Chapter 43: Loss, Grieving, and Death
The shift changed while the nursing staff was waiting for the adult children of a deceased client to arrive. The oncoming nurse has never met the family. Which of the following initial greetings is most appropriate? 1. "I'm very sorry for your loss." 2. "I'll take you in to view the body." 3. "I didn't know your father but I am sure he was a wonderful person." 4. "How long will you want to stay with your father?"
1. "I'm very sorry for your loss." this statement acknowledges the family's grief simply
When asked to sign the permission form for surgical removal of a large but noncancerous lesion on her face, the client begins to cry. Which of the following is the most appropriate response? 1. "Tell me what it means to you to have this surgery." 2. "You must be very glad to be having this lesion removed." 3. "I cry when I am happy or relieved sometimes, too." 4. "Isn't it wonderful that the lesion is not cancer?"
1. "Tell me what it means to you to have this surgery." The nurse needs to assess and explore the meaning of the client's crying
Which of the following may be considered normal or "healthy" types of grief? Select all that apply 1. Abbreviated grief 2. Anticipatory grief 3. Disenfranchised grief 4. Complicated grief 5. Unresolved grief 6. Inhibited grief
1. Abbreviated grief 2. Anticipatory grief 3. Disenfranchised grief
What are the types of loss?
1. Actual - Can be recognized by others 2. Perceived - Experienced by one person, but not verified by others 3. Anticipatory - Experienced before the loss actually occurs
In working with a dying client, the nurse demonstrates assisting the client to die with dignity when performing which action? 1. Allows the client to make as many decisions about care as possible 2. Shares with the client the nurse's own views about life after death 3. Avoids talking about about dying and focuses on the present 4. Relieves the client of as much responsibility for self-care as is possible
1. Allows the client to make as many decisions about care as possible Assisting the client to die with dignity involves allowing the client to participate in and choose the direction of the remainder of his or her life
What are the factors contributing to unresolved grief?
1. Ambivalence (mixed feelings) 2. A perceived need to be brave and in control 3. Extremely high emotional value invested in the dead person 4. Uncertainty about the loss 5. Lack of support systems
What are they symptoms of grief?
1. Anxiety 2. Depression 3. Weight loss 4. Fainting 5. Blurred vision 6. Skin rashes 7. Excessive sweating 8. Menstrual disturbances 9. Palpitations 10. Chest pain 11. Dyspnea
What are the sources of loss?
1. Aspect of self 2. External object 3. Familiar environment 4. Loved ones
What are the different types of awarenes?
1. Closed - The client is not made aware of impending death 2. Mutual - The client, family, and health care personnel know that the prognosis is terminal but do not talk about it and make an effort not to raise the subject 3. Open - The client and others know about the impending death and feel comfortable discussing it, even though it is difficult
What are Kubler-Ross's stages of grieving?
1. Denial 2. Anger 3. Bargaining 4. Depression 5. Acceptance
What are clinical manifestations of impending clinical death?
1. Loss of muscle tone 2. Slowing of the circulation 3. Changes in respirations 4. Sensory impairment
What are the observations of complicated grief?
1. The client fails to grieve 2. The client avoids visiting the grave and refuses to participate in memorial serves, even though these practices are a part of the client's culture 3. The client becomes recurrently symptomatic on the anniversary of a loss or during holidays 4. The client develops persistent guilt and lowered self-esteem 5. Even after a prolonged period, the client continues to search for the lost person 6. A relatively minor event triggers symptoms of grief 7. Even after a period of time, the client cannot discuss the deceased with composure 8. After the normal period of grief, the client experiences physical symptoms similar to those of the person who died 9. The client's relationships with friends and relatives worsen following the death
A client's family tells the nurse that their culture does not permit a dead person to be left alone before burial. Hospital policy states that after 6:00 pm when mortuaries are closed, bodies are to be stored in the hospital morgue refrigerator until the next day. How would the nurse best manage this situation? 1. Gently explain the policy to the family and then implement it 2. Inquire of the nursing supervisor how an exception to the policy could be made 3. Call the client's primary care provider for advice 4. Move the deceased to an empty room and assign an aide to stay with the body
2. Inquire of the nursing supervisor how an exception to the policy could be made When possible, modifications of policy that demonstrate respect for individual differences should be explored
At which age does a child begin to accept that he or she will someday die? 1. Less than 5 years old 2. 5-9 years old 3. 9-12 years old 4. 12-18 years old
3. 9-12 years old Until children are about 5 years old, they believe that death is reversible
The client has been close to death for some time and the family asks how the nurse will know when the client has actually died. Which of the following would be the most accurate response from the nurse? 1. When the blood pressure can no longer be measured 2. When the gag reflex is no longer present 3. When there is no apical pulse 4. When the extremities are cool and dark in color
3. When there is no apical pulse If there is no heartbeat, the client has died
An 82 year-old man has been told by his primary care provider that it is no longer safe for him to drive a car. Which statement by the client would indicate beginning positive adaptation to this loss? 1. "I told the doctor I would stop driving, but I am not going to yet." 2. "I always knew this day would come, but I hoped it wouldn't be now." 3. "What does he know? I'm a better driver that he will ever be." 4. "Well, at least I have friends and family who can take me places."
4. "Well, at least I have friends and family who can take me places." Adaptive responses indicate the client can put the loss into perspective and being to develop strategies for coping with the loss
The nurse is caring for a family in a shelter 2 days after the loss of their homes due to a fire. The fie caused minor burns to several members of the family but no life-threatening conditions. Which of the following is the most important assessment data for the nurse to gather at this time? 1. Availability of insurance coverage for rebuilding the house 2. Family members' understanding of the extent of their physical injuries 3. Psychological support resources available from friends or other sources 4. Family members' grief responses and coping behavior
4. Family members' grief responses and coping behaviors To plan with and assist the family, the nurse needs more data regarding the family's reactions to their loss
A nursing care plan includes the desired outcome of "quality of life" for a client with a chronic degenerative illness who is likely to live for many more years. Which of the following is one example that would indicate the outcome has been met? 1. The client demonstrates having adequate financial resources to pay for health care for many more years 2. The client spends the majority of his or her time in spiritual reflection 3. The client has no signs or symptoms of preventive complications of the illness 4. The client verbalizes satisfaction with current relationships with other people
4. The client verbalizes satisfaction with current relationships with other people Quality of life is determined by the client and expressed in terms of his or her satisfaction with a variety of aspects of life
What is livor mortis?
The discoloration appearing in the lowermost or dependent areas of the body
What is loss?
An actual or potential situation in which something that is valued is changed or no longer available (Being deprived of something)
What is palliative care?
An approach that improves the quality of clients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual
What are the types of grief?
Abbreviated - Brief but genuinely felt Anticipatory - Experienced in advance of the event Disenfranchised - When a person is unable to acknowledge the loss to other people Complicated - When the strategies to cope with the loss are maladaptive and out of proportion or inconsistent with cultural, religious, or age-appropriate norms
What is a heart-lung death?
Cessation of the apical pulse, respirations, and blood pressure
What is hospice?
Focuses on support and care of the dying person and family, with the gaol of facilitating a peaceful and dignified death
What is mourning?
The behavioral process through which grief is eventually resolved or altered
What is algor mortis?
The gradual decrease of the body's temperature after death
What is rigor mortis?
The stiffening of the body that occurs about 2-4 hours after death
What is bereavement?
The subjective response experienced by the surviving loved ones
What is grief?
The total response to the emotional experience related to loss (Emotional response to loss)
What is a cerebral death?
When the cerebral cortex is irreversibly destroyed