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59 Cards in this Set

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The Kubler-Ross 5 stages of Dying are:
*****************************
denial
anger
bargaining
depression
acceptance
Karla was assigned as a Hospice nurse for a terminally ill 6 year old girl
"Last Touch" by Karla Jones.
What does the last touch mean?
touching the dead body the last time and how that means so much to the brereivement process, I guess. Nursing 2001, Oct. Edition.
What is Grief?
Grief is a natural response to loss, a unigue way to heal.
In order for us to be theraputic, we must be in touch with our own mortality and feelings surrounding ...
death and dying
what are the 4 principles of grief?
GRIEF IS:
a natural & expected response to loss
each ind. carries w/ him an innate level to cope
duration & intensity of grief is unique for each individual
Caring & acceptance are helpful in resolving issues
What are the 4 levels of the Denial from Klubler-Ross again?
denial
anger
bargaining
depression
acceptance
The Kubler-Ross process of Grieving.
Denial Anger Bargaining Depression and ___________
acceptance
communication techniques are either therapeutic or non therapeutic. defending. what is this
ex you nurses dont seem to care at all about the patients, etc. a good answer would be to say "we can move you to a room further from the nurse station.
Maureen made a point to allways deliver on any promising made to a pt.
what is the comm technique restating, thera or non thera?
ex im so upset. i wonder if life is even worth it

good response "is life worth living?" its open ended, non judgmental, you offered no opinion, you are allowing pt to attempt to talk it out
the technique of giving advice, good technique?
no absouluteley not
"i lost my job and my wife is mad."
bad reply = "get a job and help out!" bad technique.
good technique. "you lost your job?"
Don't give false reassurance. ex 'I'm worried I'm going to gain weight on these new meds"
bad theraputic technique =
everyone puts some weight on, its normal"
good technique = "it might happen, that's true."
Minimizing feelings
ex 'im afraid the scar will be noticable'
bad technique = "scars make the man"
remember this is mim. the feeling
good technique = yes there will a scar but will eventually fade and not be so noticable.'
changing the subject is like bad technique
ex 'i feel like dying.'
bad technique = 'Lunch time, gotta go.' what would be a bettter answer?
"you feel like dying?"
Clarifying is like restating, a great great technique in communitating with a pt, for grief or any problem.
ex 'my husband lost his job things are going south for me. i don't care anymore.'
good technique, using clarifying =
'your husband lost his job and you feel like you won't be able to pay your bills?'
then there is the issue of grief and peds. the groups:
infants (trust vs mistrust)
Toddlers (automitry vs shame and doubt
preschool (inititive vs guilt)
school age (industry vs inferority)
adolscence (identity vs role confusion)
the idea here is how each group thinks about death, there reaction to death, and THE NURSING INTERVENTION (WHAT THE NURSE DOES TO HELP)
< than 6 months, infant is clueless. After the bonding thereafter the loss is profound. > 6 months the seperation after the parent child attachment ti profound.
this group can't comprehend absence of life, its the CHANGE IN LIFESTYLE.
the infant (trust vs mistrust) will react to the loss like it never happened but will cope as they grow older and accept it. If they themselves are going to die its not death but the pain and discomfort they have that's on their mind. The kid will also react to parents anxiety. what is the nusring intervention?
help the parents deal w/ their feelins. encourage them to be w/ child as much as possible. maintain normal enviroment and stict to ritural routine as much as possible. if a parent has died, suggest getting a consistent caregiver for child
preschool (initititve vs guilt) concepts of death are that it is like sleep, that their bad thoughts caused it, that death is temporary, etc. if the child is terminal, they might think its punishment. they hate death because it will seperate them from their parents. lossing a parent is so bad the child will deny it happened to survive the impact. WHAT ARE NURSING INTERVENTIONS FOR THE PRESCHOOL CHILD?
again help the parents w/ their feelings by allowing them more emotional reserve to meet needs of child.
Explain behavior reactions of the child.
encourage parents to be w/ child as much as possible.
school age children (industry vs inferiority) still think they are being punished if death is around SO they feel guilt and responsible.By 9 they fully understand death is irreversible. How does the nurse INTERVEN?
This develop level = industry so help child control their bodies and increase understandings helps them achieve independence, self worth, and self esteem and avoid sense of inferiority.
Adolescents have a mature sense of death but still have guilt and shame hanging around. But with more cognitive ability comes more fear. they are intrested in gross stuff like funeral details, the body itself, the unknown, etc. NURSING INTERVENTIONS?
avoid picking sides either child or parents!!!
structure enviorment for max control of patient
answer questions honestly
respect needs for privacy, etc
help parents understand child's hair loss, i mean present crisis might be greater than the future crisis like death.
effective enhancing verbal techniques include reflecting.
what is reflecting
reflecting when not used TOO much aids patient in thinking out owm problem w/o being told what to think
is not interjecting personnal opinions into a grief conversation theraputic or non theraputic
not giving an opinion is considered good theraputic form
table 29-1 describes losses
loss of stuff
loss of enviroment
loss of significant other
loss of aspect of self
loss of life
there are implications to all. what are the implications to loss of life?
loss of life creats grief for those left behind. The person facing death fears pain, loss of control, dependancy on others.
what is grief?
an emotional response to a loss
it has 5 Lubler Ross stages:
denial
anger
bargaining
depression
acceptance
which stage of grief do we act like nothing has happened?
denial, the first stage of grief
describe bargaining as a grief coping mechanism
individual postpones awareness of the reality of the loss and try to deal in ways as thro the loss can be prevented
what is postive about acceptance phase of grief?
accepting loss allows the look into the future
There is the Bowlby's 4 phases of Mourning:
numbing
yearning and searching
disorganization
reorganization
what is yearning & searching
rouses emotional outbursts or tearful sobbing and acute distress
a painful phase but must be endured
nursing knowledge is usually focused on the acute care setting so
losses are more physical in nature
what does losses in the home or community setting involve?
more comprehensive and different
So developing nursing interventions are different for each case!
factors influencing loss grief:
human development
psycosocial perspectives
socioeconomic status
personal relationships
nature of loss
culture & ethnicity
spiritual beliefs ***********
How does spirituality play with loss & grief?
hope and meaning to life
rituals & practices people can depend on for healing
pts/clients w/ strong interconnections to a higher power cope better with loss and grief
It is important for nurses to understand how people cope w/ loss and grief b/c developing interventions will involve ...
reinforcement of patient's successful coping mechanisms and introduction of new coping mechanisms
Hope is defined as anticipation of a continued good. an improvement or lessening of ...
something unpleasant
page 574 has a diagram of critical thinking with assessment in the middle with 4 concepts around it. knowlege experience standard and attitudes
what are these 4 things
these 4 things are sources of information for the nurse that can lead to a selection of appropiate nursing diagoses.
Ex knowledge of which state of greif the client is in enables nurse to better empathize w/ client and family AND id more direct assessment questions.
so attempting to determine what level of grief the client is at (assessment), the level of loss allows a baseline. The tools for the nurse are again knowledge of the grief process, experience of caring for a client experiencing a loss, apply standards outlined in a clinical book for the situation Ex American Pain Society guidelines for managing cancer pain determine what is appropiate for the client
and attitudes. But the nurse should do what?
never assume knowing the grief of a client/family person. Also never assume a particular behavior indicates grief too!
the end game here is to come up with an goal / intervention to help out so the assessment is important. How to DO the assessment is what were talking about
Knowledge of grief process is good
Knowledge of pathophysiology of illness helps
cultural slants to meaning of loss is important
family dynamics knowledge
what does this knowledge do ?
help make a good assessment
Experience in caring for clients in these situations help too like caring for someone who has died or a personnal loss
what should the nurse be asessing, the client's reaction OR how the client SHOULD be reacting? What does this mean???
clients will not follow the listed path to acceptance. They may skip anger or bargaining. Know that applying the levels of grief aids the nurse make an accurate assessment in this situation
Ask the client to describe their loss and how it affects them.
Ex "tell me how your Dx of heart disease makes you feel."
What would be a good thing to say to a client about discussing a loss?
Ask when the loss occured. If the loss is over 2 years ago, its a chronic grief. **********
feelings associated with grief are
sadness
anger
guilt
anxiety
loneliness
fatique
helplessness
shock
yearning
emanicpation
name some physical reactions to grief
hollow in the stomach
tighness in the chest
tightness in throat
sensitive to noise
sense of depesonalization (nothing seems real)
short of breath
muscle weakness
lack of energy
dry mouth
what does pallative care mean
to reduce symptoms with out curing anything
state of Oregon permits physician assisted suicide, an attmept to improve end of life care. what else does Oregon have?
capitated health care which protects the uninsured and makes end of life care assessible for poor people.
end of life care
a nurse must assess client's wishes including:
place to die
use of life support measures
pain control
so what?
if the nurse can't get these answers then they must find an agency that can get these answers to end of life requests.
Next comes the nursing Dx. what is it based on?
the conclusion of the assessment.
the nursing care plan involves
assessment - finding defining
planning - what is our goal?
"wife will accept clients death in the next 48 hours."
what would be the expected outcome?
wife will verbalize to caregiver w/in next 6 hours that husband's death is going to happen.
wife will make a decision about organ donation w/in next 12 hrs
Nursing Dx / Interventions for the nurse are:
display intrest in wife's situation and accept her behavior of denial
est trust and positive regard by creating atmoshpere of sharing. offer privacy & security.
offer wife encouragement to explore feelings of grief
whats next?
Evaluation

nursing action = say to clinet "this is a difficult tiime. Your husbands injury was so sudden.
implementation
how what can a nurse do to promote health here?
nurse can assist client and family in learning about loss, make effective decisions about their health care, and make adjustments to the disappointments, frustrations, and anxiety created by their loss.
name some forms of pallative care for the prevention relief reduction soothing of symptoms
provide relief from pain w/ meds
affirm life and regard death as natural
neither hasten or postpone death
integrate psycho spiritual aspects of care
offer support systems to help client live actively
offer support systems to help client cope
what the difference between grief and depression? pp 244 Frisch
they need different interventions. grief has to thru its stages, person progresses thru stages, exhibiting abagptive behaviors. You don't diagnose depression after 2 months after a loss. abnormal grief can occur. Treatment for depression is different
what is abnormal grief?
chronic grief
delayed grief
exaggerated grief
masked grief
normal grieving can last up to 3 years but one is grieving and the other is a mood disorder OR gieving COMPLICATED by a mood disorder
how can a nurse tell if patient is sucessfully grieving?
recognizes the loss
progress thru stages of grief
uses adaptive coping thinging like keeping busy, talking with others, joining support group
what is abnormal grief?
chronic grief
delayed grief
exaggerated grief
masked grief
normal grieving can last up to 3 years but one is grieving and the other is a mood disorder OR gieving COMPLICATED by a mood disorder
how can a nurse tell if patient is sucessfully grieving?
recognizes the loss
progress thru stages of grief
uses adaptive coping thinging like keeping busy, talking with others, joining support group
There are many factors influencing grief & loss. Different age groups display different unique symptoms of grief. How does toddlers grasp loss?
toddlers are unable to understand loss or death but feel anxiety over loss of objects and parents.
How do infants (birth to 18 months) preceive death?

How can the nurse help?
no comprehension too young

This is about helping parents deal w/ feelings
Toddlers (18 months - 3 years)
preceive death how? autonommy vs shame & doubt

How can a nurse help the Toddler ?
Toddlers are egocentric so
only think of its impact, like the change of lifestyle death might present.

Maintain a normal enviroment, encourage a constant caregiver for child, remember, change in lifestyele issue affects this child
Preschoolers (3 - 6) preceive death how? initiative vs guilt

How can a nurse help the preschooler?
superego or conscience develops at this age group so
they think if they are seriously ill its punsihment
if death comes to someone else may thing they are responsible
fewer defense mechanisms so may act weird to distance themselves from the loss
Help parents deal w/ feelings, encourage them to stay w/ child as much as possible
school age 6-12 years industry vs inferiority
what do school kids thing about loss and death?
still associate bad behavior or thoughts to causing death
they have more fears b/c they have higher cognitive skills
they think more about death and fear it the unknown, intrested in morbid stuf
Help parents deal w/ feelings
encourage kid to discuss their feelings and provide aggressive outlets
encourage patents to not lie about stuff, be honest about death and share sorrow w/ children
adolescents 12-19 identity vs role confusion
understand death but still have magical thinking and subject to guilt & shame. Could see deviations from accepted behavior as a reason someone is sick. How do they cope w/ loss and death?
have the most difficulty dealing with death here, esp if its them
will feel alone in their stuggle
b/c of idealistic young views can critise funeral rituals, money making schemes etc.
nurse to help avoid alliances w/ parent & child
aswer questions honestly and treat them as mature adults biggy
How is a nurse to handle a client that seems whos grief has become dysfunctinal?
seek out a specialist that can deal w/ grief complicated w/ a mood disorder. remember,
chronic grief=never reaches conclusion
delayed grief=
masked grief=masked by another physical looking thing or behavior
exaggerated grief=overwhelming
list several factors influencing a client's reaction to loss?
human development-what we have been discussing so far
psychosocial prespectives-
socialeco status-the poor are less able to cope
presonal relationships-quality of personnal relationships critical at this time, who's your friend or fairweather friend
nature of the loss-
cultural & ethnicity-
spiritual beliefs
spriitual beliefs are a great factor that influences loss and grief. how does belief aid here?
it has to do with connecting the dots b/t loss and the meaning of life. thus believers can cope much better with loss.