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necessary loss
part of life (house, job change)
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perceived loss
loss is felt by the person, but not evident to others (self-esteem)
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maturational loss
loss which occurs through normal development
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situational loss
loss related circumstances or events (natural disasters)
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loss
a situation, either acutal or potential, in which a valued object is changed, no longer available or gone.
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examples of loss
- known environment
- significant other
- aspect of self (limb)
- life (independence)
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grief
emotional response to loss manifested in thoughts, feelings and behaviors
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functions of grief
accep what has happened, moved on
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bereavement
response to loss, after death of person
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mourning
social way that society says we go through grief
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physical symptoms of grief
crying, fatigue, seeks medical help, loss of weight
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abbreviated grief
people go through grieving process quickly (because it's anticipated, or losing a pet)
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anticipated grief
knew it was going to happen
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unresolved grief
extended or prolonged denial
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disenfranchised grief
unable to acknowledge or share grief
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complicated/dysfunctional grief
fail to grieve or haven't gotten to in years
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stages of the grieving process
- denial
- protest/anger
- bargaining
- disorganization/depression
- acceptance/healing
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factors influencing reaction to loss
- nature of loss
- personal relationship
- cause of death
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personal resources/stressors
- health
- coping skills
- spiritual beliefs
- socioeconomic status
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assessment of the grieving process
- nursing history (support, culture)
- emotional status (recent loss, normal coping)
- physical exam (cardiac, respiratory)
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desired outcomes for end-of-life-care
- identification of patients needs
- control of symptoms of distress
- meaningful interactions between pt and family
- peaceful death
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advanced directives
written document prepared by a competent individual specifying what, if any, extraordinary actions the person would want
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DPOA
legal document assigning decision-making power to another person
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living will
legal document that instructs physicians and family members about life-sustaining treatment
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palliative care
focus on care is symptom control and compassion
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hospice care
- life expectancy of 6 mo
- dignity and peaceful death
- improve quality of life
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physical/ clinical manifestations
- coolness of extremitites
- increased sleep
- fluid and food decrease
- incontinence
- congestion and gurgling (death rattle)
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providing end of life care
- pain management
- pain is the symptom that dying pt fears most
- pain management should be scheduled to prevent any pain
- consider alternative route for med prn
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dyspnea management-pharmacological
- opiods
- anticholinergics
- bronchodilators
- sedatives
- patches
- rectally
- sublingually
- o2 therapy
- diuretic
- antibiotics
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dyspnea management/non-pharmalogical
- cool air
- wet cloths to pt face
- positioning pt to facilitat chest expansion
- rest periods
- imagery and deep breathing
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nausea and vomiting management
- aniemetic agents
- something cool
- remove any odors
- comfortable room temp
- dietary changes
- assess for and treat constipation
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restless and agitation management
- assess for pain, urinary retention, constipation
- treat underlying cause
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weakness management
- aspiration precautions
- mouth care and moisture for lips
- altered routs for meds
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symptoms at end of life
- weakness
- anorexia
- foods increase discomfort
- changes in cardio (weak pulses, cyanosis, apnea)
- changes in breathing
- changes in gastrointestinal function
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rigor mortis
the stiffening of the body that occurs 2-4 hours after death, muscles stif
body: supine, flat, put dentures in
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algor mortis
gradual decrease of body temp after death
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livor mortis
- discoloration in depend areas of the body
- (looks bruised on the back)
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cheyne-stokes respirations
apnea alternating with periods of rapid breathing
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