pattern of physical and emotional responses to bereavement, seperation, or loss
grief
presence of illness/disease
morbidity
legal inquiry into the cause or manner of death
inquest
examination to confirm or determine cause of death
autopsy
type of listening, or action that indicates you are focusing soley on the individual speaking to you or having care provided to
attending behavior
general muscle weakness and physical detoriation
cachexia
culturally defined pattern for expressing grief
mourning
reaction to death of a loved one
bereavement
temporary in home care, can be part of hospice
respite care
turn rate of something up/down
can be a med adjustment based on data collection
titrate
care for someone after death
postmortem care
study of death and dying
thanatology
give an example of an actual loss
death of someone close
give an example of a percieved loss
expecting a baby girl, but get a baby boy
give an example of a maturational loss
normal life transitions such as hair loss
give an example of a situational loss
loss due to a specific external event such as car accident, house burning, death, etc.
give an example of an individual loss
loss felt to individual, but not to others such as menopause
normal process of resolution interrupted
unresolved grieving
delayed or exaggerated response to loss; real or percieved
dysfunctional grieving
What can happen to a nurse when there are multiple deaths during their shifts over a short period of time?
bereavement overload
What can happen when your job is more stressful than the rewards it provides?
burnout
How can you prevent bereavement or becoming burned out?
take breaks off of the floor, take a vacation and completely leave work behind, talk about feelings, try keeping work and the home seperate
type of care to provide comfort care, help decrease symptoms, but does not cure
palliative care
type of care to maintain physical integrity, such as ROM, skin care, nutrition and hydration, repositioning, preventative care, safety, pain control, etc.
physical care
greyish purple marbling of the skin
results from shut down of circulation
generally on legs and fingers and moves inward
mottling
Who is a potential hospice patient?
someone who has a limited life expectancy, and is no longer receiving treatment toward a cure, but requires very close attention. The patient must choose hopice care with a clear understanding of its philosophy and services.
is a physicians order needed for hospice to provide care?
yes
The dying experience: one to three months
withdrawal from the world and people
decreased food intake
increased sleep
going inside of self
less communication
The dying experience: one to two weeks
disorientation
agitation
talking with th unseen
confusion
picking at clothes
decreased BP
pulse increase/derease
skin color changes: pale, bluish
increased perspiration
respiration irregularities
congestion
sleeping but responding
complaints of body feeling tired and heavy
not eating, taking little fluids
body temp: hot/cold
The dying experience: days or hours
intensification of one to two weeks signs
surge of energy
decrease in BP
eyes glassy, tearing, half open
irregular breathing: stop, start (apnea)
restlessness or no activity
purplish, blotchy knees, feet, hands (mottling)
pulse weak and hard to find
decreased urine output
may urinate or have BM in bed
The dying experience: minutes
"fish out of the water" breathing
cannot be awakened
Would it make a pain med more effective to give an antianxiety med to an anxious patient prior to giving the pain med?
yes
List the 5 stages from the Kubler-Ross Model of Grief in the correct order
denial
anger
bargaining
depression
acceptance
hospice requirments
less than 6 months to live
doctor has diagnosed terminal illness
when a patient dies, when do you stop documenting?
after funeral home has taken the body away
Hospice interdisciplinary team
Medical director
Nurse coordinator/hospital aide
social worker
spiritual coordinator
volunteer/bereavement coordinator
hospice pharmacist/dietician
possible meds used for palliative care:
nausea and vomiting
constipation
death rattle
anti-emetics-helps with nausea and vomiting
fluids, fiber-helps with constipation
scopolamine-dries up secretions, preventing death rattle
serves as a buffer to the patient to shield self until the indiviual is able to mobilize alternate defenses
denial stage
hostility may be directed toward caregivers or loved ones
anger stage
bargaining is often made with god. it is an attempt to postpone death and is a postivie way to maintain hope
bargaining stage
sadness and grief. time of introspection. usually request only significant others to be with them. the patient struggles with painful realities of life and preparing for death
depression stage
resolved to the fact that death is imminent. peaceful acceptance and positive feelings are often present.
acceptance stage
cessation of life
death
condition of being subject to death
mortality
loss resulting from normal life transitions
maturational loss
loss occuring in response to a specific event
situational loss
mental treatment aimed at helping a patient deal with the pain of loss
grief therapy
to expect, await, or prepare oneself for the loss of a family member or significant other
anticipatory grief
sudden death of someone who is not "supposed to die"
out-of-sequence death
5 causes of dysfunctional grief
gets 'stuck' in the grief process and becomes depressed
unable to express feelings
cant find anyone in daily life to act as the listener they need
suffers a loss that stirs up other, unresolved losses and causes them to explore long-standing feelings or emotional concerns
lacks the reassurance and support to trust the grief proces and fails to believe that they can work through the loss
physical interventions are aimed at what?
energy conservation
pain reduction
comfort measures
promotion of sleep and rest
increasing self-esteem through body image acceptance
emotional interventions are aimed at what?
offer encouragement and support
offer assistance in saying good-bye
intellectual interventions are aimed at what?
education and support of patient and family
keeping everyone informed of procedures, changes in condition, and hospital policies so that well-informed decisions can be made
perinatal death interventions
when possible, have parents see, touch, and hold the infant so that the reality of it can be faced and grief can be worked through
encourage parents to express feelings
refer to the baby by name, or 'your baby' or 'your boy/girl' to reinforce that the baby was a unique individual that was loved and will be missed
ask if the parents would like a lock of hair, blanket the baby was wrapped in, or ID bracelet as mementos
What type of death is the most difficult to bear? give an example
out-of-sequence
pediatric death
pediatric death interventions
explain whats going on in language they can understand
allow them to share fears, feelings, and opinions
supportive group therapy (during and after)
gerontologic death interventions
include patient in self-care and in decisions about treatment
pain control
treat patient as an individual and asses needs just as you would for a terminally ill patient
DNR
do not resuscitate
decision should be a joint decision of patient, family, and health care providers
withholds no care, ONLY means not to resuscitate
DNRCC-Arrest
recieves resuscitive efforts until the patient experiences a cardiac or respiratory arrest. Once an arrest is confirmed, resuscitive efforts are withdrawn and comfort care is given
DNRCC
do not resusitate
comfort care ONLY
signed and witnessed documents providing specific instructions for health care treatment in the even that a person in unable to make these decisions at the time needed
advance directives
written documents that direct treatment in accordance with a patients wishes in the even of a terminal illness or condition.
living will
What is generally needed for a living will and durable power of attorney?
2 witnesses that are not related, and not a physician
If a healthcare provider follows a living will, can they still be held liable?
no
patient designates an agent, surrogate, or proxy to make health care decisions on his or her own behalf
