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______ is an actual or potential situation in which something that is valuedis changed or no longer available.
Loss
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What are the types and sources of Loss?
- Actual loss: can be recognized by others
- Perceived loss: experienced by one person byt cannot be verified be verified by others.
- Anticipatory loss: experienced before the loss actually occurs.
- There are many sources of loss: loss of an aspect of oneself (body part, physiologic function, or a psychologic attribute), loss of an object external to oneself, sepatation from an accustomed environment, and loss of a loved or valued person.
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What is Grief?
The total resopnse to the emotional experience related to loss.
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What is Bereavement?
The subjective response eperienced by the surviving loved ones after the death of a person with whom they have shared a significant relationship.
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What is Mourning?
The behavioral process through which grief is eventually resolved or altered; it is often influenced by culture, spiritual beliefs, and custom.
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What are the different types of grief responses?
- Abbreviated Grief: brief but genuinely felt.
- Anticipatory Grief: experienced in advance of the event such as the wife who grieves before her ailing husband dies.
- Disenfranchised Grief: oocurs when a person is unable to acknowledge the loss to other persons (suicide, abortion, or giving a child up for adoption)
- Unhealthy Grief: pathologic or complicated grief, exists when the strategies to cope with the loss are maladaptive.
- Complicated Grief: may take several different forms; unresolved or chronic grief is extended in length and severity, Inhibited grief is many of the normal symptoms of grief are suppressed and other effects are experienced instead, delayed grief occurs when feelings are purposely or subconsciously suppressed until a much later time, exaggerated grief is when a survivor who appears to be using dangerous activities as a method to lessen the pain of grieving.
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Kubler-Ross described five stages of grieving, what are the stages?
- Denial: Refuses to believe that loss is happening. Is unready to deal with practical problems, such as prosthesis after the loss of a leg. May assume artificial cheerfulness to prolong denial.
- Anger: Client or family may direct anger at nurse or staff about matters that normally would not bother them.
- Bargaining: Seeks to bargain to avoidloss. May express feelings of guilt or fear of punishment for past sins, real or imagined.
- Depression: Grieves over what has happened and what cannot be. May talk freely or may withdraw.
- Acceptance: Comes to terms with loss. May have decreased interestin surroundings and support people. May wish to begin making plans.
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Name the factors influencing the loss and grief response?
- A number of factors affect a person
- s response to a loss or death. Factors include age, significance of the loss, culture, spiritual beliefs, gender, socioeconomic status, support systems, and the cause of the loss or death.
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What are the skills most relevant to situations of loss and grief?
Attentive listening, silence, open and closed questioning, paraphrasing, clarifying and reflecting feelings, and summarizing.
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What are the defining characteristics for diagnosis of Grieving?
- denial, guilt, anger, despair, feelings of worthlessness, crying, and inability to concentrate
- may extend to thoughts of cuicide, delusions, and hallucinations
- Fear, the feeling of disruption that is related to an identifiable source may also be present
- Hopelessness occurs when the person perceives no solutions to a problem
- Powerlessness happens when a person who does perceive a solution to the problem but does not believe that it is possible to impement the solution
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What are the clinical manifestations impending clinical death?
- Loss of muscle tone: relaxation of the facial muscles, difficulty speaking and swallowing, decreased activity, diminished body movement
- Slowing of te circulation: diminished sensation, mottling and cyanosis of the extremities, cold skin, slower and weaker pulse, decreased blood pressure
- Changes in respirations: rapid, shallow, irregular, or abnormally slow respirations, noisy breathing, mouth breathing, dry oral mucous membranes
- Sensory Impairment: blurred vision impaired senses of taste and smell
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There are three types of awareness shared by the dying person and the family, what are they?
- 1. Closed Awareness: the client is not made aware of impending death.
- 2. Mutual Pretense: the client, family and health personnel know that the prognosis is terminal but do not talk about is and make an effort not to raise the subject.
- 3. Open awareness: the client and others know about the impending death and feel comfortable discussing it, even though it is difficult.
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_____ care focuses on support and care of the dying person and family, with the goal of facilitating a peaceful and dignified death.
- Hospice
- Clients are elgible for hospice care when ceritifed by a physician to be likely to die within 6 months.
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_____ _____ is an approach that improves the quality of life of clients and their families facing the problem associated with life-threatening illness,through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.
- Palliative Care
- provides relief from pain and other distressing symptoms, affirms life and regards dying as a normal process, offers a support system to help clients live as actively as possible until death
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What are some of the physiologic needs a nurse must do for a dying person?
- Airway clearance: flowler's position, throat suctioning
- Air hunger: open windows or use a fan to circulate air
- Bathing/ hygiene: baths and linen changes, mouth care, moisture-barrier skin preparations for incontinent clients
- Physical mobility: assist client out of bed periodically, change client's position, elevate client's legs when sitting up
- Nutrition: encourage liquid foods as tolerated
- Constipation: dietary fiber, stool softeners or laxatives
- Urinary elimination: skin care, bedpan, urinal within easy reach, call light for assistance, keep room as clean and oder free
- Sensory/perceptual changes: preference for light or dark room, speak clearly and do not whisper, implement pain management protocol
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