Fundamentals exam 3

What is the definition of Grief?

The feelings or reactions an individual has to a loss in one's life (not necessarily related to a death).

Define Normal (Uncomplicated) Grief.

Expected grief after a loss that gradually decreases over time.

Give examples of Normal (Uncomplicated) Grief.

Death of a spouse, divorce, loss of a job, or the ending of a relationship.

Define Anticipatory Grief.

Grief that is experienced before the expected loss occurs.

Give an example of Anticipatory Grief.

A family grieving after learning that a loved one has terminal cancer.

Define Prolonged Grief Disorder (PGD) / Complicated Grief.

Grief lasting longer than 6 months where the client is unable to accept the loss and move forward; it significantly affects their ability to function.

Give an example of Prolonged Grief Disorder (Complicated Grief).

A client who continues to search for their deceased spouse months later and remains unable to function in daily life.

Define Disenfranchised Grief.

Grief related to a loss or relationship that is not socially recognized, supported, or justified by society.

Give examples of Disenfranchised Grief.

Miscarriage, abortion, death of a pet, loss of an affair relationship, or suicide.

What is the definition and example of the 'Denial' stage in Kubler-Ross?

Definition: Refuses to accept reality to help lessen the pain of the loss.
Example: 'The doctor must be wrong. I need a second opinion.'

What is the definition and example of the 'Anger' stage in Kubler-Ross?

Definition: Feels the loss is unfair and experiences severe emotional distress.
Example: 'Why me?' 'This isn't fair.'

What is the definition and example of the 'Bargaining' stage in Kubler-Ross?

Definition: Tries to negotiate with a higher power for a better outcome by making a promise.
Example: 'God, if you let me live, I'll quit smoking.'

What is the definition and example of the 'Depression' stage in Kubler-Ross?

Definition: Reality sets in, causing deep sadness, crying, and withdrawal.
Example: Stops attending family gatherings, cries frequently.

What is the definition and example of the 'Acceptance' stage in Kubler-Ross?

Definition: Accepts reality, realizes they will be all right, and prepares for the future.
Example: Makes funeral arrangements, updates will.

Are the Kubler-Ross stages of grief always experienced in order?

No. Stages are NOT always in order; clients frequently move back and forth (oscillate) between stages.

What is Worden's 1st Task of Grieving?

Accept the reality of the loss (acknowledging the person is gone).

What is Worden's 2nd Task of Grieving?

Experience the pain of grief (allowing feelings and emotions to happen).

What is Worden's 3rd Task of Grieving?

Adjust to living without the deceased (learning new routines, responsibilities, and environments).

What is Worden's 4th Task of Grieving?

Find an enduring connection while moving forward (keeping memories while continuing life and embarking on a new life).

Explain the Dual Process Model of Grief.

The process of grieving shifts back and forth (oscillates) between loss-oriented behaviors (crying, intense thoughts/sadness) and restoration-oriented behaviors (making future plans, returning to work, coping with secondary losses).

Give an example of the Dual Process Model of Grief.

Crying about a deceased spouse one day (loss-oriented), and planning a vacation the next week (restoration-oriented).

List common physical and emotional grief reactions.

Sadness, shock, anger, anxiety, numbness, denial, guilt, regret, yearning, difficulty concentrating, crying, chest tightness, fatigue, or relief (if death was expected).

What factors influence an individual's response to grief?

Culture (guidelines for expression), religion/spirituality (rituals), age, relationship to the deceased, previous losses, support systems, coping skills, life events, illness, and financial concerns.

Describe the grief response of a Toddler/Preschooler.

They do not understand that death is permanent. They express grief by becoming clingy, crying frequently, being irritable, and having difficulty sleeping.

Describe the grief response of a School-Age Child.

They have a better understanding of death, but they may regress behaviorally (e.g., bedwetting) or show aggressive behavior.

Describe the grief response of an Adolescent.

They turn to friends for support and may hide their true feelings.

Describe the grief response of an Adult.

They understand death is permanent, may question its fairness, and often experience physical manifestations like chest tightness.

Describe the grief response of an Older Adult.

They generally show a greater acceptance of death, but they may become depressed as their social circle becomes smaller.

Define Compassion Fatigue.

Cumulative stress that results from repeatedly caring for suffering clients over time.

What are the signs of Compassion Fatigue?

Emotional exhaustion, difficulty feeling sympathy, difficulty connecting with clients, and burnout.

What self-care strategies help prevent Compassion Fatigue?

Exercise, a healthy diet, meditation, reading, spending time with friends, taking breaks, and getting adequate sleep.

In the N.U.R.S.E. mnemonic for communication, what does 'N' stand for?

Name the emotion (Identify what the client stated or expressed). Example: 'You seem upset.'

In the N.U.R.S.E. mnemonic for communication, what does 'U' stand for?

Understand (Demonstrate understanding by recognizing feelings and offering an opportunity to discuss them).

In the N.U.R.S.E. mnemonic for communication, what does 'R' stand for?

Respect (Voice your respect and praise for the client under these difficult circumstances).

In the N.U.R.S.E. mnemonic for communication, what does 'S' stand for?

Support (Inform the client explicitly that you are available to help them).

In the N.U.R.S.E. mnemonic for communication, what does 'E' stand for?

Explore (Ask open-ended questions to extend the conversation and allow detailed expression of feelings/beliefs).

How should nurses manage their own grief after a client's death?

Nurses must be self-aware and actively manage their grief, recognizing that reactions differ based on clinical circumstances and personal factors.

Define Hospice Care.

Interprofessional, holistic medical and psychological care focused on comfort for clients with a terminal illness and a life expectancy of less than 6 months. Curative treatment is stopped.

What are the key admission and duration facts for Hospice Care?

Requires a provider diagnosis of < 6 months to live; must recertify if they live longer; can be stopped at any time; provides support to caregivers/family for up to 13 months after death.

Define Palliative Care.

Holistic care provided throughout the lifespan for clients experiencing severe, chronic, or life-threatening medical illnesses. It is NOT subject to time constraints and can be implemented early.

What is the primary operational difference between Palliative Care and Hospice Care?

Palliative care can be provided while the client is still actively receiving curative treatment methods; hospice care is only for terminal illness when curative treatment stops.

List examples of diseases where Palliative Care is appropriate.

Advanced stages of cancer, refractory cardiac disease (heart failure), renal failure, respiratory failure, and neurodegenerative conditions like Alzheimer's or Parkinson's disease.

Define Respite Care.

A service or agency that provides primary caregivers with a short-term, temporary break from the responsibilities of client care to allow rest and recovery.

What are the duration guidelines for Respite Care?

Can last for hours, days, or weeks. Caregivers can request that their terminally ill loved one be admitted to a professional care facility for a maximum of 5 days.

What is 'Mottling' at the end of life and what causes it?

A bluish/purplish discoloration of the skin starting in the extremities. It occurs hours or days before death due to the heart's inability to pump effectively, leading to decreased blood perfusion.

What is the nursing intervention for Mottling?

Provide a blanket for comfort and apply other general comfort measures (do not try to aggressively reverse it).

Describe Cheyne-Stokes Respirations.

An irregular respiratory pattern characterized by cycles of deep/shallow breathing followed by periods of apnea (no breathing).

What is the nursing intervention for Cheyne-Stokes Respirations?

Position a fan so that it is directed to blow lightly toward the client.

Define Dyspnea at the end of life.

Difficulty breathing or shortness of breath, often caused by advanced cancer, ascites, COPD, or a physical decline in respiratory function.

What is the pharmacologic first choice for treating end-of-life Dyspnea and why?

Opioids (specifically morphine). They cause peripheral vasodilation, reduce the client's internal sensation of breathing difficulty, and decrease anxiety.

What are the nonpharmacologic and auxiliary treatments for Dyspnea?

Using a fan to move air, positioning, reducing physical exertion, relaxation techniques, oxygen therapy, and anxiolytics (benzodiazepines) for associated anxiety.

What is the 'Death Rattle' and what causes it?

A noisy, rattling breathing sound caused by the accumulation and retention of secretions in the lungs and throat when the client is too weak to clear them.

Is the 'Death Rattle' an indication of client distress or discomfort?

No, it is not an indication of client discomfort, though it can be distressing to family members.

What are the nursing interventions for a 'Death Rattle'?

Reposition the client to the side (or turn head to side) to assist drainage; provide oral care with a moist washcloth; perform oral suctioning; administer oral atropine drops or scopolamine patches to dry up secretions.

Is deep suctioning recommended for treating pooled secretions/death rattle at the end of life?

No. Deep suctioning is ineffective for removing accumulated secretions pooled deep in the lungs and causes distress; keep suctioning oral/superficial only.

What is the nursing intervention for a poor appetite in an actively dying client?

Do not force food or fluids on the client.

How should a nurse intervene when an end-of-life client experiences Hallucinations?

Acknowledge the hallucination calmly and avoid contradicting, arguing, or denying what the client believes to be true, as denial causes distress.

What is the nursing intervention for dry mucous membranes at the end of life?

Provide frequent and thorough oral care (due to mouth breathing).

What is the nursing focus for end-of-life hypotension and decreased heart rate?

Provide comfort measures only.

How should end-of-life body temperature fluctuations be managed by the nurse?

Apply cold or hot compresses, provide warm sponge baths, use hypothermia blankets, adjust the air conditioning/fan, and administer prescribed antipyretics (acetaminophen, ibuprofen, naproxen, or aspirin).

How do nurses support a client's dignity during the active dying phase?

Manage pain/respiratory issues, advocate for independence and privacy, demonstrate empathy, speak to the client even if they are unresponsive, continue grooming (hair, nails), keep them clean/dry, and include the family.

If an end-of-life client becomes completely unresponsive, what should the nurse do regarding communication and touch?

Continue talking to the client, continue touching them for comfort, and continue providing high-quality physical care.

What fundamental aspects constitute a 'Good Death'?

A death that is comfortable, pain-controlled, respects the client's wishes, maintains dignity, includes emotional/spiritual support, involves clear decision making, allows closure, and includes family involvement.

List the essential nursing steps for Postmortem Care.

Provide privacy; clean/wash the body; account for all personal possessions; remove invasive devices (IVs, catheters); place body in a shroud/body bag; attach two identification tags (one inside the bag, one outside); follow facility policy.

Where should the two identification tags be placed during postmortem care?

One inside the body bag and one attached to the outside of the body bag (or on the toe/arm according to policy).

What must the nurse document following a client's death?

The date and time of death, the name of anyone notified, the location of the client's personal belongings, and where the body was moved (e.g., funeral home name).

Can a nurse initiate a dialogue about organ or tissue donation with a client or family?

No. A nurse is strictly NOT allowed to begin a dialogue about donation. Only healthcare professionals who have completed an endorsed course by an Organ Procurement Organization (OPO) can initiate the request.

What is the nurse's legal/professional role regarding organ and tissue donation?

To assist and support families who are dealing with this challenging decision once the certified OPO professional has initiated the request.

Define Stress.

The mental, emotional, or physical response and adaptation to real or perceived changes and challenges that affect the body's normally balanced state (equilibrium/homeostasis).

Explain the physiological pathway that triggers the immediate 'Fight-or-Flight' response.

Hypothalamus secretes corticotropin-releasing factor (CRF) -> Activates the sympathetic nervous system (SNS) -> Releases norepinephrine, epinephrine, and dopamine.

List the major physiological manifestations of Sympathetic Nervous System (SNS) activation.

Increased heart rate, increased blood pressure, increased cardiac output, bronchodilation (dilated airways), pupil dilation, increased blood glucose levels, fast breathing, muscle tension, and increased mental alertness.

Explain the Pituitary-Adrenal pathway during stress.

CRF signals the anterior and posterior pituitary glands to release adrenocorticotropic hormone (ACTH) -> ACTH stimulates the adrenal cortex to release cortisol.

What behavioral changes are initiated by the release of Cortisol?

Increased mental alertness, enhanced focus, and a reduction of pain receptors.

What is the main goal of the General Adaptation Syndrome (GAS)?

For the body to return to a steady state of internal, physical, and chemical balance (homeostasis) to maintain optimal functioning.

Do the physiological changes of GAS occur for both positive and negative stressors?

Yes. Physiological changes occur identically whether the perceived stressor is positive (eustress) or negative (distress).

Describe the 1st stage of General Adaptation Syndrome (GAS).

Alarm Stage: The body recognizes the stressor, the fight-or-flight response is immediately activated, systems shift, and HR, BP, and pupil dilation increase.

Describe the 2nd stage of General Adaptation Syndrome (GAS).

Resistance Stage: The body attempts adaptation. Physiological functions begin returning toward normal, but the body remains on high alert.

Describe the 3rd stage of General Adaptation Syndrome (GAS).

Exhaustion Stage: Resources are entirely depleted, and the body can no longer cope. Illness may develop (e.g., depression, hypertension, autoimmune disorders).

Explain the Transactional Theory of Stress and Coping.

Stress is a dynamic transactional process between a person and their environment. An individual goes through two stages of appraisal (primary and secondary) before responding.

Differentiate between Primary and Secondary Appraisal in stress theory.

Primary Appraisal: Evaluates if the situation is a threat.
Secondary Appraisal: Assesses whether the individual can cope with the threat by examining demands vs. available resources.

Define Eustress and give examples.

Positive stress that accompanies favorable life events.
Examples: Graduation, job promotion.

Define Distress and give examples.

Negative stress that accompanies unfavorable life events.
Examples: Acute/chronic illness, divorce.

Define Acute Stress and give an example.

Short-term, brief stress that triggers an immediate fight-or-flight response. Can be positive or negative.
Example: Having an exam tomorrow.

Define Episodic Acute Stress.

Occurs when an individual experiences frequent, repetitive bouts of acute stress, which can negatively impact health and relationships over time.

Define Chronic Stress and give examples.

A disabling, prolonged condition where stress levels remain constant and heightened over a long period.
Examples: Poverty, living in an abusive relationship.

Define Physiological Stress and give examples.

A physical stressor that threatens the body's physical structures or survival; reaction is immediate.
Examples: Injury, illness, severe pain.

Define Psychological Stress and give examples.

An emotional stressor associated with a situation, comment, or interaction interpreted as negative or threatening.
Examples: Financial problems, school pressure.

Differentiate between Acute Stress Disorder (ASD) and Posttraumatic Stress Disorder (PTSD) based on duration.

Acute Stress Disorder (ASD) lasts less than a month following a traumatic event. If symptoms persist longer than one month, it is diagnosed as PTSD.

What are the classic signs of PTSD?

Flashbacks, nightmares, hypervigilance, an exaggerated startle response, increased heart rate, and severe anxiety.

Define a Crisis and its severity levels.

A threatening situation where a person experiences an intensive behavioral, emotional, or psychiatric response triggered by a precipitating event. Severity ranges from Level 1 (least) to Level 4 (highest).

Define Ego Defense Mechanisms.

Mental operations that occur completely outside of conscious awareness to protect an individual's self-esteem and shield them from excessive anxiety.

Define the defense mechanism: Denial.

Refusal to acknowledge or accept reality in order to avoid its emotional impact.

Define the defense mechanism: Rationalization.

Justifying or explaining away undesirable behaviors/outcomes to avoid emotional discomfort or save face.

Define the defense mechanism: Projection.

Attributing one's own negative or uncomfortable thoughts, feelings, or motives onto someone else (e.g., accusing others of being angry when you are angry).

Define the defense mechanism: Repression.

Unconsciously blocking painful or unpleasant memories, thoughts, or beliefs from conscious awareness in hopes of forgetting them.

Define the defense mechanism: Regression.

Moving backward to behaviors characteristic of an earlier, safer developmental time in life (e.g., bedwetting after a major loss).

Define the defense mechanism: Compartmentalization.

Categorizing life experiences into separate mental segments to avoid facing anxieties while in a specific mindset.

List healthy coping strategies to recommend to clients.

Daily exercise, healthy eating/nutritious foods, adequate hydration, deep breathing exercises, meditation, prayer/spirituality, adequate sleep, social support, taking breaks, reading, and spending time outdoors.

Define Self-Concept.

The overarching, holistic perception of who a person is; how a person thinks about themselves. It is dynamic, subjective, and evolves throughout the lifespan.

Differentiate between Self-Concept and Self-Esteem.

Self-concept relates to how a person perceives or thinks about him- or herself. Self-esteem relates to how a person evaluates or feels about him- or herself (self-worth).