week 13- end of life/loss/bereavement

signs of impending death

Increased weakness, immobility, weight loss, decreased appetite, loss of bladder/bowel control, decreased awareness of surroundings (hearing is the last sense to go!), altered breathing patterns, lung congestion (gurgling sound), slowed pulse, relaxed open jaw

hospice

Type of palliative care, have to have a terminal diagnosis, symptom relief, supports the patient through the dying process and the survivors through the period of bereavement

preschool age reaction/understanding of death

feared by adults, see death as reversible and see it as being asleep, magical thinking distorts reality of death

school aged children’s reaction to death

more concept as death is permanent, may believe life continues in another form, seek specific facts and become less anxious about death

adolescence reactions to death

may begin to question the meaning of life, understanding that death is permanent and inevitable, faith can help cope, feel immortal-  thinks it occurs in others not them

adulthood reaction of death

quit addictive drugs, wearing seat belts, adopt other precautions, attitudes shifts to what they are leaving behind

late adulthood death reactions

death anxiety decreases and hope rises- believe in afterlife, accept mortality, plan for the future and death, acceptance of death

kubler-ross’ stages of grief

Denial, anger, bargaining, depression, acceptance

DABDA

living will

drawn up before a patient is ill or incapacitated, wishes of the person in end of life care, respected in courts

power of attorney

designate someone to make sound decisions about the patient while they can’t/incapacitated -usually a spouse or child, may sign legal consents for treatments

physician assisted suicide

 facilitation of suicide where the person knowingly takes lethal drugs

euthanasia

intentional act (lethal injection of a drug) with purpose of causing death

• passive version: seriously ill person is allowed to die naturally through cessation of medical intervention (off breathing tube)

brain death

no brainwaves, pain response or breathing, absent voluntary movement

locked in syndrome

cannot move except eyes, normal brainwaves

coma

deep unconsciousness, depressed brainstem reflexes, no pain response

vegetative state

cognitive functions absent, breathing and HR present, eyes may be open but don’t respond to stimuli

ethical issues revolving death

culture, values, and religion, legal issues and informed consent (to someone conscious like family member)

grief associated with suicide

blaming- them and the patient, police investigation increases guilt, decreased self esteem, rejected and deserted

children’s respond to grief

anger, fear, guilt

adolescent’s grief

academic withdrawal, no motivation in school

young adult’s grief

rage at lost opportunities, anxiety about the future

normal grief

lack of energy, weight loss/gain, insomnia, anger, anxiety, relief, despair, disbelief, confusion, inability to concentrate, crying, impaired functioning, withdrawal, change in relationships- goes through a series of stages

dysfunctional grief

failure to follow predictable course of normal grieving, maladaptive coping strategies, unresolved issues come out- symptoms that interfere with functioning, profound continuous sadness, talk of suicide or attempts

incomplete grief

circumstances interfere with the process of grieving, mourning is cut short, distracted from role in recovery- death during pregnancy (needing to take care of a newborn while grieving)

cultural competence for the dying patient

being truthful, encourage regular routines, address fears

nursing response to the grieving

• Focus of care is on the patient and the family unit, cultural competence is the key

• Condolence, sympathy, empathy, compassion