Death and Loss Flashcards broken up

Loss

the experience of losing someone or something significant

Grief

natural reaction in response to the death of a loved one or to a significant life change

Anticipatory Grief

grief in the expectation of loss

Mourning

period of mourning and grief following the death

Bereavement

having lost someone close, encompassing both the emotional response and the period of adjustment following the loss

What is informed end of life care?

scientific and clinical knowledge of disease processes and biological dying

What are the 3 things involved in informed end of life care?

interpersonal skills, ethical/legal/professional principles, interprofessional collaboration

Complicated grief

unresolved grief or complex bereavement

How long must symptoms last to be considered complicated grief?

At least 6 months after the death of a significant person.

Disenfranchised grief

any loss that is not validated or recognized

Why is disenfranchised grief difficult for patients?

The person may not feel allowed to openly express or share their grief

Why is grief considered a necessary process?

It is a healing process and there simply can be no healing without it

What are some factors affecting grief and bereavement?

age, health /cognitive status of survivor, relationship to deceased, coping styles/concurrent stressors, support systems, socioeconomic status

What is the focus of physical assessment in end-of-life care?

Identifying physical changes that occur as the patient declines and approaches death

What should the nurse assess regarding physical symptoms at the end of life?

Pain; Breathing changes; Fatigue/weakness; Decreased appetite; Difficulty swallowing

What are signs of impending death?

Decreased level of consciousness; Irregular breathing (e.g., Cheyne-Stokes); Terminal restlessness/agitation; Cool, mottled skin; Decreased urine output

What are signs that death has occurred?

No pulse or heartbeat; No respirations; Fixed, dilated pupils; Unresponsiveness; Cool skin

What happens to appetite in the early stage of dying?

Appetite decreases and the patient shows less interest in food; the body requires fewer nutrients as it begins to shut down

What eating-related difficulties may occur in early dying?

Trouble swallowing; Feeling full quickly; Pain with chewing or digestion

What physical causes make eating uncomfortable in the early stage?

Dry mouth; Oral sores; Dry throat; Bloating

What stage is often difficult for family members and caregivers?

early stage since providing nourishment is essential to caregiving

How long does the middle stage of dying typically last?

From a few hours to several days

What is the main physiological change in the middle stage of dying?

Reduced peripheral circulation as blood is redirected to vital organs

What vital sign changes occur in the middle stage?

Low blood pressure; Irregular breathing; Bradycardia (slow heart rate)

What happens to the patient’s hands and feet in the middle stage of dying?

They become cool to the touch due to decreased circulation

What skin changes occur in the middle stage of dying?

Pallor (pale skin); Mottling (bluish-red, lace-like pattern)

What energy related symptoms are seen at the middle stage?

weakness and fatigue

How does decreased blood flow affect the brain in the middle stage?

cognition and verbal responses leaving some individuals unable to speak

What can individuals still experience in the middle stage?

touch, hearing and emotions

What defines the late stage of dying?

Progressive failure of body organ systems

What respiratory changes occur in the late stage?

Shallow breathing; Noisy breathing; Labored breathing; Periods of apnea

What elimination changes occur in the late stage?

Bowel and bladder incontinence; Decreased or absent urine/stool output

What skin changes are seen in the late stage?

Widespread mottling due to poor circulation

What cardiovascular changes occur in the late stage?

Bradycardia and Hypotension

What happens to appetite in the late stage?

Patients typically lose all interest in food and may develop abdominal ascites

When do signs of impending death typically occur?

In the last hours before death

Are signs of impending death new or a continuation of earlier symptoms?

Often a continuation of earlier symptoms, but more pronounced

What happens to consciousness at the end of life?

Fading consciousness; Periods of unconsciousness; terminal restlessness or terminal agitation

What sensory changes may occur before death?

Hallucinations; Delusions; Illusions; Death awareness

What is breathing like in impending death?

cheyne-stokes breathing and agonal breathing

Cheyne-stokes breathing

pattern of abnormal breathing characterized by deeper and sometimes faster breathing, followed by a temporary stop in breathing (apnea)

Agonal breathing

gasping or labored breaths that may be followed by periods of apnea lasting many seconds

Signs that death has occured

coolness of skin, rigor mortis, incontinence or release of bodily fluids, changes in skin color, loss of reflexed (corneal reflex), absence of blood pressure readings

Declaration of death

post-mortem care begins after the client has been officially declared decreased by 2 licensed healthcare professionals

Dianoses examples

greif, chronic sadness, death anxiety, fear etc

What does nursing process planning include for death and dying?

creating smart goals

Grief comes in

waves rather than stages and emotions don’t follow a set pattern; grief hits people differently

Nursing interventions

provide education about the stages of grief, encourage healthy behaviors, listen, include entire family in assessment and planning, use resources

Advance care planning for end of life; advance directives

legal docuements that can inform health care providers about a pt’s goals of care and whom to contact for decisions about that care

Communication

simple, avoid overloading/overwhelming, telling the family the pt has died in an open and honest manner with compassion and support

Care of dying pt

fav belongings, allow pets, unrestricted visiting hours, time for privacy, space, nursing care (bathing, oral care, turning and repositioning)

People who are grieving need to demonstrate what?

that they can talk about the meaning of their loss, use available support systems, and deal with the loss

Care of the patient at the time of death

remove unnecessary items, clean room, ask family for any religious or cultural practices need to be followed during physical care of the body

Will all nurses experience death and loss?

yes regardless of health care setting

Caring for dying impact on nurses

effective suppory systems, self care and ability to handle stressors