verbalizing frustration with the exercise program indicates anger.

The nurse is caring for a patient who experienced the loss of a child a month ago. Which finding would support the nurse documenting that the patient is in the early stages of experiencing grief?

Staying at home except for work The parent is isolating themselves and does not want to leave the house except for work. This is a sign that the parent is experiencing grief. Intense feelings of grief over the loss of a loved one are generally believed to lessen over a few months, and to resolve—or at least partly resolve—within 1-2 years. Individuals who are unable to process their grief to a point of resolution may experience complicated grief; the nurse would need to monitor for this development. Resolving legal insurance matters, planning to move to a smaller home, and packing up clothes indicate bereavement and the ability to move on past the loss.

An older patient with a history of hypertension and coronary heart disease is experiencing complicated grief. The patient has been prescribed an antidepressant. The nurse should monitor for which side effect?

Suicidal thoughts The use of antidepressants can cause suicidal thoughts and result in the patient harming themselves. Elevated blood pressure, bradycardia, or severe headaches are not seen with the use of antidepressants.

The nurse is assigned to care for four patients today in a medical-surgical unit. Which patient should the nurse expect to experience anticipatory grief?

The patient who is scheduled for a mastectomy this afternoon The patient who is having a mastectomy this afternoon would be at highest risk for having anticipatory grieving due to the upcoming loss of a breast. The patient who underwent an above-the-knee amputation, the patient who lost a spouse 2 months ago, and the patient diagnosed 2 months ago with type 2 diabetes have already experienced their initial losses and thus have moved beyond anticipatory grieving.

The nurse is discussing the loss of an infant who was stillborn at 38 weeks' gestation with the parents. Which statement by the nurse supports the cultural beliefs of the family?

"Have you been able to discuss this loss with any of your family or friends?" Many cultures have a difficult time being open with discussing stillbirths and miscarriages. Therefore, the nurse would assess if the patient has a support system within their community. Telling the patient that the nurse understands that it must be difficult to have had this happen so far into the pregnancy does not address cultural needs. The nurse would not state that they imagine that it must be difficult for the patient to see others with newborn babies. It would be inappropriate for the nurse to state that it is God's plan.

The nurse is caring for a patient who received test results indicating a new diagnosis of lung cancer. Which patient statement indicates that they are experiencing the bargaining stage of Kübler-Ross's stages of grieving?

"I will volunteer to help the homeless if this cancer goes away." According to Kübler-Ross, the bargaining stage of grief is when a person decides to bargain with a higher power or become a better person for more time. Therefore, the patient who states they will volunteer to help the homeless if the cancer is successfully treated indicates the bargaining stage. The other three options demonstrate acceptance.

The parents of a 4-year-old child state that their child has been regressing in their toilet training, demanding extra attention, and has no interest in playing. The family has recently experienced the death of the grandmother, who lived with them in the household. How should the nurse respond to the family's concerns?

"These are expected behaviors for a child their age in dealing with the loss of a close grandparent." This child is grieving the loss of the grandparent. These are expected behaviors for a child their age in dealing with grief. These would not be the behaviors of a child testing their learning and independence. Although the child is seeking attention, it is not because their parents are busy. The child does not exhibit any manifestations of an infection.

The nurse is talking to a 25-year-old man whose life partner was recently killed in the line of duty as a police officer. The patient tells you that his family has never approved of his sexual orientation and does not accept his grief over the death of his boyfriend. Which question should the nurse ask the patient in order to obtain further information needed to develop an appropriate plan of care?

"What is it like to have your family not accept your grief?" Open-ended questions are exploratory questions to which the nurse may or may not know the answer. Asking what it is like to have his family not accept his grief over the death of his partner is an open-ended question that invites further communication. Asking whether it is difficult to have the family not accept his grief or to confirm that the patient is saying it is difficult to have his family not accept the grief are questions to which the patient can answer with just a yes or no. The nurse's acknowledgment that it must be difficult to have the family not accept the grief is an example of reflection.

The hospice nurse is working with the spouse and family of a patient who is diagnosed with terminal cancer. The spouse tells the nurse that it will be impossible to move on without their partner. Which type of grieving is the spouse experiencing?

Anticipatory grieving The spouse is exhibiting signs of anticipatory grieving, because they know that their spouse has a terminal diagnosis and will die. They are trying to picture what life will be like without their spouse. Disenfranchised grieving occurs when a person cannot tell others of the loss, such as an abortion. Complicated grieving is life-altering grieving that lasts past 6 months after the loss. A perceived loss, not perceived grieving, is a loss that is not visible, such as loss of independence or self-esteem.

The nurse is caring for a patient at the primary care clinic who experienced a miscarriage after 20 weeks' gestation. The spouse reports that the patient lies in bed all the time, has missed several days of work, and does not want to eat. Which intervention should the nurse expect the healthcare provider to order?

Antidepressants Antidepressants, often coupled with hormone therapy, have been shown to be effective in the treatment of postpartum depression and depression from perinatal loss; medication can also be used in combination with other forms of therapy and counseling. Unless this patient develops postpartum psychosis, she is not at risk for self-harm nor harm to others, so the patient would not need inpatient hospitalization. The patient is not at risk for infection, because there is no evidence of placental retention or infection. There is no evidence of blood loss, so there is no need for blood transfusions.

The nurse is discussing Kübler-Ross's stages of grieving with a group of patients who are undergoing cancer treatment. A patient states that they will become a better person and help others if the cancer treatment is successful. In which stage of grieving should the nurse place this patient?

Bargaining The patient is in the bargaining stage of grief, because the patient states that they will become a better person and help others if the cancer is cured. The patient is not denying the cancer diagnosis, nor is the patient showing signs of depression or acceptance.

The nurse is talking with a child who has sustained the loss of a parent. Which behavior should the nurse expect the child to display in relation to the grief?

Being withdrawn at home but acting out at school While behavioral responses to grief vary depending on developmental age, temperament, and other factors, common behaviors manifested by children in response to grief are usually withdrawing at home and acting out at school.

The nurse is caring for a patient who lost his spouse to cancer a year ago. Which assessment finding supports the diagnosis of complicated grief?

Distrustful of family A patient with complicated grief may distrust others. Crying, anger, and confusion are expected alterations and manifestations of grief.

An older patient who has been admitted to a mental health unit for treatment of depression and failure to thrive. The patient reports losing their spouse 4 months ago. The healthcare provider has prescribed nutritional supplements and antidepressant medication along with counseling. During a follow-up visit, which assessment finding indicates improvement in the patient's status?

Gaining 2 pounds in one week The older adult who is exhibiting symptoms of depression severe enough to be diagnosed with failure to thrive is malnourished due to lack of intake. Therefore, a weight gain of 2 pounds in one week indicates improvement in appetite. Lying in bed half the day indicates a lack of energy or motivation, which are findings of depression. The initiation of total parenteral nutrition indicates the patient's nutritional status has worsened and needs supplementation. The patient changing their code status to do not resuscitate without having a terminal diagnosis indicates a willingness to die.

The nurse is consoling the family of a patient who has just passed away. The patient and family practice the Jewish faith. It is currently the Sabbath day. Which intervention should the nurse perform first?

Keeping the patient in the room until the Sabbath is over According to the Jewish faith and culture, if a person dies on the Sabbath, they are to be left where they are and cannot be moved until the Sabbath is over. Therefore, the nurse would not move the body to a private room, would not take the patient to the morgue, and would not notify the funeral home to take the patient.

The parish nurse is visiting the home of an older patient who just lost their spouse a couple of months ago. The patient has a diminished appetite, does not want to leave the house, and does not enjoy activities anymore. The nurse should consider that which factor would most impact the grieving process?

Loss of ability to drive Older adult patients who lose a spouse may suffer multiple losses in a short amount of time. Some losses are intangible, such as loss of independence and mobility, isolation, and loss of vision/hearing. Therefore, losing the ability to drive would potentiate the loss of a spouse, because it also affects independence. While the paperwork for settling an estate can be overwhelming, it is not a loss. An inability to use a computer for an older adult can impede paying bills and managing bank accounts, but it is not a loss. It is difficult to cook for one, but it is not a loss.

The nurse is visiting a family whose 15-year-old child died. The family has two remaining children, aged 11 and 9. Which information should the nurse provide the siblings regarding the loss of their older sibling?

That the death of their sibling is not their fault The nurse should explain to the parents that children between the ages of 8-11 may believe that they are responsible for the death of a close family member because of negative thoughts or misbehaviors. Therefore, the parents need to explain that the death is not their fault. The parents should not be instructed to enforce chores just as a result of grieving. The children may not feel comfortable discussing this with the school counselor, but they should be encouraged to discuss the loss with the parents. Children between 8-11 years understand that death is permanent.

The nurse is teaching a group of parents how a child's developmental level affects their concept of death and loss. Which finding should the nurse expect to see in an 8-year-old child as opposed to an adolescent?

The 8-year-old child may become withdrawn and prefer solitude, whereas an adolescent directs anger toward the parent. An 8-year-old child may become aggressive and believe that the death is their fault or become withdrawn and prefer solitude. Adolescents may direct their grief toward their parents. Toddlers may regress in toilet training and experience bedwetting. Toddlers and early school-age children see death as reversible and that the person will come back. Adolescents prefer to discuss the loss with their peers or those outside the family, but do not regress, nor do they believe that the death is their fault.

Which behavior exhibited by a child indicates that they have experienced childhood traumatic grief?

The child refuses to go to the mall where the parent died from a heart attack. Childhood traumatic grief happens after the child experiences a loss associated with a traumatic death. The child associates the location of the death with horrible memories and refuses to go there. Therefore, the child refusing to go to the mall where the parent died of a heart attack is an example of childhood traumatic grief. Normal grief involves sadness and loneliness and is not related to childhood traumatic grief. If the child chooses not to participate in after-school activities, it may indicate depression, not childhood traumatic grief. Preferring to stay at home and not socializing may also indicate depression.

The nurse is caring for a patient who passed away 10 minutes ago. The nurse and the unlicensed assistive personnel prepare the body for the family to view. Which action by the nurse indicates a need for a coworker or the nurse manager to intervene?

The nurse sobbing in the room with the patient's family It can be emotionally draining to care for patients who are dying. The nurse must be supportive and provide empathy but should not be sobbing in the patient's room. This action requires a coworker or manager to intervene. Rather than turning to the patient's family, the nurse should use other resources for support including coworkers, professional therapists or social workers, and grief counseling resources offered through employers. It is appropriate for the nurse to allow a spouse to help prepare the body, such as combing the hair. The nurse should provide enough chairs, if possible, for the family to be in the room. The nurse can provide extra time for the family and can provide basic information to the family regarding the dying process and having kept the patient comfortable, if necessary.