Principals Chp 15 Loss, Grief, Dying

What are the physiological stages of dying?

1-3 months prior- withdraw, increased sleep, difficulty digesting food, appetite decrease, protective anorexia (ketosis can increase persons sense of well-being) 1-2 weeks prior- cardiovascular deterioration reduces blood pressure, changes in pulse and skin color, temp fluctuates and perspiration increases, resp, rate may increase or decrease. days to hours- Surge of energy brings mental clarity and desire to eat and talk with family members, dehydration and difficulty swallowing decrease blood volume. Dehydration may stimulate endorphin release. Congestion can cause "death rattle". peripheral circ. decreases, clammy feeling, muscles relax and face droops, urine and feces output reduces, bowel and bladder incontinence can occur, restlessness or agitation may occur, Moments prior- does not respond to touch or sound and cannot be awakened.

What is an advanced directive?

A group of instructions stating a persons wishes relative to his healthcare if he were unable to make that decision.

How is actual loss different than perceived loss?

Actual loss is more tangible and able to be identified by others such as death, theft, deterioration, or destruction. Whereas perceived loss is internal and identified only by the person experiencing it.

What is a DNAR?

An order NOT to resuscitate the patient in the even of cardiac or respiratory failure.

A man who is caring for his wife with advanced Alzheimer's may experience what kind of grief?

Anticipatory Grief

What are some types of complicated grief?

Chronic Grief: begins as normal but continues long term with little resolution of feelings and inability to rejoin normal life. Masked Grief: Person expresses grief through other types of behavior such as drinking or arguing. Delayed grief: Put off until a later time.

What are the psychological stages of dying?

Denial- state of shock. gives person a chance to prepare psychologically Anger- A persons response to the feeling that the situation is unfair. Bargaining- A person makes deals with God or a higher power. Depression- A withdrawn sadness response to current or future losses. Acceptance- Coming to terms with death.

A mistress whose lover has died may experience what type of grief?

Disenfranchised grief

John knew that going to college was going to be a change but he had no idea how much he was going to miss his home. What kind of loss is he experiencing?

Environmental loss.

How is external loss different from internal loss?

External losses are actual losses of important objects like jewelry with sentimental value. Internal loss is like perceived or psychological loss and is identified by the individual experiencing it.

True or False: All bodies undergo an autopsy after death?

False: an autopsy requires signed permission from next of kin except in cases where autopsy is required by law.

Define: Grief

Grieving requires energy and thereby can impact health but it is also essential to healing after loss. It is the physical, psychological, and spiritual response to loss.

What is the difference between palliative care and hospice care?

In palliative care no further effort will be made to stop the progression of the disease but certain symptoms will be treated. This is comfort care. In hospice care the focus is on patients who are dying of debilitated and not likely to improve. A physician must certify that the patient is likely to die in 6 mo. based on 2 key premises: 1. quality of life is as important as length of life. 2. those who are terminally ill must be allowed to face death with dignity and surrounded by the comfort of their homes and families.

What are some types of loss experienced in middle childhood (6yrs to puberty)

Independence (loss of dependence) Bodily changes

What are some types of loss experienced in young adulthood (21-45yrs)?

Leaving schools, changing relationships, more independence from parents

When Susie's sister Anne died the whole family dynamic changed and Susie wished desperately that things could just go back to the way they were when Anne was alive. Worst off all, the person she wanted to talk to most about the situation was Anne. What type of loss is Susie experiencing?

Loss of a significant relationship.

After her mastectomy Judy began to experience a decrease in hope. She had always dreamed of climbing Mt. Whitney but now she just didn't see the point. What kind of loss is she experiencing?

Loss of aspects of self.

What are some types of loss experienced in early childhood (3-6yrs)?

Loss of friends (moving or changing schools), leaving home for school, childhood illness and injuries .

What are some types of loss experienced by middle adults (45-65)?

Marriage (loss of single status)Divorce, separation, Job changes, Moving, Children leaving home, Deaths (parents, grandparents), Surgeries

How is physical loss different than psychological loss?

Physical loss is an alteration of our physical selff like amputation, removal of an organ, or loss of function whereas psychological loss challenge ones belief system and often have to do with things like sexuality, fairness, meaning and trust.

What are some phases of grief?

Shock and numbness, developing awareness of the loss, restitution and recovery, yearning and searching, disorganization and despair, reorganization, avoidance, confrontation, accommodation, working through the pain, adjusting to new environment, emotionally relocating the deceased and moving on.

What are some losses experienced by older adults (over 65)?

Spousal death, Death of friends, Body changes, (degeneration, loss of function), Retirement, Loss of independence

What is End of Life Care?

The patient has a fatal condition Death is likely with the next exacerbation of the disease the patient acknowledges seriousness of the situation.

What are some types of loss experienced in infancy (Birth - 12-18mo.)?

Weaning, birth, no longer being carried.

What are some types of loss experienced in adolescence (puberty to 21 or 22 years)?

dramatic bodily changes, loss of childhood, first crushes and breakups

What are some types of loss experienced by toddlers (12-18mo to 3 yrs)?

toilet training, preschool. loss of the familiar

How is uncomplicated grief different from complicated grief?

uncomplicated grief is the normal response to loss. the emotions are intense but diminish over time. In complicated grief the persons responses are maladaptive, dysfunctional, prolonged or overwhelming