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A person's reaction to loss is influenced by the importance of
what was lost and the culture in which the person is raised.
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To meet the emotional and physical needs of patients and their significant others
nurses must first take the time to look at their own views of death and come to terms with its reality.
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Loss is
to no longer possess or have an object, person or situation.
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Only the person experiencing the loss
can define the value of the loss- you must put aside your own values regarding loss and accept the patient's meaning of loss.
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Grief is
the total emotional feeling of pain and distress that a person experiences as a reaction to loss.
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The grieving process occurs
over a period of time.
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Bereavement is
the state of having suffered a loss by death.
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Anticipatory grieving may occur
before the loss actually happens and when a person thinks or knows that a loss is going to occur in the future.
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Stages of Grief
- 1. Denial- No, not me. Cannot believe diagnosis or prognosis
- 2. Anger- Why me? Looks for a cause or fixes a blame
- 3. Bargaining- If I am good then i get a reward. Wish to live longer
- 4. Depression-Its hopeless. Sense of great loss
- 5. Acceptance- I'm ready. Pt has found peace. Withdrawal from everything
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Death is
marked in different ways.
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Brain death is
the permanent stopping of integrated functioning of the person as a whole as evidence by the absence of EEG waves.
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Hospice is
a philosophy of care for the dying and their families. Developed in England in the early 1960s
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Hospice philosophy is
based on the acceptance of death as a natural part of life and emphasizes the quality of remaining life.
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Palliative care is
concerned with treating symptoms, providing comfort measures, and promoting the best quality of life possible day by remaining day.
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Thanatology is
the study of death and continues to grow.
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Hope is
an inner positive life force, a feeling that what is desired is possible.
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Comfort care is
a concept focused on identifying symptoms that cause the patient distress and adequately treating those symptoms.
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Palliation is
the relief of symptoms when cure is no longer possible, and treatment is provided solely for comfort.
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Therapeutic communication is
an important skill the nurse uses to promote communication.
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At no time should
the patient be pushed to discuss something he is obviously avoiding.
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Giving the patient control is
a first priority at a time when it seems that he has no control.
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A truly compassionate nurse
studies and learns about pain management and applies those principles in daily practice.
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Regurlarly scheduled pain medication
with PRN backup for breakthrough pain is one of the most effective methods of controlling pain.
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There is no concern for addiction or of reaching a safety or effectiveness limit
when narcotics are increased in response to pain for the dying patient.
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The dying patient is not going to get stronger or better,
he gets weaker and weaker, not because he is lying in bed, but because he is dying.
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It is important to
listen than to talk.
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Cheyne-Stokes respirations are
respirations that gradually become shallower and are followed by periods of apnea (no breathing)
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To die with closure is
to say goodbye to those people and things that are important.
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Rather than impose your own religious beliefs on dying patients and family,
you should assist patients to find comfort and support in their own belief systems.
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Always be aware of remarks you make in the
presence of an unresponsive patient because they DO hear.
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Hearing is believed to be
one of the last senses to be lost before death, and "dying" patients have awakend to report conversations by family and health care workers that they were not meant to overhear.
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Advance directive
spells out patients' wishes for health care at that time when they may be unable to indicate their choice.
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Durable power of attorney for healthcare is
a legal document that appoints a person chosen by the patient to carry out his wishes as expressed in an advance directive.
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Euthanasia is
the act of ending another person's life to end suffering with (voluntary) or withouth (involuntary) his consent. Mercy killing.
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Passive Euthanasia
occurs when a patient chooses to die by refusing treatment that might prolong life. Ex. witholding artificial feeding or parenteral IV fluids
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Honoring the refusal of life prologing treatment
of a patient with a terminal illness is legally and ethically permissible.
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Active Euthanasia is
generally defined as administering a drug or treatment to end the patient's life. Not legal or permissible.
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Assisted suicide is
making available to patients the means to end thier life such as a weapon or drug with knowledge that suicide is their intent.
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Coroner is
a person with legal authority to determine cause of death.
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Autopsy is
an examination of the body, organs, and tissues to determine the cause of death. Consent must be obtained by the next of kin, except in coroner's case, when no permission is needed.
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Postmortem is
after death.
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Rigor Mortis is
rigidity of muscless that occurs after death.
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Shroud is
a sheet used to wrap body after death.
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