Fundamentals Final Examination Study Guide

Fundamentals Final Examination Study Guide

Chapter 37: The Experience of Loss, Death, & Grief

1.Discuss the nursing diagnoses pertaining to Death and Dying. (Pg. 757) Compromised Family Coping Death Anxiety Grieving Complicated Grieving Risk for Complicated Grieving Hopelessness Pain (Acute or Chronic) Spiritual Distress You cannot make accurate nursing diagnoses on the basis of just one or two defining characteristics. Carefully review your pts. assessment data to consider if more than one diagnosis applies.

2.Discuss the types of grieving. (Pg. 752)

Normal Grief: (uncomplicated grief) is a common & universal reaction

characterized by complex emotional, cognitive, social, physical, behavioral, & spiritual responses to loss & death. Some normal feelings of grief are disbelief, yearning, anger, & depression.Anticipatory Grief: a person experiences anticipatory grief before the actual loss or death occurs, especially in situations of prolonged or predicted loss such as caring for patients diagnosed w/ dementia or amyotrophic lateral sclerosis (ALS). They experience intense responses to grief (shock, denial, tearfulness) before actual death occurs & often feel relief when it finally happens.

Disenfranchised Grief: people experience disenfranchised grief when their

relationship to the deceased person is not socially sanctioned, cannot be shared openly, or seems of lesser significance. Ex: death of former spouse, married lover, incarcerated person, or terminated pregnancy.Ambiguous loss: a type of disenfranchised grief, can occur when the lost person is physically present but not psychologically available. Ex: cases of severe dementia or brain injury. Other times person is gone (after kidnapping, prisoner of war, lost hiker, or 9/11 where body was never found), but the grieving person maintains an ongoing, intense psychological attachment, never sure of the reality of the situation.Complicated Grief: in complicated grief a person has a prolonged or significantly difficult time moving forward after a loss. He/she experiences a chronic & disruptive yearning for the deceased; has trouble accepting death & trusting others; feels excessively bitter, emotionally numb, or anxious about the future.

Specific types of complicated grief:

Chronic Grief: a person w/ chronic grief experiences a normal grief response, except that it extends for a longer period of time (years to decades).Exaggerated Grief: a person w/ exaggerated grief response often exhibits self- destructive or maladaptive behavior, obsessions, or psychiatric disorder (risk for 1 / 3

suicide).Delayed Grief: person’s grief response is unusually delayed or postponed b/c the loss is so overwhelming that person must avoid the full realization of the loss (frequently triggered by a second loss).

Masked Grief: sometimes a grieving person behaves in ways that interfere w/

normal functioning but is unaware that the disruptive behavior is a result of the loss

& ineffective grief resolution. Ex: clubbing or drinking too much

3.How does the nurse assist a family during a terminal illness of a family member? (Pg.

763-765)

Offer holistic, family-centered support, compassion, & education that incorporates the uniqueness of each pt.Educate family members in all settings about the symptoms that the pt. will likely experience & the implications for care.During the dying process check frequently on families, offering support, info, &, if appropriate, encouragement to continue touching & talking w/ their loved ones.Nurses are primary source of family support.Nurses often provide options that family members do not know are available & are advocates for pts. & family members making decisions at the end of life in the form of an advanced directive.

4.Discuss the stages of Kubler-Ross for death and dying. (Pg. 753) Stages of Dying: (can work for someone experiencing someone else’s death or death of their own) Denial: the person cannot accept the fact of the loss. It is a form of psychological protection from a loss that the person cannot yet bear.Anger: the person expresses resistance or intense anger at God, other people, or the situation.Bargaining: the person cushions & postpones awareness of the loss by trying to

prevent it from happening. (Ex: promises)

Depression: the person realizes the full impact of the loss.

Acceptance: the person incorporates the loss into life, and finds a way to move forward.

5.Discuss what Hospice can accomplish for patients who are dying and their families. (Pg.761) Hospice care is a philosophy & model for the care of terminally ill pts. & their families at the end of life. It gives priority to managing a pts. pain & other symptoms, comfort; quality of life; & attention to physical, psychological, social, & spiritual needs & resources.A trusting relationship between the hospice team & the pt. & family.Hospice services provide bereavement visits made by the staff after the death of the pt. to help family move through the grieving process.Home care aides offer help w/ hygienic needs, & a nurse is available to coordinate & manage symptom relief.Nurses providing hospice care use therapeutic communication, offer psychosocial 2 / 3

care & expert symptom management, promote pt. dignity & self-esteem, maintain a comfortable & peaceful environment, provide spiritual comfort & hope, protect against abandonment or isolation, offer family support, help w/ ethical decision making, & facilitate mourning.Hospice team members offer 24-hr accessibility & coordinate care b/w the home & inpatient setting.

6.How does the nurse assist the patient to be more comfortable with the symptoms related to dying? (Pg. 763)

Symptoms & Nursing Implications:

Pain: collaborate w/ team members to identify & implement appropriate

pharmacological & nonpharmacological interventions to reduce pain & promote comfort.Skin discomfort: keep skin clean, dry, & moisturized. Monitor for incontinence.Mucous membrane discomfort: provide oral care at least every 2-4 hrs. Apply a light film of lip balm for dryness. Apply topical analgesics to oral lesions prn.Corneal irritation: optical lubricants or artificial tears reduce corneal drying.Fatigue: provide periods of rest & educate pt. about energy conservation.Anxiety: provide opportunity for pt. to express feelings through active listening.Provide calm, supportive environment. Consult members of health care to determine if pharmacological interventions are appropriate.Nausea: determine cause of nausea & work to reduce nausea triggers such as strong smells. Administer antiemetics or promotility agents. Encourage pts. to lie on their right side. Provide oral care at least every 2-4 hrs.Constipation: increase fiber in diet if appropriate. Administer stool softeners or laxatives if needed. If possible encourage increased liquid intake & regular periods of ambulation.Diarrhea: consult w/ members of the health care to determine the cause & make appropriate changes. Provide skin care & easy accessibility to the toilet or bedside commode.

Urinary incontinence: provide good skin care & frequent assessment for

incontinent urine. Place Foley catheter as appropriate.Altered nutrition: encourage pts. to eat small, frequent meals of preferred foods.Pts. should never be forced to eat.Dehydration: reduce discomfort from dehydration; give mouth care at least every 2-4 hrs; offer ice chips or moist cloth to lips. Keep lips & tongue moist.Ineffective breathing patterns (dyspnea, SOB): treat/control underlying cause.Use nonpharmacological interventions such as elevating head of bed to promote lung expansion. Provide oxygen as needed. Keeping air cool provides ease & comfort for terminal pt. Using narcotic to treat tachypnea is sometimes appropriate.Noisy breathing (death rattle): elevate head to facilitate postural drainage. Turn pt.at least q2h. Provide oral care & maintain hydration as tolerated.

7.Define normal grieving. Discuss how losses affect children. What is bereavement and mourning? (pg. 751-753)

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