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29 Cards in this Set

  • Front
  • Back

Types of Loss


  1. Actual
  2. Perceived
  3. Anticipatory
  4. Situational
  5. Developmental

Actual Loss

Recognized by others

Perceived

Experienced by one person but cannot be verified by others


Ex. Woman leaves job to care for her child

•Anticipatory

–Experiencedbefore loss occurs


–Canbe actual or perceive


Ex. Wife's whose husband is dying may be experiencing actual loss in the anticipation of his death

Situational Loss

–i.e.,Loss of job, death of child, loss of functional ability due to illness

•Developmental Loss

–i.e., Departure of children from home, loss of independence due to aging, retirement, death of aged parents

Loss

an actual or potential situation in which something that is valued is changed or no longer available

Sources of Loss

•Aspectself (body image)


•Externalobjects (loss money, House burnt in fire; death of a pet)


•Familiarenvironment (HS graduate leaves home for school, feels a source of loss)


•Lovedones (b/c of illness, divorce, death, or a disease like Alzheimer's disease, etc.)

Grief

-The total response to the emotional experience related to loss


-It is manifested in thoughts, feelings and behaviors assoc. w/ overwhelming distress or sorrow

Bereavement

The subjective response experienced by the surviving loved ones

Mourning

The behavioral process through which grief is eventually resolved or altered (influenced by culture, spiritual beliefs, and custom)

Anticipatory grief

experienced in advance of the event

Complicated or Pathologic Grief (aka- unhealthy grief)

Exists when the strategies to cope w/ the loss are maladaptive and out of proportion or inconsistent w/ cultural, religious, or age appropriate norms


-Ineffective grieving

Kubler-Ross Stages of Grieving

  1. Denial
  2. Anger
  3. Bargaining
  4. Depression
  5. Acceptance

Engel's Stages of Grieving


  1. Shock and disbelief
  2. Developing awareness
  3. Restitution
  4. Resolving the loss
  5. Idealization
  6. Outcome

Sander's Stages of Grieving


  1. Shock
  2. Awareness of loss
  3. Conservation/ withdrawal
  4. Healing: the turning point
  5. Renewal

Factors Influencing the Loss and Grief Responses

  1. Age
  2. Significance of loss
  3. Culture
  4. Spiritual beliefs
  5. Gender
  6. Socioeconomic status
  7. support systems
  8. Cause of loss/ death

NANADA labels for Dx


  • Grieving
  • Complicated grieving/ Risk for complicated grieving
  • Interrupted Family process
  • Risk-Prone Health Behavior
  • Risk for Loneliness


Nurse's Role facilitating Grief Work

  1. Explore and respect ethnic, cultural, religious, and personal values
  2. Teach what to expect in grief process
  3. Encourage the client to express and share grief with support people
  4. Teach family members to encourage the client's expression of grief
  5. Encourage the client to resume activities on a schedule that promotes physical and psychological health

"Normal" manifestations of grief

-Verbalization of loss


-Crying


-Sleep disturbance


-Loss of appetite


-Difficulty concentrating

Manifestations of "Complicated" Grief

-Extended time of denial


-Depression


-Severe physiologic symptoms


-Suicidal thoughts

Signs of Death

Cessation of



  • Apical pulse
  • Respiration
  • Blood pressure
  • Referred to as heart-lung death

World Medical Assembly Guidelines for Death

•Totallack of response to external stimuli


•Nomuscular movement, especially during breathing


•Noreflexes


•Flatencephalogram


•Ininstances of artificial support, absence of brain waves for at least 24 hours



Cerebral Death

•Occurswhen cerebral cortex is irreversibly destroyed


•Permanentloss of cerebral and brainstem function


–Absenceof responsiveness to external stimuli –Absenceof cephalic reflexes


–Apnea


•IsoelectricEEG for at least 30 minutes in the absence of hypothermia and poisoning by CNSdepressants

3 types of Awareness

•Threetypes of awareness


–Closedawareness


Client not aware of impending death


–Mutualpretense


Client, family, and health personnel knowthe prognosis is terminal but do not talk about it


–Openawareness


Client and others know about theimpending death and feel comfortable discussing it

Impending Clinical Death

•Lossof muscle tone


•Slowingof the circulation


•Changesin respirations


•Sensoryimpairment

Dx: -CLIENT

–Fear


–Hopelessness


–Powerlessness

Dx: Caregivier

–Riskfor Caregiver Role Strain


–InterruptedFamily Processes

Palliative Care strategies

•Identifypersonal feelings about death


•Focuson client’s needs


•Talkto the client or family about how the client usually copes with stress


•Establishcommunication relationship•Determinewhat client knows about illness•Respondwith honesty and directness


•Maketime to be available