Chapter 42: Loss and Grieving

A client with end-stage chronic obstructive pulmonary disease (COPD) has reached the end of the 6-month period for hospice services and the family caregiver states, "I don't know what we will do if they cut off our hospice services." What is the best response by the hospice nurse?

"I will contact the health care provider to extend services since your family member meets the criteria." Hospice care is generally provided to clients that have 6 months or less to live, although they are not automatically discharged when they reach 6 months after having been admitted to hospice care. The client may still receive care as long as the health care provider certifies that the client continues to meet the criteria for hospice services.

5 Stages of Grief

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

The nurse has noted that a dying client is increasingly withdrawn and is often teary at various times during the day.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

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?

Inpatient pain management for hospice clients is covered by Medicare.

Which statement accurately describes the process known as grief reaction?

Reactions to grief may differ from client to family. Reactions to grief and dying are similar. Grief refers to deep sorrow, especially that caused by someone's death. Dying refers to the time/point of death. The stages of these reactions overlap and vary among individuals. One person may skip a reaction stage, whereas another may repeat an earlier stage. Each person is different, and clients and family members may be at different reaction stages. More important than the actual stages of any given grief reaction is the idea that grief is a process that varies from person to person.

A group of nursing students is reviewing the various models of grieving. The students demonstrate understanding of the information when they identify the stages of the grief cycle model listed

Shock Protest Disorganization Reorganization

A nurse is providing care to a terminally ill client. Which finding would alert the nurse to the fact that the client is dying?

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.

A nurse is providing end-of-life care for a client. Which symptom indicates brain failure?

Stupor, disorientation, and hyporeflexia are signs indicative of failure of the brain in the dying client.

Postmortem Care

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.

The nurse is caring for a client with terminal illness. Which should the nurse teach the family about physiological signs of imminent death?

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.

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

A nurse is providing end-of-life care to a client who spends most of the time praying and talking about a "spiritual connection." The nurse interprets this as indicating which stage of grief?

acceptance The client is in the acceptance stage of death. In this stage, the client comes to terms with the loss, begins to detach from supportive people, and loses interest in worldly activities. This stage can also be marked by individuals addressing social and spiritual matters, such as saying goodbye to loved ones and making peace with a higher power.

A client is diagnosed with terminal kidney failure. The spouse demonstrates loss and grief behaviors. What type of loss is the spouse experiencing?

anticipatory loss