LOSS, GRIEF, AND THE DYING PATIENT CH 15
Terms
undefined, object
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- Loss
- -refers to no longer possessing or having an object, person or situation
- Eq of loss
-
-losing money,
-a job,
-one's health or
-life - What is the most difficult loss to accept?
- -one's own death
- Grief
- -the emotional feeling of pain & distress in response to a loss
- Grieving process
- -a process that occurs over a period of time as a person adapts to and moves through the pain of loss
- Bereavement
- -State of having suffered a loss by death
- Anticipatory grieving
- may occur before a loss actually happens
- dysfunctional grieving
- -when it falls outside the normal responses
- Death or dying
- -the cessation of all physical & chemical processes that invariably occurs in all living organism; a stage of life
- brain death
- the permantent stopping of integrated functioning of the person as a whole
- Hospice
- -philosophy of care for the dying
- Thanatology
- -study of death
- Kubler-Ross's stages of coping with death
-
-denial
-anger
-bargaining
-depression
-acceptance -
Hope
Hope for cure
Hope for treatment
Hope for prolonged life
Hope for peaceful death - -an inner positive life force, a feeling that what is desired is possible
- Comfort care
- -focused on identifying symptoms that cause the patient distress & adequately treating those symptoms
- Palliation
- -relief of symptoms when cure is no longer possible
- Nsg diagnosis for the pt who is dying
-
-activity intolerance
-death anxiety
-fear
-anticipatory grieving
-imbalanced nutrition: less than the body requirement
-risk of loniless
-pain
-impaired physical mobility
-fatique
-imparied skin integrity
-deficient knowledge
-self-care deficit - Cheyenne-Stokes respirations
- -respirations may gradually become more shallow & are followed by periods of apnea
- closure
-
to say goodbye to those people & things that are important.
it may also be saying i am sorry, forgive me. I forgive you. I love you. - Advance directive
- -spells out pt's wishes for health care at that time when they may be unable to indicate their choice
- Durable power of attorney for health care
- -a legal document that appoints a person chosen by the pt to carry out his wishes as expressed in an advance directive (health care proxy)
- DRN means
- Do NOT Resuscitate
-
Euthansia
AKA -
-act of ending another person's life to end suffering, with (voluntary) or without (involuntary) his consent
*mercy killing* -
Passive Euthansia
Give an eg -
-when a pt chooses to die by refusing treatment that might prolong life
-witholding atrifical feeding or Parental (IV) fluids, not treating pnuemonia with antibotics - Active Euthansia
- -administrating a drug or tx to kill the pt
-
T or F
Both passive euthanasia and assisted suicide are considered to be a violation of the AMA's Code for Nurses -
False
active euthansia not passive -
T or F
Honoring the refusal of life-prolonging treatment of a patient w/ a terminal illness is legally & morally permissble -
False
it is ethically not morally - Coroner
- person w/ legal authority to determine cause of death
- Autopsy
- an examination of the body, organs and tissues to determine the cause of death
- Postmortem
- after death, the care of the body
- A person's reaction to loss is influenced by what
- the importance of what was lost & the culture in which the person is raised
-
-Life expectancy for white female is highest
-African American females
-White males
-African American -
-79.9 yrs
-74.7 yrs
-74.6 yrs
-67.8 yrs - In order to meet the emotional and physical needs of pts and their significant others, nurses must first what?
- take the time to look at their own views of death & come to terms with its reality
- A loss consist of what aspects
-
-PHYSICAL
eg amputation of a leg, inablity to speak or walk after a stroke
-PSYCHOSOCIAL
eg disfiguring surgery
scarring from burns may result in an alter self image and emotional problems
loss of a job
role of a homemaker
familiar environment
independence such as a move to nsg home -
T or F
A major loss may result in normal grieving for 1 to 2 yrs
NOTE: There is no actual time frame for grieving. - True
- Visible absence of grieving may be viewed by others as good adjustment, but it often results in what?
- psychosomatic illness
- How does a ns validate a pt's loss?
-
reassure the grieving person:
-that the loss was important
-that you understand the loss - Crying may be embarassing for the patient and a simple act of _____________ acknowledges the acceptability of weeping
- handing a tissue
- What cultures are less likely to want to be told if they have a terminal illness & they feel that the family should make decisions, not the patient, about life-sustaining treatment
-
Mexican American
Korena American - Palliative care the focus is on what?
-
-symptom management
-comfort care - Where is hospice care provided
-
-pt's home
-nursing home
-hospital
-hospice unit - Who identified the stages of copying with death
- Kubler-Ross
- shroud
- -sheet used to wrap body after death
- rigor mortis
- rigidity of muscles that occurs after death
- Identify common fears a pt is likely to experience when dying
-
-fear of pain
-loniless
-abandonment
-the unknown
-loss of dignity
-loss of control -
T or F
At sometime a pt should be pushed to discuss what he is obviously avoiding -
False
At no time - there are steps for a beginning students and new graduates can do to understand what to say to a dying pt
-
1st step become comfortable w/ your own beliefs, values, and attitudes about death and dying
2nd step read and learn about the actual dying process and observe exp nurses talking with dying pts and grieving relatives
3rd step be open to the difficult questions of life & death that permit pts to discuss their feelings and needs - Nonchemical approaches to pain relief may include:
-
-visualization & guided imagery
-relaxation & breathing exericises
-massage
-music therapy
-mediation
-religious healing
-biofeedback
-hypnosis
-self-hypnosis
use of TEN (transcutaneous electrical nerve stimulation)
-hydrotherapy eg whirlpool - When a pt is no longer taking oral fluids, small amts of concentrated pain medication can be inserted ______________
- in the buccal cavity (cheek)
- ________scheduled pain medication with _____ backup for breakthrough pain is most __________
-
-regular
-PRN
-effective - Pt's w severe pain can recieve _____doses of narcotics without ________depression or tolerance when the dose has been increased in response to increasing pain
-
-huge
-resp - Research has shown that ___________ results in less distress and pain and that _______ does not improve comfort
-
-dehydration
-hydration - When a dying pt has dyspnea and suctioning is not effective;what is used?
-
-medication eg scopolamine patch or morphine can decrease secretions
-O2 by nasal may provide comfort - For the dying pt, what contributes to the risk of skin breakdown:
-
-wt loss
-decreased nutrition
-incontinence
-inactivity -
T or F
The dying pt is not going to get stronger or better;he gets weaker and weaker,because he is lying in bed -
False
not because he is lying in bed, but because he is dying