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death is defined as
the irreversible cessation of respiratory and circulatory fxn or the irreversible cessation of all fxns of the entire brain
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can RNs declare death
- depends on state
- otherwise, coroner must declare
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loss def.
a potential or actual situation in which sth that is valued is changed, or no longer available, or gone.
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ex. of situational losses
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ex. of developmental losses
- innocence
- abilities (like walking)
- self-image
- appearance (like wrinkles)
- independence
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4 srcs of loss
- loss of an aspect of oneself
- loss of an object
- separation from an accustomed envt
- loss of a loved one
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2 types of loss
- perceived
- actual
- *both of these can be anticipatory
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RNs responsibility re: how help person cope w/ loss
open doors to create opportunities for discussion; don't shove people through the door tho
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grief def.
an emotion experienced in rel. to loss
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2 types of processes grief is...
- indv. process
- social process
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purpose of grief
allows indv to cope with and accept the loss
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stages of grieving
- denial
- anger
- bargaining
- depression
- acceptance
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2 types of grief responses
- dysfunctional/pathological grief
- healthy/adaptive grief
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factors that influence the grief and loss responses (9)
- age
- life experiences
- culture
- spiritual beliefs
- gender
- socioeconomic status
- support system
- cause of loss of death
- relationships
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infant to 5 yr old - beliefs about death
death is reversible
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5 to 9 yrs - beliefs about death
death is final, but also avoidable
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9 to 12 yrs beliefs about death
inevitable end of life
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12 to 18 yrs - beliefs about death
various beliefs/attitudes
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18 to 45 yrs - beliefs about death
religious/cultural beliefs
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45 to 65 yrs - beliefs about death
accepts own mortality
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65+ yrs - beliefs about death
multiple meanings
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3 things to explore as RN re: assessmenjt of loss and grief
- nursing history - explore previous losses and coping abilities
- assess personal coping resources
- physical assessment
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word of caution re: nursing diagnoses for loss and grief
be alert to projecting judgment and/or your own values
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list some nursing diagnoses for loss and grief
- risk for loneliness
- dysfxnal grieving
- interrupted family processes
- impaired adjustment
- ineffective coping *bad, says KK!
- spiritual distress
- fear
- anticipatory grieving
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ex. of dysfxnal grieving
- alcohol abuse
- anger
- violence
- w/drawal
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in planning stage, what would an RN's goal be to help w/ "loss of fxn"?
redirect energy into rehabilitation and adjust to the change
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in planning stage, what would an RN's goal be to help w/ "grieving the loss of a loved one"?
adjust to the actual or impending loss and decrease painful feelings with memories
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what are patients most concerned with when they find out they're sick
being a burden to the family
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what are families most concerned about when they find out a family member is sick
physical pain of that person
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how can a nurse facilitate grief work
- encourage routine and self care
- explain expectations
- set realistic goals
- encourage reflection
- explore values
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how can a nurse provide emotional support
- presence
- referral
- acknowledgement
- therapeutic communication
- promote autonomy/self-care
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for nursing evaluation re: grief, how do you evaluate the goals/outcomes?
- based on the goals set by the family
- outcomes vary according to indv. client and characteristics of the loss
- difficult to assess due to long-term transitions
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bereavement programsf
grief education and support
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4 things to "consider" as an RN re: grief
- functional vs. dysfunctional grief
- realistic vs. unrealistic goals
- nursing implementation
- other stressors or factors
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6 legal issues re: death and dying
- advanced health care directives
- DNR/DNI vs. full code
- euthanasia
- organ donation
- autopsy
- self-determination act
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self-determination act means pt. must be given what written info (3)
- The right to facilitate their own health care decisions
- The right to accept or refuse medical treatment
- The right to make an advance health care directive
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7 ethical issues
- beneficence
- non-malefecence
- autonomy
- veracity
- justice
- quality of life
- w/drawal of treatment
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non-malefecence
you can't intentionally make things worse for a person, i.e. "do no harm". MDs can't regard sb w/ malice
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beneficence
MDs are obligated to help/benefit their pts
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re: w/drawal of treatment, what can a pt refuse?
pt can choose not to eat or drink
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what affects a nurse's ability to care for the client and their family re: death
whether or not the nurse has acknowledged his or her own attitude about death
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4 goals for the dying person
- maintain comfort (physiologic and psychosocial)
- maintain dignity (personal control)
- 'The Dying Person's Bill of Rights"
- mgmt of physical needs/symptoms
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13 physical nees/symptoms of a dying person
- PAWN BUMRS 4D
- pain
- delirium/anxiety
- restlessness
- dehydrations
- dysphagia
- dyspnea
- weakness/fatigue
- myoclonus
- skin integrity
- bowel patterns
- urinary incontinence
- anorexia
- nausea/vomiting
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KNO!! 9 signs of impending death
- SPAMD body VAC
- changes in alertness
- changes in breathing pattern
- loss of muscle tone/decreased activity
- decrease circulation
- sensory implairment
- slowing of body processes
- decrease in appetite and/or dysphagia
- changes in VS
- near-death awareness
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what is a s/s death re: decreased circulation
splotchy blueness
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what is the last sense to go when sb dies
hearing
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8 nursing interventions for the dying pt
- provide personal hygeine for pt
- assist w/ elim, nutr, mobility
- edu/support fam. and sig. others involved (saying bye etc)
- refer/provide emotional support
- assess/provide adeq. pain ctrl s/s mgmt
- holistic approaches: life review, imagery, relaxation, rituals that have sig. meaning
- refer to hospice (early referral)
- collaboration w/ other HCP team members
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7 things re: post mortem care
- follow hosp/facility protocols
- allow fam members choice to view body
- respect religious beliefs/customs
- wash/dress body
- make the room comfortable for fam
- in some facilities place ID tags and wrap in shroud
- handle deceased w/ dignity
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hospice care focuses on what
- pain and symptom mgmt
- a shift from aggressive, curative treatment
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hospice care is a philosophy of care that...
guides people w/ a terminal illness on a journey to improve their quality of life
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is hospice in home or facility
both
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3 institutions that pay for hospice care
- medicare
- medical assistance
- private insurance
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5 services included in hospice care
- medications
- team services
- equipment
- respite care
- short-term inpatient or continuous care
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7 RN roles in end of life care
- critical thinker
- holistic caregiver
- advocate
- teacher
- leader
- lifelong learner
- collaborator
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Dying person's bill of rights: "I have the right to..."
- be treated as a living human being until I die
- be in ctrl
- maintain a sense of hopefulness, however changing its focus may be
- be cared for by those who can maintain a sense of hopefulness, however changing this may be
- have a sense of purpose
- express my feelings and emotions about my approaching death in my own way
- participate in decisions about my care
- expect continuing medical and nursing attn. even though "cure" goals must be changed to "comfort" goals
- not to die alone
- be free of pain
- have a respected spirituality
- have my questions answered honestly
- not be deceived
- have help from and for my family in accepting my death
- die in peace and dignity
- retain my indiciduality and not be judged for my decisions that may be contrary to beliefs of others
- discuss and enlarge my religious and/or spiritual experiences, whatever these may mean to others
- expect that sanctity of the human body will be respected after death
- be cared for by caring, sensitive, knowledgeable people who will try to understand my needs and will be able to gain some satisfaction in helping me face my death
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situational loss
sudden, unpredictable external events that bring about a loss
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actual loss
when a person can no longer feel, hear, or know a person or object
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perceived loss
- foex, perceived rejection by a friend
- loss of status in group
- these losses are uniquely defined by the person experiencing the loss
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anticipatory grief
the unconscious process of disengaging or letting go before the actual loss or death occurs
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