N303 - Ch 41 Ob

Front 1

What is perinatal loss?

Back 1

Death of a fetus or infant through the 28th day after birth

Front 2

What are the types of perinatal loss?

Back 2

1. Ectopic pregnancy
2. Fetal death
3. Miscarriage
4. Induced abortion
5. Stillbirth

Front 3

What is "hidden" or "silent" loss?

Back 3

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

Front 4

What is stillbirth?

Back 4

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

Front 5

Why is stillbirth devastating?

Back 5

Because it occurs suddenly and late in pregnancy when expectant parents are preparing for the birth of a healthy infant

Front 6

What is the primary cause of infant death?

Back 6

Birth defects

Front 7

What are the other causes of infant death?

Back 7

1. Sudden infant death syndrome (SIDS)

2. Maternal complications of pregnancy

3. Respiratory distress syndrome (RDS)

Front 8

What is grief?

Back 8

The painful emotions and related behavioral and physical responses to a major loss

Front 9

Why is grief so difficult regarding perinatal loss?

Back 9

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

Front 10

What is bereavement?

Back 10

A cluster of painful responses experienced by individuals coping with the death of a relative or close friend

(also known as GRIEF)

Front 11

What are the stages of grief or bereavement regarding perinatal loss?

Back 11

1. Phase of acute distress
2. Phase of intense grief
3. Reorganization

Front 12

What do parents experience during the phase of acute distress?

Back 12

1. Shock
2. Numbness
3. Intense crying
4. Depression

Front 13

What do parents experience during the phase of intense grief?

Back 13

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

Front 14

What do parents experience during reorganization?

Back 14

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

Front 15

How do some fathers respond to perinatal loss?

Back 15

They are distressed by the grief of the mother and often feel helpless as to how to help her with the intense pain

Front 16

What are the signs of problematic grieving?

Back 16

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

Front 17

What is "bittersweet grief"?

Back 17

The grief response that occurs with the reminders of the loss, which typically occurs on the anniversary dates r/t the loss

Front 18

What is "survivor guilt"?

Back 18

Guilt experienced by grandparents because they feel that death is out of order as they are still alive and their grandchild has died

Front 19

What should nurses assess with parents experiencing perinatal loss?

Back 19

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

Front 20

What are the nursing diagnoses of perinatal loss?

Back 20

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

Front 21

What are the expected outcomes for parents experiencing perinatal loss?

Back 21

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

Front 22

What is one way of actualizing the loss?

Back 22

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

Front 23

What must nurses be aware of regarding naming an infant that has died?

Back 23

Cultural taboos and rules in some religious faiths prohibit the naming of an infant that has died

Front 24

What offers parents an opportunity for closure?

Back 24

Seeing the fetus/baby

Front 25

How can nurses convey to the parents that their baby (although dead) has been cared for in a special way?

Back 25

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

Front 26

What is the purpose of the use of powder or lotions?

Back 26

Stimulates the parents senses and provides pleasant memories of their baby

Front 27

What is used to help position the dead baby?

Back 27

Cold cream rubbed over stiffened joints

Front 28

How long should parents be given to spend with their baby?

Back 28

It is difficult to predict the amount of time parents need - some only a few minutes, others hours

Front 29

What decision do parents need help with after their baby has died?

Back 29

1. Conducting an autopsy
2. Organ donation
3. Spiritual rituals
4. Disposition of the body

Front 30

What is one of the most important goals of the nurse to help the bereaved parents?

Back 30

To validate the experience and feelings of the parents by encouraging them to tell their stories and listening with care

Front 31

What to say to bereaved parents:

Back 31

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

Front 32

What NOT to say to bereaved parents:

Back 32

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

Front 33

What are the five stages of grief?

Back 33

1. Denial

2. Anger

3. Bargaining

4. Depression

5. Acceptance

Front 34

What is denial?

Back 34

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.

Front 35

What is anger?

Back 35

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.

Front 36

What is bargaining?

Back 36

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.

Front 37

What is depression?

Back 37

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.

Front 38

What is acceptance?

Back 38

The person incorporates the loss into life and finds ways to move forward.

Front 39

What are the components of a caring concept?

Back 39

1. Knowing
2. Being with
3. Doing for
4. Enabling
5. Maintaining belief

Front 40

What is knowing?

Back 40

Implies that the nurse has taken the time to understand the perception of the loss and its meaning to the woman and her family

Front 41

What is being with?

Back 41

Involves how the nurse conveys acceptance of the various feelings and perceptions of each family member

Front 42

What is doing for?

Back 42

Refers to the activities performed by the nurse that provide physical care, comfort, and safety for the woman and her family

Front 43

What is enabling?

Back 43

Occurs when the nurse offers the woman and her family options for care

Front 44

What is maintaining belief?

Back 44

Involves encouraging the woman and her family to believe in their own ability to pick up the pieces and begin to heal

Front 45

How is sensitive care provided at discharged for a bereaved mother?

Back 45

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

Front 46

What is the first step for the nurse in caring for the bereaved adolescent?

Back 46

To acknowledge the significance of giving birth, no matter what age the mother might be

Front 47

What is the second step for the nurse in caring for a bereaved adolescent?

Back 47

Make additional efforts to develop a trusting relationship in working with the adolescent

Front 48

What is the third step for the nurse in caring for a bereaved adolescent?

Back 48

Offer options for saying good-bye, anticipatory grief, support, and information to meet the adolescent at the point of her need

Front 49

Why might adolescents take longer to process their grief?

Back 49

Because of their level of cognitive and emotional maturation

Front 50

What is complicated bereavement?

Back 50

Extremely intense grief reactions that last for a very long time

Front 51

What factors put women at risk for depressive symptoms after a miscarriage?

Back 51

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

Front 52

What are the evidence of complicated grief?

Back 52

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

Front 53

What are the symptoms of posttraumatic stress?

Back 53

1. Reliving the trauma

2. Avoiding things and places that are reminders

3. Disassociation

Front 54

What must nurses be aware of regarding care for bereaved families?

Back 54

Aware of their own feelings of grief and loss to provide nonjudgmental environment of care and support of bereaved families

Front 55

What is the effect of loss of one in a multiple birth?

Back 55

1. Such a death imposes a confusing and ambivalent induction into parenthood

2. Parents may feel torn regarding how they should feel

Front 56

What is the complication regarding bereaved parents of loss of one in a multiple birth?

Back 56

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

Front 57

What should NOT be said to parents who have lost one child in a multiple birth?

Back 57

"Well, at least you have the other baby"