Loss and Grief Ch. 27

A patient diagnosed with end-stage lung disease asks about palliative care. Which of the following statements about palliative care are accurate? (Select all that apply.) 1. A patient with end-stage lung disease can receive palliative care. 2. When a patient chooses palliative care, the patient stops all acute treatments. 3. People must be considered as having less than 6 months to live to be eligible for palliative care. 4. Palliative care must be started when the patient is in the hospital. 5. Palliative care interventions focus on providing symptom relief and maintaining a high quality of life.

1 and 5

Moving through Worden's four tasks can vary, but typically the process takes at least ____________

1 year

A patient who was just diagnosed with terminal cancer says she will not tell her family about the diagnosis. Which of the following responses is most helpful at this time? 1. "Tell me about your decision to not tell your family." 2. "Your family will need to help you now." 3. "It sounds like you do not like your family. Is there someone you are afraid of?" 4. "Have you considered what this will mean to your family?"

1. "Tell me about your decision to not tell your family."

A patient diagnosed with a progressive neurological disease believes she will live independently until her death. Which of the following statements is appropriate to begin your assessment of the patient's care decisions? 1. "Tell me what you already know about your disease." 2. "Many people are afraid of what hospice care means." 3. "Palliative care is different than hospice care." 4. "I think you do not understand what will happen as this disease progresses."

1. "Tell me what you already know about your disease."

A patient recently diagnosed with a terminal disease cries intermittently, refuses to see his spiritual advisor of 15 years, and becomes angry with his significant other of 25 years. Which of the following nursing diagnoses is the priority at this time? 1. Spiritual Distress 2. Complicated Grieving 3. Ineffective Denial 4. Social Isolation

1. Spiritual Distress

Which of the following statements made by a patient with a new diagnosis of end-stage heart failure best illustrates the numbing phase of loss? 1​. "I am in shock; how can this be really happening?" 2. "I have always eaten healthy food and exercised. Why me?" 3. "This must have happened because I smoked as a teenager and didn't care." 4. "I think my disease will actually kill me."

1​. "I am in shock; how can this be really happening?"

A patient's husband asks the nurse to explain what grief is. Which points does the nurse include in the teaching? (Select all that apply.) 1. Individuals grieve with all the steps or patterns described in grief theories. 2. Complicated grief occurs when a person has dif culty progressing through the loss experience. 3. Grief is an emotional response to a loss. 4. People grieve based on their experiences, cultural expectations, and spiritual values. 5. Disenfranchised grief occurs when people discuss their losses with strangers. 6. Anticipatory grief begins when family hears the diagnosis of a terminal illness.

2, 3, and 4

A patient's family members ask the nurse what bodily changes they should expect when their relative's death is imminent. Which points does the nurse include in the teaching? (Select all that apply.) 1. Warm hands and feet 2. Noisy breathing 3. Limited intake of food 4. Consistent shallow breaths 5. Reduction of urine output 6. Orientation to person, place, and time

2, 3, and 5

A woman experienced the suicide death of her adult son 2 years ago. Her friends do not talk about her son's suicide, and her brother tells her that her son did not care enough to live and to feel grateful for the family she has. The woman is angry that people do not understand her sadness, and she feels isolated from family and friends. Which type of grief is this woman experiencing? 1. Anticipatory grief 2. Complicated grief 3. Disenfranchised grief 4. Normal grief

3. Disenfranchised grief

A patient's son is taking care of his father at the end of life. The family used to watch television together frequently before the father became ill. The son states, "I think if he interacted with us he would feel better." Which of the following responses is the most therapeutic? 1. "Maybe you should place the TV in your dad's room so he does not need to move." 2. "Your dad is telling you he wants to die. This is the time to acknowledge his feelings." 3. "Try playing his favorite shows to encourage time together." 4. "What do you miss most about not being able to share this time with your dad?"

4. "What do you miss most about not being able to share this time with your dad?"

A patient's family is at the bedside when the patient dies. Which of the interventions best helps the family cope with their loss? 1. Instruct family members to leave the room as you prepare the body. 2. Describe the patient's death using medical terminology. 3. Encourage the family to touch the body. 4. Acknowledge the family's loss.

4. Acknowledge the family's loss.

At the time of death the nurse will note

Absence of breathing and heartbeat Bowel and bladder release Unresponsiveness Eyes fixed on a certain spot Dilated pupils

Postmortem care includes

Asking the family members if they want to help with care Close the patient's eyes Leave the dentures in the patent's mouth Elevate the head of the bed Remove all lines, dressings, tubes

Nursing interventions for a terminally ill patient with constipation

Consumption of fresh vegetables Consumption of whole grain products Obtaining an order for stool softeners

Factors influencing loss and grief

Human development Psychological perspectives Socioeconomic status Nature of personal relationships Nature of the loss Culture and ethnicity Spiritual beliefs.

Nursing interventions for a family dealing with a diagnosis of terminal illness

Involving family in discussions Promote open communication Answer all questions Provide support

Signs of impending death

Little food and water intake Noisy breathing Increased sleep Less conscious Cold hands and feet Disorientation and restlessness Decreased urinary output and/or incontinence Irregular breathing patterns with long pauses

Rando's R Process Model

Recognizing the loss Reacting to the pain of separation Reminiscence Relinquishing old attachments Readjusting to life after loss.

Behaviors associated with normal grieving include

Sleep disturbances Appetite disturbances Dreams of the deceased Sighing Crying Carrying objects that belonged to the deceased

Interdisciplinary care for terminally ill patients

Social workers Dietician Respiratory therapists Pharmacists PT Spiritual care providers Psychologists Pain-management specialist

Accept the reality of the loss

Task I

Work through the pain of grief

Task II

Adjust to the environment in which the deceased is missing

Task III

Emotionally relocate the deceased and move on with life

Task IV

What should be documented following a patient's death?

Time & date of death Name of HCP who called death Organ or tissue donation status Preparation of the body Medical devices in/on the body Valuables or belongings left with the or given to the family Time of discharge Destination of the body.

True or False: Older adults are at risk for complicated grieving due to multiple losses, a potential for cognitive impairment, or decreased physical abilities

True

True or False: Unexpected unemployment may be perceived as a loss

True

The loss of a known environment is associated with: a. being hospitalized for several days b. the death of a pet c. amputation of the right leg d. a recent burglary in the home

a. being hospitalized for several days

A patient living in the long term care facility is to receive palliative care measures only during the end stages of a terminal illness. The nurse anticipates this will include: a. pain relief measures b. emergency surgery c. pulmonary resuscitation d. transfer to ICU

a. pain relief measures

when a person can no longer touch, hear, see, or have valued people or objects

actual loss

A patient is experiencing a very serious illness that may not be curable, The nurse promotes hope for this patient when: a. establish firm goals b. encourage the development of supportive relationships c. withholding information about the illness and its treatment d. referring the patient for psychological counseling

b. encourage the development of supportive relationships

While working with young children in s day care center, a nurse responds to instances that occur in their lives. Toddlers at the center generally express loss and grief associated with: a. anticipation of loss b. separation from parents c. changes in physical abilities d. development of their identities

b. separation from parents

The nurse is using Worden's Four Tasks or Mourning to assess the family members response of the death of a loved one. What is expected when the indivual moves into Task III, Adjust to the environment in which the deceased is missing? a. realizing that the loved one is gone b. taking on roles of the loved one c. suppressing feelings over the love d. forgetting the deceased and moving on

b. taking on roles of the loved one

inner feelings and outward behaviors of a survivor

bereavement

A nurse is working with a patient who has been diagnosed with a terminal disease. The patient, who is moving into Kubler-Ross's denial stage of grieving, may respond: a. I understand what the diagnosis means, and I know that I may die b. I would like to be able to make it to my son's wedding June c. I think that the diagnostic tests are wrong, and they should be redone d. I don't think that I can stand to have any more treatments, I just want to feel better

c. I think that the diagnostic tests are wrong, and they should be redone

A nurse recognizes anticipatory grief in the person who: a. has an active period of mourning that does not decrease and continues over time b. cannnot function and is overwhelmed, with resulting substance abuse of phobias c. accepts the reality of a terminal illness and begins to say goodbye and complete life affairs before death d. is not aware that behaviors such as interfering with daily activities such as sleeping and eating

c. accepts the reality of a terminal illness and begins to say goodbye and complete life affairs before death

In a senior citizen center, a nurse is talking with a group of older adults. The recurrent theme associated with loss for this age group is: a. confusion of fact and fantasy b. perceived threat fo their identity c. change in status, role, and lifestyle d. determination to reexamine life goals

c. change in status, role, and lifestyle

A patient arrives for outpatient chemotherapy. The patient tells the nurse that she is experiencing periods of nausea. The nurse promotes patient comfort by providing: a. milk b. coffee c. ginger ale d. orange juice

c. ginger ale

The spouse of a patient who has just died is having more frequent episodes of headaches and generalized joint pain. The initial nursing intervention for this individual is to: a. complete a thorough pain assessment b. encourage more frequent use of analgesics c. sit with the patient and encourage discussion of feelings d. refer the patient immediately to a psychologist or grief counselor

c. sit with the patient and encourage discussion of feelings

An individual in Bowlby's second phase of mourning, yearning, and searching may be expected to: a. be unable to believe the loss b. endlessly examine how the loss occurred c. acquire new skills and build new relationships d. experience emotional outbursts and sobbing

d. experience emotional outbursts and sobbing

A nurse who has recently graduated from the nursing school is employed by an oncology unit. There are a number of patients who will not improve and will need assistance with dying. The nurse prepares for this experience by: a. compelling a detailed course on legal aspects of end of life issues b. controlling his or her emotions about dying patients c. experiencing the death of a close family member d. identifying his or her own feelings about death and dying

d. identifying his or her own feelings about death and dying

Of the following, a situational loss occurs when a: a. parent requires physical assistance b. family friend dies c. child goes to college d. job demotion and pay reduction occur

d. job demotion and pay reduction occur

A patient has had a long illness and is now approaching the end stages of his life. To assist this patient to meet his need for self-worth and support during this time, the nurse: a. arranges for a grief counselor to visit b. leaves the patient alone to deal with his life issues c. asks the patient's family to visit d. plans to visit the patient regularly throughout the day

d. plans to visit the patient regularly throughout the day

An autopsy is performed in accordance with state legislation and usually in circumstances when

death may have resulted from an accident, homicide or suicide

Which conditions may cause disenfranchised grief in patients?

death of a married lover death of ex-spouse death of pet early pregnancy loss

Kübler-Ross Theory

denial anger bargaining depression acceptance

Endless examination of how and why the loss has occurred

disorganization and despair

The emotional response to loss

grief

divorce, loss of family member, friend, trusted nurse, or pet

loss of a significant other

loss of body part, psychological or physiological function, job, or financial uncertainty

loss of an aspect of self

misplacement, theft, destruction by nature

loss of external objects

moving from a neighborhood, hospitalization, a new job, moving to a long-term care facility

loss of known environment

death of a friend, family member, or acquaintance

loss of life

a lifetime of normal developmental process

maturational loss

The conscious and unconscious behaviors associated with loss

mourning

person has periods of extremely intense emotion and reports feeling stunned or unreal

numbing

The Bowlby's Four Phases of Mourning

numbing yearning and searching disorganization and despair reorganization

How do modern theories of greed differ from earlier theories?

people don't grieve in predictable, linear stages, nor do they necessarily complete the grieving tasks. Instead they move back and forth between stages

A loss that is uniquely defined by the person experiencing the loss and is less obvious to other people

perceived loss

recollecting and re-experience of the deceased and the relationship by mentally or verbally reliving and remembering the person and past experiences

reminiscence

person accepts unaccustomed roles, acquires new skills, and builds new relationships

reorganization

the result of an unpredictable life event

situational loss

emotional outbursts of tearful sobbing and acute distress

yearning and searching