8.1 Loss Grief Dying and End of Life Care

depression stage

grief crying and not speaking much

grief

internal emotional response to loss

traditional heart lung death

irreversable cessation of spontaneous respiration and circulation

what to do when post mortem patient has dentures

leave them in -keeps shape of mouth

end of life care

time frame in last few weeks of life

mourning

showing grief

bereavement

state of grieving loss

postmortem care steps

take vitals and record when ceased remove medical equipment provide hygiene pay attention to cultural or religious practice provide dignity

active euthanasia

taking steps to cause pt death "assisted suicide"

when are people placed on hospice

terminally ill

types of code

Full code DNR

POLST

Physician order for life sustaining treatment indicates pt wishes for treatment in medical crisis

actual loss

can be recognized by others

nurses role in organ donation

cannot talk about organ donation refer to charge nurse or appropriate staff

death definitions

traditional heart lung cessation of brain function

passive euthanasia

withdrawing treatment w intention of causing pt death

a nurse is assessing a client who was diagnosed with metastatic prostate cancer. the nurse notes that the client is exhibiting signs of loss, grief, and intense sadness. based on this assessment data, the nurse will document that the client is in what stage of death and dying? A depression B denial C anger D acceptance

A depression

Living Will (type of advance directive)

A document that indicates what medical intervention an individual wants if he or she becomes incapable of expressing those wishes.

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? SATA A gurgling sounds emanating from the client's throat with each breath B a regular apical pulse of 90 beats/ min C systolic blood pressure which rose from 100 to 110 mmHg D distended abd with last bowel movement documented 7 days ago E cyanotic nail beds in hands and feet bilaterally

A gurgling sounds emanating from the client's throat with each breath

when providing end of life care for clients what will the nurse most often need to prioritize A pain control and emotional support B hydration and hygiene C oxygen supplementation and assistance with end of life planning D neurological assessment and protection of skin integrity

A pain control and emotional support

A nurse is consoling the partner of a client who just expired after a long battle with liver cancer. The partner is displaying grief and states, "I hate him for leaving me." Which of the following statements by the nurse successfully facilitate mourning for the grieving partner? (Select all that apply.) A. "Would you like me to contact the chaplain to come speak with you?" B "You will feel better soon. You have been expecting this for a while now. C. "Let's talk about your children and how they are going to react." D."You know, it is quite normal to feel anger toward your husband at this time." E "Tell me more about how you are feeling.

A. Asking the client whether she would like spiritual support at this time is an acceptable nursing intervention to facilitate mourning D. Educating the client's partner on the grieving process and expected emotions is recommended at this time. E. Encouraging the open communication of feelings by using therapeutic communication is recommended to facilitate mourning.

the nurse is assessing a client recently diagnosed with terminal lung cancer who states, "this can't be happening to me maybe the doctor made a mistake." which stage of death and dying is the client exhibiting A depression D denial C bargaining D anger

B denial

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 engels mode of grief A idealization B developing awareness C restitution D shock and disbelief

B developing awareness

the family of a client with severe traumatic brain injury is considering the withdrawal of his mechanical ventilation. what is the nurse's primary role in the preparation for terminal weaning A assisting w chest physiotherapy before and after ventilation ceases B educating the family on what to reasonable expect after ventilation is discontinued C preparing the bedside for postmortem care D assisting w pulmonary resuscitation if the client is unable to breathe independently

B educating the family on what to reasonably expect after ventilation is discontinued

A nurse is caring for a client who has terminal lung cancer. The nurse observes the client's family assisting with all ADLs. Which of the following rationales for self-care should the nurse communicate to the family? A. Allowing the client to function independently will strengthen her muscles and promote healing. B. The client needs to be given privacy at times for self-reflecting and organizing her life. C. The client's sense of loss can be lessened through retaining control of certain areas of her life. D. Performing ADLs is required prior to discharge from an acute care facility.

C Allowing the client as much control as possible maintains dignity and self-esteem

when assessing a client which statement indicates that the client is experiencing the anger stage of death and dying A now I can go in peace knowing everyone will be fine B if I can just make it to Christmas I'll be satisfied C I am a good person why did this happen to me D maybe they made a mistake in my diagnosis

C I am a good person why did this happen to me

A nurse is assisting a newly licensed nurse with postmortem care of a client. The family wishes to view the body. Which of the following statements by the newly licensed nurse indicate an understanding of the procedure? (Select all that apply.) A. "I will remove the dentures from the body. B. "I will make sure the body is lying completely flat." C."I will apply fresh linens and place a clean gown on the body." D. "I will remove all equipment from the bedside E. "I will dim the lights in the room.

C The body and the environment should be as clean as possible. This includes washing soiled areas of the body and applying fresh linens and a clean gown. D. The environment should be as clutter-free as possible. All equipment and supplies should be removed from the bedside. E Dimming the lights helps to provide a calm environment for the family.

A nurse is caring for a client who has stage IV lung cancer and is 3 days postoperative following a wedge resection. The client states, "I told myself that I would go through with the surgery and quit smoking, if I could just live long enough to attend my daughter's wedding." Based on Kübler-Ross' model, which stage of grief is the client experiencing? A. Anger B. Denial C. Bargaining D. Acceptance

C The client is displaying bargaining by attempting to negotiate more time to live to see his daughter get married.

which assessment finding wound best support a nursing diagnosis of dysfunctional grieving A a woman has been experiencing chronic insomnia since her mother's death earlier this year B a women cries frequently and loudly in the weeks following her childs death in an accident C a man is unable to return to work after his sister's death 18 months ago D a man blames himself for not doing more to make his wife's recent death more comfortable

C a man is unable to return to work after his sister's death 18 months ago

a client has been diagnosed with a terminal illness and has made an appt with an attorney to complete a will. how will the nurse document this stage of grief according to the kumbler ross model A bargaining B denial C acceptance D depression

C acceptance

a client has responded to a recent diagnosis of lung cancer by making extensive plans for overseas travel w 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 A supplement conversations w the client by using written material about the diagnosis B enlist the assistance of another nurse to help the client face the reality of the situation C address the clients diagnosis and prognosis at a later time or date D restate the client's situation in a more specific and detailed terms

C address the client diagnosis and prognosis at a later time or date

'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? A eliminating all forms of medical and nursing care B treatment of disease process C aggressive management of symptoms D providing counseling related to the stages of death and dying

C aggressive management of symptoms

a client diagnosed with terminal cancer is making plans to take a trip to visit an estranged sibling. what stage of death and dying according to kubler ross is best illustrated A depression B acceptance C bargaining D anger

C bargaining

A nurse enters a client's room and finds the client unresponsive, not breathing, and without a carotid pulse. The nurse is aware that the client has mentioned that he does not wish to be resuscitated by there is no DNR order on the chart. what is the best action A respect the clients wishes and avoid calling a code B consult with the charge nurse or nurse manager before calling the code C call a code and begin resuscitating the client D initiate a slow code until the physician arrives

C call a code and begin resuscitating the client

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): A significant power B exemplary representative C durable power of attorney D advance estate director

C durable power of attorney

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

C leaving the wife's room and belongings intact

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: A give permission for organ donation B dictate how the client wants his estate handled after his death C specify the treatment measures that the client wants and does not want D make legal provisions for active euthanasia

C specify the treatment measures that the client wants and does not want

the nurse is making sure that all factors are in place for a clients death certificate. what potential error does the nurse identify may occur A the client was in good health prior to an accident or medical incident that caused death B the client lived with numerous comorbidities prior to death C the client had a condition that has the potential to temporarily suspend life process D the client was younger than 12 or older than 75

C the client had a condition that has the potential to temporarily suspend life process

A nurse is caring for a client who has a terminal illness. Death is expected within 24 hr. The client's family is at the bedside and asks the nurse about anticipated findings at this time. Which of the following findings should the nurse include in the discussion? A. Regular breathing patterns B. Warm extremities C. Increased urine output D. Decreased muscle tone

D Muscle relaxation is an expected finding when a client is approaching death.

which situation is most likely to warrant an autopsy A a client dies after unsuccessful CPR B a clients death is attributed to an infectious disease C a palliative client dies unwitnessed during the night D a clients death involves an allegation of a medical error

D a clients death involves an allegation of a medical error

the nurse should explain to the client's family member that a comfort measures only order is being implemented to obtain which expected outcome A prevention of family from making health care decisions B use of all available life sustaining measures C harvesting of the client's organs for donation D a comfortable dignified death for the client

D a comfortable dignified death for the client

a terminally ill client states, "I am ready to die." what stage of grief does the nurse expect A anger B bargaining C resentment D acceptance

D acceptance

which of the following would be an example of assisted suicide A neglecting the resuscitate a client w a DNR status B administering a morphine infusion C granting a client's request not to initiate enteral feeding when the client is unable to eat D administering a lethal dose of medication

D administering a lethal dose of medication

Upon interviewing the client, the nurse finds that the client is providing care for her mother who is terminally ill. The client is depressed and already mourning the loss. Which nursing diagnosis would be most appropriate for the client? A dysfunctional grieving B prolonged grieving C normal grieving D anticipatory grieving

D anticipatory grieving

to assist a client and family from a different culture with the death and dying process , the nurse should A have felt distress and anger B progress through the stages of grieg C experience death in his own life D be aware of the client's cultural beliefs

D be aware of the client's cultural beliefs

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 A increased urinary output B increased sensory stimulation C decreased pain D difficulty swallowing

D difficulty swallowing

Mr. Cooney, age 85, is in advanced stages of pneumonia with a no-code order in his chart. Which of the following nursing care actions will help establish a trusting nurse-patient relationship? A the nurse reduces verbal and nonverbal contact with the client to avoid confusing him B the nurse avoids proving counseling and death education because it is not within the scope of nursing practice C the nurse arranges a visit from the spiritual advisor for dying clients, regardless of the client's wishes, to provide hope in the face of death D the nurse discusses the client's fears and doubts openly and serves as a nonjudgmental listener

D the nurse discusses the client's fears and doubts openly and serves as a nonjudgmental listener

dysfunctional grieving

Depression Severe physiological symptoms Suicidal thoughts Extended period of grieving Prolonged time in stage of denial Prolonged or sever social isolation Persistent guilt Drug abuse

factors affecting grief loss and death

Developmental considerations Family Socioeconomic factors Cause of death Cultural, Gender and Religious Influences

signs of impending death

Difficulty talking or swallowing Nausea, flatus, abdominal distention Urinary and/or bowel incontinence or constipation Loss of movement, sensation and reflexes cold or clammy skin decreasing vitals Noisy, irregular, or Cheyne-Stokes respirations Restlessness and/or agitation Cooling, mottling and cyanosis of the extremities Decreased LOC or agitated delirium

functional grieving

Verbalization of the loss Crying Sleep disturbances Loss of appetite Difficulty concentrating Fatigue

acceptance stage

accepted reality ready for death

types of loss

actual perceived anticipatory situational maturational

Cheyne-Stokes respirations

an abnormal pattern of breathing characterized by periods of apnea followed by deep rapid breathing

signs of imminent death

breathing cheyne stokes color and temp change (cyanosis) mottling

nursing interventions when providing post mortem care.

caring for the body caring for the family cultural considerations

mottling

changes in skin color (pale and bluish) of the hands, arms, feet, and legs when death is near

spiritual care for dying pt and family

clergy pastoral care workers

hospice

comfort care for people w limited life expectancy (6 months or less) without curative intent

palliative care

comfort care of whole person for greater than 6 months

5 stages of grief

denial and isolation anger bargaining depression acceptance

denial and isolation stage

denies reality of death, may repress what was discussed

The nurse has noted that a dying client is increasingly withdrawn and is often teary at various times during the day. The nurse recognizes that the client may be experiencing which of Kübler-Ross's stages of grief?

depression

nurses role in coroners cases

do not remove anything from the body EVIDENCE

nursing process to plan and implement care for dying patients and their families.

dying pt bill of rights stages of grieving respect culture and religion practices therapeutic communication open environment for expression nonjudgmental life review be yourself empathize show kindness keep it simple

situational loss

experienced as a result of an unpredictable event

maturational loss

experienced as a result of natural developmental process

perceived loss

experienced but not tangible by others

euthanasia

good dying

anticipatory loss

loss that hasnt happen yet

goal of end of life care

maintain comfort maintain quality of life provide means for dignified death

A couple has sent their youngest child to college in another state and both are experiencing "empty nest syndrome." This is an example of: A situational loss B physical loss C anticipatory loss D maturational loss

maturational loss

types of DNR

no code AND (allow natural death)

durable power of attorney

person to make decisions in case of subsequent incapacity

physiological care of a dying pt

personal hygiene pain control nutrition and fluids movement elimination respiratory care

bargaining stage

put affairs in order make wills fulfill wishes

anger stage

rage and hostility "why me?"