Grief & Loss

3. Assist the client to obtain the necessary information to make this decision

A client that was recently diagnosed with a terminal illness asks his nurse about organ donation. The nurse should: 1. Have the client first discuss the subject with the family 2. Suggest the client delay making a decision at this time 3. Assist the client to obtain the necessary information to make this decision 4. Contact the client's physician so consent can be obtained from the family

4. Capable of producing grief similar to an actual loss

A client who recently experienced an amputation of the left thumb has a perceived loss of physical attractiveness. The nurse recognizes that such a loss is: 1. More easily assessed than actual losses 2. Much less personal than an actual loss 3. Universally experienced by all amputees 4. Capable of producing grief similar to an actual loss

2. Denial

A client, who is receiving chemotherapy on a medical unit due to a recent diagnosis of terminal cancer of the liver, has an in-depth conversation with the nurse. The client says, "This cannot be happening to me." The nurse identifies that this stage is associated with, according to Kübler-Ross: 1. Anxiety 2. Denial 3. Confrontation 4. Depression

1. Provide mouth care at least every 2 hours

In order to most effectively address the discomfort of limited oral fluid intake for a client in the latter stages of the dying process, the nurse should: 1. Provide mouth care at least every 2 hours 2. Offer ice chips each time the client is visited 3. Provide the client frequent sips of a favorite beverage 4. Moisten the client's lips with an appropriate water based lubricant

3.Denial, anger, bargaining, depression acceptance Kubler-Ross's five successive stages of death and dying are denial, anger, bargaining, depression, and acceptance. The patient may move back and forth through the different stages as he and his family members react to the process of dying, but he usually goes through all of these stages to reach acceptance.

Kubler-Ross's five successive stages of death and dying are: 1.Anger, bargaining, denial, depression, acceptance 2.Denial, anger, depression, bargaining, acceptance 3.Denial, anger, bargaining, depression acceptance 4.Bargaining, denial, anger, depression, acceptance

3.Reflecting on the significance of death According to thanatologists, reflecting on the significance of death helps to reduce the fear of death and enables the health care provider to better understand the terminally ill patient's feelings. It also helps to overcome the belief that medical and nursing measures have failed, when a patient cannot be cured.

Nurses and other healthcare providers often have difficulty helping a terminally ill patient through the necessary stages leading to acceptance of death. Which of the following strategies is most helpful to the nurse in achieving this goal? 1.Taking psychology courses related to gerontology 2.Reading books and other literature on the subject of thanatology 3.Reflecting on the significance of death 4.Reviewing varying cultural beliefs and practices related to death

4. Help a person progress to a healthier emotional state

One of the benefits of anticipatory grieving to a client or family is that it can: 1. Be done in private 2. Be discussed with others 3. Promote separation of the ill client from the family 4. Help a person progress to a healthier emotional state

1. Anger stage

The wife of a client recently diagnosed with end-stage renal failure shares with the nurse that, "He just accepts this; I want a second opinion." The nurse recognizes that while the client has reached the acceptance stage of grieving, his wife is experiencing the: 1. Anger stage 2. Denial stage 3. Depression stage 4. Bargaining stage

1. Designed to meet the client's individual wishes, as much as possible

There is a different focus for the client with hospice nursing care. The nurse is aware that client care provided through a hospice is: 1. Designed to meet the client's individual wishes, as much as possible 2. Aimed at offering curative treatment plans intended for client recovery 3. Involved in teaching families and/or caregivers to provide postmortem care 4. Offered primarily for hospitalized clients for whom at-home care is not possible

4. Determine valued activities and schedule rest periods

To provide comfort for the client, while preparing to assist the client in the end stage of her life in response to anticipated symptom development, the nurse plans to: 1. Decrease the client's fluid intake 2. Limit the use of over-the-counter analgesics 3. Provide larger meals with more appealing seasoning 4. Determine valued activities and schedule rest periods

a. Patient

A 70-year-old female patient who has had a number of strokes refuses further life-sustaining interventions, including artificial nutrition and hydration. She is competent, understands the consequences of her actions, is not depressed, and persists in refusing treatment. Her doctor is adamant that she cannot be allowed to die this way, and her daughter agrees. An ethics consult has been initiated. Who would be the appropriate decision maker? a. Patient b. Daughter c. Doctor d. Ethics consult team

2. Hopelessness

A client has a terminal illness and is discussing future treatments with the nurse. The nurse notes that he has not been eating and his response to the nurse's information is, "What does it matter?" The most appropriate nursing diagnosis for this client is: 1. Denial 2. Hopelessness 3. Social isolation 4. Spiritual distress

D. Begin the discussion by asking the patient to identify his or her beliefs about the goals of care while the family member is present If you ask the patient first what he or she believes is best, you know how to discuss that option in more detail and give realistic ways of reaching that desired goal. Discussing other possible options after the patient's preference helps family members know and understand the patient's wishes.

A family member asks a home care nurse what he should do if the patient's serious chronic illness worsens even with increased medical interventions. How does the nurse best begin a conversation about the goals of care at the end of life? A. Encourage the family member to think more positively about the patient's new therapy B. Avoid the discussion because it has to do with medical, not nursing, diagnoses C. Initiate a discussion about advance directives with the patient, family, and health care team D. Begin the discussion by asking the patient to identify his or her beliefs about the goals of care while the family member is present

4) Is holistic care for patients dying or debilitated and not expected to improve Rationale: Hospice care focuses on holistic care of patients actively dying or not expected to improve. It helps patients face death with dignity and comfort. Euthanasia refers to the deliberate ending of a life. Palliative care is aggressively planned care that manages symptoms of patients whose disease process no longer responds to treatment. Aggressive medical treatment is aimed at stopping the disease process.

A family member asks the nurse to explain the purpose of hospice care. Which of the following is the best response? Hospice care: 1) Is appropriate when the patient desires to intentionally end his life 2) Focuses on minimizing the disease process as rapidly as possible 3) Focuses on symptom management for patients not responding to treatment 4) Is holistic care for patients dying or debilitated and not expected to improve

B. Anticipatory grief If a person has been anticipating a loss for some time, he or she may have already experienced many of the emotions (sadness, shock) commonly associated with death.

A family member of a recently deceased patient talks casually with the nurse at the time of the patient ' s death and expresses relief that she will not have to visit at the hospital anymore. What theoretical description of grief best applies to this family member? A. Denial B. Anticipatory grief C. Dysfunctional grief C. Yearning and searching

a. Acceptance

A home health care nurse has been visiting a patient with AIDS who says, "I'm no longer afraid of dying. I think I've made my peace with everyone, and I'm actually ready to move on." This reflects the patient's progress to which stage of death and dying? a. Acceptance b. Anger c. Bargaining d. Denial

a. The nurse promises the patient that he or she will do everything possible to keep the patient comfortable but cannot administer an injection or overdose to cause the patient's death.

A hospice nurse is caring for a patient who is terminally ill and who is on a ventilator. After a restless night, the patient hands the nurse a note with the request: "Please help me end my suffering." Which response by a nurse would best reflect adherence to the position of the American Nurses Association regarding assisted suicide? a. The nurse promises the patient that he or she will do everything possible to keep the patient comfortable but cannot administer an injection or overdose to cause the patient's death. b. The nurse tells the patient that under no condition can he be removed from the ventilator because this is active euthanasia and is expressly forbidden by the Code for Nurses. c. After exhausting every intervention to keep a dying patient comfortable, the nurse says, "I think you are now at a point where I'm prepared to do what you've been asking me. Let's talk about when and how you want to die." d. The nurse responds: "I'm personally opposed to assisted suicide, but I'll find you a colleague who can help you."

4. Has developed a personal understanding of his own feelings about death

A newly graduated nurse is best prepared for the assignment of his first dying patient if he: 1. Completed a course dealing with death and dying 2. Is able to control his own personal emotions about death 3. Has previously experienced the death of a dear loved one 4. Has developed a personal understanding of his own feelings about death

c. Dysfunctional

A nurse interviews an 82-year-old resident of a long-term care facility who says that she has never gotten over the death of her son 20 years ago. She reports that her life fell apart after that and she never again felt like herself or was able to enjoy life. What type of grief is this woman experiencing? a. Abbreviated b. Anticipatory c. Dysfunctional d. Inhibited

3) Tell the patient when the nurse is about to leave the room. Rationale: The nurse should continue to communicate with dying patients even if they are nonresponsive. Research indicates that patients continue to hear even though the level of consciousness is low, sometimes up to the moment of death. Nonverbal actions would not communicate meaning for a patient who is nonresponsive; nor would the patient be aware that the nurse is sitting instead of standing when speaking. The nurse should direct explanations of care to the patient, as always; nurses should not talk about the patient to others in the patient's presence, even when the patient is comatose.

A nurse is caring for a dying patient who is nonresponsive, and on comfort care. Which of the following is it important for the nurse to do? 1) Be alert to the patient's nonverbal cues. 2) Direct explanations about care to family members. 3) Tell the patient when the nurse is about to leave the room. 4) Sit by the head of the bed when speaking to the patient.

a. Actual b. Perceived c. Psychological

A nurse midwife is assisting a patient to deliver a full-term baby. The patient is firmly committed to natural childbirth and has attended each natural childbirth class in preparation for labor and delivery. A cesarean delivery becomes necessary when her fetus displays signs of distress. Inconsolable, the patient cries and calls herself a failure as a mother. The nurse notes that the patient is experiencing what type of loss? Select all that apply. a. Actual b. Perceived c. Psychological d. Anticipatory e. Physical f. Maturational

c. Living will

A patient tells a nurse that he has no one he trusts to make health care decisions for him should he become incapacitated. What should the nurse suggest he prepare? a. Combination advance medical directive b. Durable power of attorney for health care c. Living will d. Proxy for health care

3.Numbness Numbness is typical of the depression stage, when the patient feels a great sense of loss. The anger stage includes such feelings as rage, envy, resentment, and the patient's questioning "Why me?"

A terminally ill patient usually experiences all of the following feelings during the anger stage except: Rage Envy Numbness Resentment

1) "Your feelings are a normal response to watching your loved one suffer." Rationale: The nurse should reassure the patient's daughter that her feelings are normal; there is no need for the daughter to seek counseling based on the information provided in this situation. Keep in mind that people can grieve in a dysfunctional manner for which they would benefit from counseling or other mental health support services. By responding, "It's unusual for family members to be grateful that a loved one has died," the nurse is being judgmental. The nurse who states she doesn't understand the family member's comment should at least seek clarification and prompt further exploration of the person's feelings. A comment of this nature can be a discussion starter for the daughter to release feelings and begin the grieving process.

After a patient dies of ovarian cancer, her daughter says to the nurse, "You'll probably think I'm terrible, but I'm glad she can finally rest peacefully." Which response by the nurse is best? 1) "Your feelings are a normal response to watching your loved one suffer." 2) "It's unusual for family members to be grateful that a loved one has died." 3) "Your mother's death has been very hard on you; you should seek counseling." 4) "I don't understand what you mean by this comment."

3. Recognition of the client's needs and fears

The family of a client with a terminal illness will be able to help provide some psychological support to their family member. To assist the family to meet this outcome, the nurse plans to include in the teaching plan: 1. Demonstration of bathing techniques 2. Application of oxygen delivery devices 3. Recognition of the client's needs and fears 4. Information on when to contact the hospice nurse

3. Bargaining Rationale: Denial, bargaining, anger, depression, and acceptance are recognized stages that a client facing a life-threatening illness experiences. Bargaining identifies a behavior in which the individual is willing to do anything to avoid loss or change the prognosis or fate. Anger also may be a first response to upsetting news, and the predominant theme is "Why me?" or the blaming of others. Denial is expressed as shock and disbelief and may be the first response to hearing bad news. Depression may be manifested by hopelessness, weeping openly, or remaining quiet or withdrawn.

The hospice nurse visits a client who is dying of ovarian cancer. During the visit, the client says, "If I can just live long enough to celebrate my daughter's 'sweet 16' birthday party, I'll be ready to die." Which phase of coping is this client experiencing? 1. Anger 2. Denial 3. Bargaining 4. Depression

1. "Palliative care interventions hasten death." Rationale: Palliative care interventions do not serve to hasten death; rather, they provide pain and symptom management, attention to issues faced by the child and family with regard to death and dying, and promotion of optimal functioning and quality of life.

The nurse is caring for a terminally ill child who is receiving palliative care. When explaining the purpose of palliative care to the child's caregiver, the nurse recognizes the need for additional instruction when the caregiver makes which statement? 1. "Palliative care interventions hasten death." 2. "Palliative care promotes optimal functioning." 3. "Palliative care will provide pain management." 4. "Palliative care will provide symptom management."

3.Encourage expression of feelings, concerns, and fears. 5.Touch and hold the client's or family member's hand if appropriate. 6.Be honest and let the client and family know that they will not be abandoned by the nurse. Rationale: The nurse must determine whether there is a spokesperson for the family and how much the client and family want to know. The nurse needs to allow the family and client the opportunity for informed choices and assist with the decision-making process if asked. The nurse should encourage expression of feelings, concerns, and fears and reminiscing. The nurse needs to be honest and let the client and family know that they will not be abandoned. The nurse should touch and hold the client's or family member's hand, if appropriate.

The nurse is preparing to care for a dying client, and several family members are at the client's bedside. Which therapeutic techniques should the nurse use when communicating with the family? Select all that apply. 1.Discourage reminiscing. 2.Make the decisions for the family. 3.Encourage expression of feelings, concerns, and fears. 4.Explain everything that is happening to all family members. 5.Touch and hold the client's or family member's hand if appropriate. 6.Be honest and let the client and family know that they will not be abandoned by the nurse.

3. A teenage parent whose child died of sudden infant death syndrome (SIDS)

The nurse recognizes that which of the following clients is at greatest risk for complicated (dysfunctional) grief? 1. A 26-year-old who is diagnosed with rheumatoid arthritis 2. The 58-year-old only child whose mother recently died of cancer 3. A teenage parent whose child died of sudden infant death syndrome (SIDS) 4. A 50-year-old diabetic client who has experienced an above-the-knee amputation

B. Palliative care is for any patient, any time, any disease, in any setting. D. Palliative care interventions relieve the symptoms of illness and treatment. Palliative care is not reserved for people who are at the end of life. The goal of palliative care is to help relieve the burdens of illness at any time along the continuum of that illness

The nurse suggests that a patient receive a palliative care consultation for symptom management related to anxiety and increasing pain. A family member asks the nurse if this means that the patient is dying and is now "in hospice." What does the nurse tell the family member about palliative care? (Select all that apply.) A. Hospice and palliative care are the same thing. B. Palliative care is for any patient, any time, any disease, in any setting. C. Palliative care strategies are primarily designed to treat the patient's illness. D. Palliative care interventions relieve the symptoms of illness and treatment.