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62 Cards in this Set
- Front
- Back
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loss
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occurs when a valued person, object,or situation is changed or made inaccessible so that its value is diminished or removed
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actual loss
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recognized by others as well as by the person sustaining the loss
ex. loss of a limb, of a spouse, of a valued object such as money, and of a job |
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perceived loss
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felt by the person but is intangible to others
ex. intagible to others; loss of youth, of financial independence, and of a valued enviroment |
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physical loss and phychological loss
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a person who loses an arm in an automobile accident suffers both
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physical loss
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losing a body part
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psychological loss
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caused by an altered self-image and the inability to return to his or her occupation
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maturational loss
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experienced as a result of natural developmental processes
ex. the 1st child may experience a loss of status when a sibling is born, parent sense of loss when a child begins school |
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situational loss
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is experienced as a result of an unpredictable event
ex. traumatic injury, disease, death or national disaster |
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anticipatory loss
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a person displays loss and grief behaviors for a loss that has yet to take place.
-often seen in the families of patients with serious and life-threatening illnesses and serves to lessen the impact of the actual loss of a family member |
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grief
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the emotional reaction to loss. it occurs with loss caused by separation as well as with loss caused by death
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bereavement
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the state of grieving during which a person goes through a grief reaction
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mourning
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is the period of acceptance of loss and grief during which the person learns to deal with the loss
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Engel six stages of grief
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1)shock and disbelief-refusal to accept the fact of loss, followed by a stunned or numb response
2) developing awareness-physical and emotional responses such as anger, feeling, empty, and crying 3)restitution-the rituals surrounding loss includes religious, cultural, or social expressions of mourning 4)resolving the loss-dealing with the void left by the loss 5)the exaggeration of the good qualities that the person or object had 6) outcome-the final resolution of the grief process, includes dealing with loss as a common life occurence |
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abbreviated grief
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short duration but is genuine
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anticipatory grief
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occurs before the actual loss, as in the extended terminal illness of a family member
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dysfunctional grief
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is abnormal or distorted; it may be either unresolved or inhibited
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unresolved grief
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a person may have trouble expressing feelings of loss or may deny them, also describes a state of bereavemnt that extends over lengthy period
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inhibited grief
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a person suppresses felling of grief and may instead manifest somatic symptoms
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death
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as present when an individual has sustained either
1-irreverible cessation of circulatory and respiratory functions 2-irrevesible cessation of all functions of the entire brain, including the brainstem |
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traditional heart-lung definition
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the irreversible cessation of spontaneous respiration and circulation
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whole-brain definition
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irreversible cessation of all functions of the entire brain
1)require 2 separate clinical examinations, including induction of painful stimuli, pupillary responses, to light, oculovestibular testing, and apnea tesing |
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Harvard committee stated that the following characteristics must be present for at least 24 hours before death can be decleared:
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-lack of receptivity and responsivness
-lack of movement or breathing -lack of reflexes -flat encephalogram |
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higher-brain death
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the irreversible loss of all "higher" brain functions, of cognitive function
-critical functions are the indiviual's personality, conscious life, uniqueness and capacity fro remembering, judging, reasoning, acting, enjoying, and worrying |
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clinical signs of impending or approaching death
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-inability to swallow
-pitting edema -decreased GI and urinary tract activity -bowel and bladder incontinence -loss of motion, sensation, and reflexes -elevated temp., but cold or clammy skin; cyanosis -lowered blood pressure -noisy or irregular respiration -Cheyne-Stokes respirations |
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Cheyne-Stokes respirations
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alternating period of deep rapid breathing followed by apnea
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6 major components of a good death
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1)pain and symptom management
2)clear decision making 3)preparation for death 4)completion 5)contributing to others 6)affirmation of the whole person -each are process-oriented attributes of good death, and each has biomedical, psychological, social, and spiritual components 0 |
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Kubler-Ross's 5 stages of grief
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1)denial and isolation-the pt denies that he/she will die, may repress what is discussed, and may isolate himself/herself from reality
2)anger stage-the pt expresses rage and hostility and adopts a "why me?" attitude 3)bargaining stage- the pt. tries to barter for more time. many pt. put their personal affairs in order, make wills, and fulfill last wishes(trips, visiting relatives, and so forth 4)depression stage- the pt. goes through a period of grief before death. the grief is often characterized by crying and not speaking much 5)acceptance stage- the pt feels tranquil. she/he has accepted death and is prepared to die |
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terminal illness
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an illness in which death is expected within a limited space of time, the md is usually responsible for deciding what, when, and how the pt. should be told. nurses and other healthcare professionals may be involved with decision making so that they can begin appropriate planning and take care should know exactly what the patient and the family have been told
-cultural influences may indicate how much information is desired and which family members are to be informed. |
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terminal illness and impact on pt.
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pt. must be allowed to go through the stages of the greiving process and to make decision making. Competent pt. have the right to consent to and refuse any and all indicated medical treatment- and should be made aware of this right.
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palliative care
(aka hospice care) |
taking care of the whole person-body, mind, spirit, heart and soul. the goal- give pts. with life threatening illnesses the best quality of life they can have by the aggressive management of symptoms
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5 principles of palliative care
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1) repect the goals, likes, and choices of the dying person and his or her loved ones.. helping them to understand the illness and what can be expected from it important during this time
2)looks after medical, emotional, social, and spiritual needs of the dying person..with a focus on making sure he/she is comfortable, not left alone, and able to look back on his/her life and find peace 3)supports the needs of family members..helping them with the responsibilities of caregiving and even supporting them as they grieve 4)gain access to needed health-care providers and appropriate care setting.. invovloving various kinds of trained providers in different setting, tailored to the needs of the pt. and his/her family 5)builds ways to provide excellent care at the end of life...through education of care providers, appropriate health policies, and adequate funding from insurers and the goverment |
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advance directives
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minimize difficulties by allowing individuals to state in advance what thier choices would be for healthcare should certain circumstances develop.
-decide the kind of med. treat the pt. wants or doesn't want -decides how comfortable the pt. wants to be -decides how the pt. will be treated by others -decide what the pt. wants loved ones to know **b/c the status of advance directives varies from state to state, it is important for nurses to be familiar with federal and state laws concerning these directives. |
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living will
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specific instructions about the kinds of healthcare that should be provdied or forgone in particular situations.
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combination directive
5 wishes |
1. the person I want to make care decisions for me when I can't
2. the kind of medical treatment I want or don't want 3. how comfortable I want ot be 4. How I want people to treat me 5. What I want my loved ones to know |
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do-not-resuscitate order
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means simply that; no attempts are to be made to resuscitate a pt. who stops breathing or whose heart stops breathing
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slow-code
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a md who believes the pt. will not benefit from resuscitative measure may indcate verbally to the nurse that this hould be called; in the case of cardiopulmonary or respiratory arrest, calling a code and resuscitating the pt. are to be delayed until these measures will be ineffectual.
-never good practice, and many healthcare institutions now have policies forbidding their use. it is likely that a nurse could be charged with negligence in the event of a slow-code and resultant pt. death. |
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standard of care
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obligates healthcare professionals to attempts resuscitatiion it a pt. stops breathing or his/her heart stops(cardiopulmonary arrest) and there is no DNR order to the contrary
-it is important for nurses to clarigy a pt's code status |
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comforts-measures-only order
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which indicates that the goal of treatment is a comfortable, dignified death and that further life-sustaining measures are no longer indicated
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do-not-hospitalize order
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used by pts. in nurising homes and other residential settings who have elected not to be hospitalized for further aggressive treatment
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terminal weaning
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the gradual withdrawl of mechanical ventilation from a pt. with a terminal illness or an irreversible condition with a poor prognosis
-competent pts. and family members should be prepared for all possiblites in regards to the weaning. -a nurse's role in terminal weaning is to participate in the decision-making process by offering helpful information about the benefits and burdens of continued ventilation and a description of what to expect if terminal weaning is initiated. supporting family is very important. nurses invovled in terminal weaning should consult the literature and be familiar with the latest research |
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euthanasia
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means "good dying".
most societies maintained that the distiction bewteen "killing" and "allowing to die" was morally relevant. |
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passive euthanasia
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the withholding or withdrawing of medically ineffective or disproportionately burdensome therapies, was morally and legally justified even when this hastened or directly caused a pt's death
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relationship between assisted suicide and active euthanasia
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both deemed immoral and illegal
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assisted suicide
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making a lethal combination of drugs available to a pt. wishing to die
-the clinician provides the means the patient used to cause her own death ex. provides a rx for a lethal dose of barbituates |
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active euthanasia
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administering a lethal injection or carbon monoxide, even when performed with compassionate intent at the request of a pt.
-the clinician acts directly to cause the death of the pt. ex. administers a lethal dose of med |
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arguments in favor of assisted suicide and acetive euthansia
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it is a bebeficient and compassionate act; that it respects autonomy by preserving the pts. control of the manner, method, and timing of death
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arguments against assisted suicide and active euthanasia
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argue that it undermines the value of, and respect for, all human life
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ANA position on assisted death
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assisting in suicide and participating in active euthanasia are in violation of the Code for Nurses, the ethical traditions and goals of the profession, and its covenant with society
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developmental considerations
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-children do not understand death on the same level as adults do, but their sense of loss is just as great
-older adults may lose a spouse or friends and relatives their own age. -they reminisce about life, put their lives and the purpose of living in perspective, and prepare themselves for their own inevitable death |
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family
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roles have an important impact on a person's reactions to and expression of grief
-the death of a child is usually a devastating experience for the family |
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SOCIOECONOMIC FACTORS
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A BEREAVED FAMILY MAY SUFFER MORE ACUTELY IF THERE IS NO HEALTH OR LIFE INSURANCE OR PENSION AFTER THE DEATH OF THE FAMILY PROVIDER
-OLDER PEOPLE ESPECIALLY MAY BE PLACED DIFFICULT POSITION B/C THE DEATH OF A SPOUSE MAY RESULT IN THE DECREASE OR EVEN ELIMINATION OF A SOURCE OF RETIREMENT INCOME FOR THE SURVIVING SPOUSE |
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CULTURE INFLUENCES
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WESTERN CULTURE, GRIEF IS A PRIVATE MATTER SHARED ONLY WITH THE FAMILY, ON THE OTHER HAND, CULTURAL BACKGROUND MAY NECESSITATE THAT THE PT.'S AND FAMILY'S PUBLIC DISPLAY BE EMOTIONAL AND DISTRESSED, WITH LOUD WEEPING AND MOARNING
MEX-AMERICANS WERE GENERALLY MORE POSITIVE ABOUT THE USE OF LIFE SUPPORT AND WERE MORE LIKELY TO PERSONALLY WANT SUCH TREATMENTS EURO-AMERICANS, KOREAN-AMERI WERE VERY POSITIVE REGARDING LIFE SUPPORT, BUT DID NOT WANT TECHNOLOGY SUPPORT -EURO-AMERI,AFRICAN-AMERI- FELT THAT IT WAS GENERALLY ACCEPTABLE TO WITHHOLD OR WITHDRAW LIFE SUPPORT BUT WERE THE MOST LIKELY TO WANT TO BE KEPT ALIVE ON LIFE SUPPORT |
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RELIGIOUS INFLUENCES VS GRIEF
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THEY PLAY AN IMPORTANT ROLE IN THE EXPRESSION OF GRIEF AND PROVIDE COMFORT AND SOLACE TO THE PERSON EXPERIENCING LOSS. MANY PEOPLE WHO HAVE PUT SPIRITUAL MATTERS IN THE BACKGROUND HAVE A HARDER TIME DEALING WITH DEATH
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CAUSE OF DEATH VS GREIVING
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*SUDDEN DEATH INVOLVE SHOCK AND NORMAL GRIEVING
*DEATH FROM DISEASE MAY GENERATE SEVERAL TYPES OF RESPONSE INCLUDING THE BELIEF THAT THE DEATH IS A PUNISHMENT, TERROR AND PANIC AND GUILT *ACCIDENTAL DEATH IS OFTEN ASS. W/FEELING OF BAD LUCK |
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PHYSIOLOGIC NEEDS OF DYING PT
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HYGIENE NEEDS-CLEANLINESS OF THE SKIN, HAIR, MOUTH, NOSE, AND EYES. FREQUENT BATHS AND LINEN CHANGES MAY BE NEEDED
PAIN- THE MD WILL DETERMINE THE MED AND DOSAGE NEEDED NUTRITION AND FLUIDS- ENCOURAGED TO TAKE SIPS OF H2O IF STILL ABLE TO SWALLOW. PT. MAY SAY STOP MOVEMENT- SHOULD BE DONE REGULALY TO PREVENT PRESSURE ULCERS ELIMINATION- DEVELOPMENT OF INCONTINENCE, CONSTIPATION, AND URINARY RETENTION RESP CARE- SEMI-FOWLER'S POSITION(CONSCIOUS PT) SIMEPRONE POSITION (UNCONSCIOUS PT) |
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PSYCHOLOGICAL NEEDS OF DYING
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PT. NEEDS CONTROL OVER FEAR OF THE UNKNOWN PAIN, SEPRATION, LEAVING LOVED ONES, LOSS OF DIGNITY, LOSS OF CONTROL, UNFINISHED BUSINESS, ISOLATION
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SEXUAL NEEDS OF DYING
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PT. NEEDS WAY TO BE PHYSICALLY INTIMATE THAT MEETS NEEDS OF BOTH PARTNERS
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SPIRITUAL NEEDS OF DYING
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PT. NEEDS TO PRACTICE RELIGIOUS FAITH
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TRUSTING NURSE-PT RELATIONSHIP
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EXPLAIN THE PT CONDITION AND TREATMENT
TEACH SELF-CARE AND PROMOTING SELF-ESTEEM TEACH FAMILY MEMBERS TO ASSIST IN CARE MEET THE NEEDS OF DYING PT MEET FAMILY NEEDS |
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PROVIDING POSTMORTEM CARE
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CARE OF BODY-REMOVE ALL TUBING AND CHANGE BANDAGES IF PERMITTED (NO AUTOPSY),place body in anatomic position to avoid pooling of blood, solid dressings are replaced,
nurse is legalley responsible for placing idntifying tags, dentures should be tagged unless autopsy done. body in fridge. |
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care of family postmortem
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nurse provides support and care of the pt.'s family, w/listening to family expression's of grief, loss, and helplessness. be an attentive listener
arrange for family members to view the body in case of sudden death, provide a private place for family to begin grieving it is appropriate for the nurse to attend the funeral and make a follow-up visit to the family |
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care of other pt postmortem
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nurse must continue to provide care to the other patiens. they are aware of a death and may need to be consoled.
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