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71 Cards in this Set
- Front
- Back
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What is perinatal loss?
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Death of a fetus or infant through the 28th day after birth
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What are the types of perinatal loss?
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1. Ectopic pregnancy
2. Fetal death 3. Miscarriage 4. Induced abortion 5. Stillbirth |
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What is "hidden" or "silent" loss?
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Termination of pregnancy in the early months in which friends and family of the woman may not even know about the pregnancy or subsequent loss
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What is stillbirth?
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The birth of a baby after 20 weeks of gestation and 1 day or weighing 350 g (depending on the state code) that does not show any signs of life
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Why is stillbirth devastating?
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Because it occurs suddenly and late in pregnancy when expectant parents are preparing for the birth of a healthy infant
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What is the primary cause of infant death?
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Birth defects
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What are the other causes of infant death?
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1. Sudden infant death syndrome (SIDS)
2. Maternal complications of pregnancy 3. Respiratory distress syndrome (RDS) |
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What is grief?
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The painful emotions and related behavioral and physical responses to a major loss
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Why is grief so difficult regarding perinatal loss?
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1. Societal belief that there are no barriers to getting pregnant
2. The expectation that once a woman is pregnant, the outcome will be a healthy live infant 3. Society tends to minimize perinatal loss and to lack understanding of the associated pain |
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What is bereavement?
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A cluster of painful responses experienced by individuals coping with the death of a relative or close friend
(also known as GRIEF) |
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What are the stages of grief or bereavement regarding perinatal loss?
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1. Phase of acute distress
2. Phase of intense grief 3. Reorganization |
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What do parents experience during the phase of acute distress?
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1. Shock
2. Numbness 3. Intense crying 4. Depression |
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What do parents experience during the phase of intense grief?
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1. Loneliness, emptiness, and yearning
2. Guilt 3. Anger, resentment, bitterness, irritability 4. Fear and anxiety (especially about being pregnant again) 5. Disorganization 6. Difficulties with cognitive processing 7. Sadness and depression 8. Physical symptoms |
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What do parents experience during reorganization?
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1. Search for meaning
2. Reduction of distress 3. Reentering normal life activities with more enthusiasm 4. Can make future plans, including decision about another pregnancy |
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How do some fathers respond to perinatal loss?
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They are distressed by the grief of the mother and often feel helpless as to how to help her with the intense pain
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What are the signs of problematic grieving?
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1. Withdrawal
2. Reliance on alcohol or drugs 3. Extramarital affairs 4. Prolonged hours at work 5. Overinvolvement in activities outside the home as an escape |
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What is "bittersweet grief"?
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The grief response that occurs with the reminders of the loss, which typically occurs on the anniversary dates r/t the loss
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What is "survivor guilt"?
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Guilt experienced by grandparents because they feel that death is out of order as they are still alive and their grandchild has died
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What should nurses assess with parents experiencing perinatal loss?
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1. The meaning of the pregnancy and infant to the parent
2. The meaning of the loss 3. Circumstances of the loss 4. Immediate responses of the parents to the loss 5. Social support network of the parent |
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What are the nursing diagnoses of perinatal loss?
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1. Anxiety
2. Ineffective family coping 3. Powerlessness 4. Interrupted family processes 5. Ineffective sexuality patterns between the mother and father 6. Fatigue 7. Disturbed sleep patterns 8. Dysfunctional grieving 9. Situational low self-esteem 10. Spiritual distress 11. Disturbed thought processes |
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What are the expected outcomes for parents experiencing perinatal loss?
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1. Actualize the loss
2. Feeling of support 3. Share experiences and verbalizes feelings 4. Understand the normal grief responses 5. Demonstrates increasing independence 6. Identify resources for support 7. Verbalize satisfaction with the care and support of professionals |
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What is one way of actualizing the loss?
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Tell the parents the sex of the baby and give them the option of naming the fetus or to help them to name the infant who has died
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What must nurses be aware of regarding naming an infant that has died?
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Cultural taboos and rules in some religious faiths prohibit the naming of an infant that has died
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What offers parents an opportunity for closure?
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Seeing the fetus/baby
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How can nurses convey to the parents that their baby (although dead) has been cared for in a special way?
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1. Bathing the baby
2. Applying lotion to the baby's skin 3. Combing baby's hair 4. Placing identification bracelets on the arm and leg 5. Dressing the baby in a diaper or special outfit 6. Sprinkling powder in the baby's blanket 7. Wrapping the baby in a pretty blanket |
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What is the purpose of the use of powder or lotions?
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Stimulates the parents senses and provides pleasant memories of their baby
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What is used to help position the dead baby?
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Cold cream rubbed over stiffened joints
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How long should parents be given to spend with their baby?
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It is difficult to predict the amount of time parents need - some only a few minutes, others hours
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What decision do parents need help with after their baby has died?
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1. Conducting an autopsy
2. Organ donation 3. Spiritual rituals 4. Disposition of the body |
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What is one of the most important goals of the nurse to help the bereaved parents?
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To validate the experience and feelings of the parents by encouraging them to tell their stories and listening with care
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What to say to bereaved parents:
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1. I'm sad for you
2. How are you doing with all of this? 3. This must be hard for you 4. What can I do for you? 5. I'm sorry 6. I'm here, and I want to listen |
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What NOT to say to bereaved parents:
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1. God had a purpose for her/him
2. Be thankful you have another child 3. The living must go on 4. I know how you feel 5. It's God's will 6. You have to keep on going for her sake 7. You're young, you can have others 8. We'll see you back next year, and you'll be happier 9. Now you have an angel in heaven 10. This happened for the best 11. Better for this to happen now, before you knew the baby 12. There was something wrong with the baby anyway |
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What are the five stages of grief?
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1. Denial
2. Anger 3. Bargaining 4. Depression 5. Acceptance |
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What is denial?
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A person acts as though nothing has happened and refuses to accept the fact of the loss. The person shows no understanding of what has occurred.
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What is anger?
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When experiencing the anger stage of adjustment to loss, a person expresses resistance and sometimes feels intense anger at God, other people, or the situation.
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What is bargaining?
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Bargaining cushions and postpones awareness of the loss by trying to prevent it from happening. Grieving or dying people make promises to self, God, or loved ones that they will live or believe differently if they can be spared the dreaded outcome.
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What is depression?
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When a person realizes the full impact of the loss, depression occurs. Some individuals feel overwhelmingly sad, hopeless, and lonely. Resigned to the bad outcome, they sometimes withdraw from relationships and life.
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What is acceptance?
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The person incorporates the loss into life and finds ways to move forward.
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What are the components of a caring concept?
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1. Knowing
2. Being with 3. Doing for 4. Enabling 5. Maintaining belief |
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What is knowing?
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Implies that the nurse has taken the time to understand the perception of the loss and its meaning to the woman and her family
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What is being with?
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Involves how the nurse conveys acceptance of the various feelings and perceptions of each family member
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What is doing for?
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Refers to the activities performed by the nurse that provide physical care, comfort, and safety for the woman and her family
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What is enabling?
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Occurs when the nurse offers the woman and her family options for care
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What is maintaining belief?
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Involves encouraging the woman and her family to believe in their own ability to pick up the pieces and begin to heal
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How is sensitive care provided at discharged for a bereaved mother?
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1. Avoid sending her home when other moms with live babies are leaving
2. Give her a special flower to carry in her arms as a thoughtful gesture |
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What is the first step for the nurse in caring for the bereaved adolescent?
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To acknowledge the significance of giving birth, no matter what age the mother might be
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What is the second step for the nurse in caring for a bereaved adolescent?
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Make additional efforts to develop a trusting relationship in working with the adolescent
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What is the third step for the nurse in caring for a bereaved adolescent?
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Offer options for saying good-bye, anticipatory grief, support, and information to meet the adolescent at the point of her need
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Why might adolescents take longer to process their grief?
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Because of their level of cognitive and emotional maturation
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What is complicated bereavement?
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Extremely intense grief reactions that last for a very long time
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What factors put women at risk for depressive symptoms after a miscarriage?
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1. Higher personal significance to the loss
2. Lack of social support 3. Lower emotional strength 4. Passive coping styles 5. Low-income 6. Not conceiving another pregnancy by a year later |
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What are the evidence of complicated grief?
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1. Continued yearning and loneliness
2. Intense and continued guilt or anger 3. Relentless depression or anxiety that interferes with role functioning 4. Abuse of drugs or alcohol 5. Severe relationship difficulties 6. High depressive symptomatology 7. Low self-esteem 8. Feelings of inadequacy 9. Suicidal thoughts or threats years after the loss has occurred |
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What are the symptoms of posttraumatic stress?
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1. Reliving the trauma
2. Avoiding things and places that are reminders 3. Disassociation |
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What must nurses be aware of regarding care for bereaved families?
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Aware of their own feelings of grief and loss to provide nonjudgmental environment of care and support of bereaved families
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What is the effect of loss of one in a multiple birth?
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1. Such a death imposes a confusing and ambivalent induction into parenthood
2. Parents may feel torn regarding how they should feel |
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What is the complication regarding bereaved parents of loss of one in a multiple birth?
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Parents may have difficulty parenting their surviving child with all the joy and enthusiasm of new parents because they can't fully grieve their loss while responding to the demands of the surviving child
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What should NOT be said to parents who have lost one child in a multiple birth?
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"Well, at least you have the other baby"
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A family is visiting two surviving triplets. The third triplet died 2 days ago. What action indicates that the family has begun to grieve for the dead infant?
a. They refer to the two live infants as twins b. They ask about the dead triplet’s current status c. They bring in play clothes for all three infants d. They refer to the dead infant in the past tense |
ANS: D
Accepting that the infant is dead (in the past tense of the word) demonstrates acceptance of the reality and that the family has begun to grieve. Parents of multiples are challenged with the task of parenting and grieving at the same time. Referring to the two live infants as twins does not acknowledge acceptance of the existence of their third child. Bringing in play clothes for all three infants indicates that the parents are still in denial regarding the death of the third triplet. The death of the third infant has imposed a confusing and ambivalent induction into parenthood for this couple. Clearly they are still in denial regarding the death of one of the triplets. |
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2. A newborn in the neonatal intensive care unit (NICU) is dying as a result of a massive infection. The parents speak to the neonatologist, who informs them of their son’s prognosis. When the father sees his son, he says, “He looks just fine to me. I can’t understand what all this is about.” The most appropriate response by the nurse is:
a “Didn’t the doctor tell you about your son’s problems?” b. “This must be a difficult time for you. Tell me how you’re doing.” c. To stand beside him quietly d. “You’ll have to face up to the fact that he is going to die sooner or later.” |
ANS: B
The phase of intense grief can be very difficult, especially for fathers. Parents should be encouraged to share their feelings as the initial steps in the grieving process. This father is in a phase of acute distress and is “reaching out” to the nurse as a source of direction in his grieving process. Shifting the focus is not in the best interest of the parent. Nursing actions may help the parents actualize the loss of their infant through sharing and verbalization of feelings of grief. |
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3. A woman experienced a miscarriage at 10 weeks of gestation and had a dilation and curettage (D&C). She states that she is just fine and wants to go home as soon as possible. While you are assessing her responses to her loss, she tells you that she had purchased some baby things and had picked out a name. Based on your assessment of her responses, what nursing intervention would you do for her first?
a. Ready her for discharge b. Notify pastoral care to offer her a blessing c. Ask her if she would like to see what was obtained from her D&C d. Ask her what name she had picked out for her baby |
ANS: D
One appropriate way of actualizing the loss is to allow parents to name the infant. The nurse should follow this client’s cues and inquire about naming the infant. The client is looking for an opportunity to express her feelings of loss. The nurse should take this opportunity to offer support by allowing the woman to talk about her feelings. Getting the woman ready for discharge is not a priority nursing intervention at this time. |
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During the initial acute distress phase of grieving, parents still must make unexpected and unwanted decisions about funeral arrangements and even naming the baby. The nurse’s role should be to:
a Take over as much as possible to relieve the pressure b Encourage grandparents to take over c.Make sure the parents themselves approve the final decisions d.Leave them alone to work things out |
ANS: C
The nurse is always the client’s advocate. Nurses can offer support and guidance and leave room for the same from grandparents. In the end, however, nurses should let the parents make the final decisions. It is essential the nurse be able to present options regarding burial, autopsy, and so on in a sensitive and respectful manner. The nurse should assist the parents in any way possible; however, it is not the nurse’s role to take over all arrangements. |
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A nurse concludes that grieving parents have progressed to the reorganization/recovery phase during a follow-up visit a year later if:
a.They say they feel no pain b.They are discussing sex and a future pregnancy, even if they have not sorted out their feelings yet c.They have abandoned those moments of bittersweet grief d.Their questions have progressed from “why?” to “why us?” |
ANS: B
Many couples have conflicting feelings about sexuality and future pregnancies. A little pain is always present, certainly past the first year, when recovery begins to peak. Bittersweet grief describes the brief grief response that occurs with reminders of a loss, often on anniversary dates. Most couples never abandon it. Recovery is ongoing. Typically a couple’s search for meaning progresses from “why?” in the acute phase to “why me?” in the intense phase to “What does this loss mean to my life?” in the reorganizational phase. |
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A nurse caring for a family during a loss might notice that survivor guilt is sometimes experienced by the infant’s:
a.Siblings b Mother c.Father d.Grandparents |
ANS: D
Survivor guilt sometimes is felt by grandparents because they feel that the death is out of order as they are still alive while their grandchild has died. They are angry that they are alive and their grandchild is not. |
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7. When helping the mother, father, and other family members actualize the loss of the infant, nurses should:
a. Use the words lost or gone rather than dead or died b. Make sure the family understands that it is important to name the baby c.If the parents choose to visit with the baby, apply powder and lotion to the baby and wrap the infant in a pretty blanket d.Set a firm time for ending the visit with the baby so that the parents know when to let go |
ANS: C
Presenting the baby in a nice way stimulates the parents’ senses and provides pleasant memories of their baby. Nurses must use dead and died to assist the bereaved in accepting reality. Although naming the baby can be helpful, it is important not to create the sense that parents have to name the baby. In fact, some cultural taboos and religious rules prohibit the naming of an infant who has died. |
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8. Nurses who want to help parents with their decision making about an autopsy or who may be required to be involved in seeking consent for autopsies should be aware that:
a.Autopsies are usually covered by insurance b.Autopsies must be done within a few hours after delivery c.In the current litigious society, more autopsies are performed than in the past d.Some religions prohibit autopsy |
ANS: D
Some religions prohibit autopsy or limit the choice to times when it may help prevent further loss. The cost of the autopsy must be considered because it is not covered by insurance and can be very expensive. There is no rush to perform an autopsy unless evidence of contagious disease or maternal infection is present at the time of death. The rate of autopsies is declining, in part because of medical facilities’ fear that errors by the staff might be revealed, resulting in litigation. |
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With regard to organ donation after an infant’s death, nurses should be aware that:
a.Federal law requires medical staff to ask the parents about organ donation and then to contact their state’s organ procurement organization (OPO) to handle the procedure if the parents agree b.Organ donation can aid grieving by giving the family an opportunity to see something positive about the experience c.The most common donation is the infant’s kidneys d.Corneas can be donated if the infant was either stillborn or alive as long as the pregnancy went full term |
ANS: B
Some see organ donation as a healing experience. The federal Gift of Life Act made state OPOs responsible for deciding whether to request a donation and for making that request. The most common donation is the cornea. For cornea donation the infant must have been born alive at 36 weeks of gestation or later. |
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10. What is appropriate for a nurse to say to bereaved parents?
a.“This happened for the best.” b “God had a purpose for him.” c.“I know how you feel.” d.“What can I do for you?” |
ANS: D
Acknowledging the loss and being open to listening is the best the nurse can do. No bereaved parent would find that comforting. Nurses should resist the temptation to give advice or to use clichés. Nurses must resist the impulse to speak for God to people in pain. They also should resist the temptation to give advice or to use clichés. Unless you have lost a child yourself, you don’t. Nurses should resist the temptation to give advice or to use clichés. |
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11. In helping bereaved parents cope and move on, nurses should keep in mind that:
a.A perinatal or parental grief support group is more likely to be helpful if the needs of the parents are matched with the focus of the group b.When pictures of the infant are taken for keepsakes, no close-ups should be taken of any congenital anomalies c.No significant differences exist in grieving individuals from various cultures, ethnic groups, and religions d.In emergency situations, nurses who are so disposed must resist the temptation to baptize the infant in the absence of a priest or minister |
ANS: A
For example, a religious-based group may not work for nonreligious parents. Close-up pictures of the baby must be taken as the infant was, congenital anomalies and all. Although death and grieving are events shared by all people, mourning rituals, traditions, and taboos vary by culture, ethnicity, and religion. Differences must be respected. Baptism for some religious groups can be performed by a layperson, such as a nurse, in an emergency situation when a priest is not available. |
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12. Many women and their partners, whether infertile or not, will experience perinatal loss. The nurse who cares for these families should understand that those experiencing a “silent” or “hidden” loss will also grieve and require the support of caregivers, family, and friends. A(n) _________________ is not an example of a silent loss.
a.Ectopic pregnancy b.Stillbirth c.Miscarriage d.Induced abortion |
ANS: B
Stillbirth is particularly devastating because it occurs suddenly and at the end of the pregnancy. It is not a silent loss because the expectant parents and their family are preparing for the delivery of a healthy infant. Approximately 20 of each 1000 pregnancies result in an ectopic pregnancy, which are those that take place outside the uterus, most commonly in a fallopian tube. Others in the woman’s network may not yet have knowledge of the pregnancy and subsequent loss. Hidden or silent losses are those that occur early in the pregnancy. Approximately 15% of pregnancies end in miscarriage. This is also a hidden loss because miscarriage occurs early in the pregnancy. Families and friends may not feel comfortable bringing up the loss with the woman or her partner. Feelings of helplessness or loss of control are common, especially if there is no identified cause for the miscarriage. The nurse must be supportive especially if the couple has had repeated miscarriages. Abortions are induced for a number of reasons, often for congenital anomalies. This often occurs earlier in the pregnancy prior to many in the mother’s support network having knowledge of the event. |
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1. The term _________________________ refers to the grief response that occurs with reminders of loss. This typically happens on special anniversary dates of the loss.
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Bittersweet grief
Parents have shared that they will never forget the baby who has died, and they are not the same people as before the loss. Grief feelings also can be triggered during subsequent pregnancies and after birth as well as on anniversaries. |
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1. Society tends to minimize perinatal loss because of the prevailing belief that there are no barriers to getting pregnant and the expectation that once a woman is pregnant, a healthy, live infant will result. Is this statement true or false?
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ANS: T
Because of these perceptions, grieving parents often do not receive the support they need, and society often allows much too short a time for mothers to grieve (and even less for fathers). |
