| A | B |
|---|
| Abbreviated Grieving | (1) type of normal grieving that involves feelings that are brief but genuinely felt (2) grief that occurs when a lost object is not significantly important (3) assoc w/event where a lost object is immediately replaced by another equally esteemed object |
| Actual Loss | (1) can be verified by everyone i.e., the loss of a loved one, the loss of a job, or the loss of a home |
| Adolescent (12 to 18) | (1) may apply beliefs from earlier dev stages (2) believe personal death cannot occur at this age & engage in dangerous activities (reckless driving or substance abuse) (3) anger manifest itself as rage or sorrow & may turn suicidal (4) immediacy of death when it affects teenagers is stark in contrast to desire to see death as part of a far distant future (6) actions center around proving self more powerful than death (death defying) involving risk-taking activities which may be exacerbated by loss of risk-inhibitions due to traumatization (7) express selves by acting out & thru experiment w/new behavior & where violence may exhibit expression of manhood (8) violation of law perceived as a substance statement against adult standards or as admission to the adult world |
| Adult 18 to 45 | religious and cultural beliefs are the primary factors that influence an individual’s attitude toward death |
| Additional Definition Of Death | incl cerebral or higher-brain death manifested by permanent loss of cerebral function, apnea, absence of responsiveness to external stimuli, and absence of cephalic reflexes. With this definition, a bioelectric electroencephalogram administered for at least thirty minutes in the absence of hypothermia or poisoning by central nervous system depressants supports the diagnosis of death |
| After Death | (1) facility & health department guidelines must be followed (2) aim to comply w/client’s religious practices for care of the body (3) for family & friends viewing the body, a clean environ, natural & comfortable appearance of the body is important (3) all equipment, soiled linen, & supplies sh/be removed (6) after viewing, pt's wrist identification tag sh/be left on, other tags sh/be added, & the body sh/be wrapped in a shroud, or a large piece of plastic or cotton material used to enclose a body after death (7) apply identification to the outside of the shroud (8) thruout process, the nurse has an ethical duty to treat the body w/respect & dignity |
| Algor Mortis | (1) the gradual cooling of a person’s body after death (2) blood circulation terminates & hypothalamus stops functioning, body temp falls to about 1.8 F or 1 C per hr until it reaches room temp (3) skin loses its elasticity & can be easily torn as dressings are removed |
| Analysis Data Of Dying Patient | (1) collaboration w/client, family, and hc team synthesizes assessment data to identify actual or potential health problems (nursing diagnosis) (2) in end-of-life care, a range of physiological & psychosocial measures applied depend on appropriateness of information found during assessment & described in dxs (3) determine & prioritize dxs (Maslow) (4) give basic physiological needs first priority, comfort & safety needs, then needs r/t self-esteem & self-actualization (5) cultural sensitivity & spiritual support are important to establishing end-of-life priorities (6) client & family involvement ensures needs are met in a respectful & appropriate manner |
| Anticipatory Grieving | (1) normal grieving occurring in advance of an event (2) family members of a person diagnosed w/pancreatic cancer, for example, may experience this type of grief response in anticipation of loss (3) for some, the period of anticipatory grief is so intense & so prolonged that when the actual loss occurs, the grief response following the loss may be short |
| Artificial Life Support | with the new definition of death, when artificial life support is being used, a person’s brain waves must be absent for twenty-four hours before a physician can pronounce death. Only after the person is pronounced dead by the physician can life support be terminated |
| Assessment Phase Near End Of Life | (1) gathers relevant subjective and objective data about the client’s health status (2) relates to client and family awareness of the state of the client’s health and the client’s prognosis (3) Three types of awareness have been described: (a) closed awareness in which the client is not informed of their impending death (b) mutual pretense refers to the situation in which everyone (client, family, providers) knows that the client’s prognosis is terminal but makes an effort not to talk about it (c).open awareness everyone acknowledges the impending death and feels comfortable talking about it, even though doing so is very difficult |
| Assessment Phase Stage Of Grieving | (1) refer to theories to determine stages of grief client & family are in providing a starting point for further individual assessment (2) assess effectiveness of physical & emotional symptom & control measures for the client (ongoing process that evolves as client’s status changes) (3) assessments sh/cover q/body system & effective breathing, pain management, skin integrity & cognitive/emotional behaviors (4) signs of impending death sh/be noted inclu loss of muscle tone, slowing circulation, respiratory changes, sensory alterations & family response to client’s changing status sh/be repeatedly analyzed (5) assessing family’s expectations of what will happen provides source of information on what interventions will be needed |
| Bereavement | (1) subjective sense of loss people feel after the death of a person with whom they have shared a significant relationship (2) can have chronic negative effects on health |
| Caring for Dying Person | (1) in the trajectories of dying the body physiological process slows (2) care incl (a) assist w/personal hygiene (b) controlling pain (c) relieving respiratory distress (d) assist w/movement (e) nutrition (f) hydration (g) elimination (3) sensory changes occur as a person approaches death |
| Caring for a Terminally Ill Client | (1) goal of treatment shifts from curative to palliative (comfort care) (2) caring for two clients, the dying person & family (3) interventions: (a) comfort measures (b) pain control (c) dehydration management (d) therapeutic communication |
| Cerebral (higherbrain) Death | (1) permanent loss of cerebral function, apnea, absence of responsiveness to external stimuli, and absence of cephalic reflexes (2) a bioelectric electroencephalogram admin for at least 30 minutes in absence of hypothermia or poisoning by CNS depressants supports the dx of death |
| Changing View Of Death Over The LifeSpan | (1) age impacts a person’s response to loss (2) understanding of the concept of death, changes and develops over the lifespan (3) childhood response to death is seen as temporary, adulthood response is acceptance to reality of death but it is still quite frightening; older adults’ response, death may actually be welcomed in the face of disabling medical conditions |
| Cheyne-Stokes Respirations | (1) shallow breaths that alternate with periods of no breathing that last anywhere from five seconds to one minute (2) there might also be rapid shallow panting |
| Childhood Grief children | (1) sh/process grief at each developmental stage & may need to revisit a stage in light of traumatic grief if trauma & grief inhibit, delay, or cause a child to "skip" a developmental stage (3) process grief slowly d/t several aspects r/t reactions to death (4) do not fully grasp permanence of death (5) unable to sustain conscious sadness for long time periods (6) do not deny trauma of death but may deny reality of death. (7) do not have an alternative reality assurance of possibility of finding new relationships to rely upon (8) self-blame & guilt about death & believe they caused it (9) resolution of grief is impeded because they do not know how to think about or plan a future or develop new relationships & establish connections w/others |
| Common End Of Life Symptoms Gastrointentinal Function | (1) (a) anorexia (b) dysphagia (c) unpleasant taste (d) nausea & vomiting (e) weight loss (f) ascites (2) interventions (a) soft, bland foods, liquid diets as tolerated (b) smaller more frequent meals (c) elevating client’s head & torso during & after meals |
| Common End Of Life Symptoms Bowel Function | (1) (a) constipation (b) diarrhea (c) loss of functional control (2) interventions (a) dietary fiber as tolerated (b) stool softeners/laxative as needed |
| Common End Of Life Symptoms Bladder Function | (1) (a) incontinence (b) urine flow decreases & color darkens as circulation to kidneys slows (b) bladder spasms (2) interventions (a) skin care in r/t incontinence (b) placement of bedpan, urinal, commode chair w/in easy reach (c) use of absorbent pads under client & linen changes as often as needed (d) keeping the client’s room as odor free as possible |
| Common End Of Life Symptoms Skin Integrity | (1) (a) pressure ulcer (b) candidiasis (c) edema (d) hemorrhage or blood loss (e) shingles (f) ascites (g) pruritis (h) mucositis (3) interventions (a) frequent baths & linen changes if diaphoretic (b) liberal use of moisturizing creams (c) moisture-barrier skin preparation for incontinent clients |
| Common End Of Life Symptoms Breathing | (1) (a) dyspnea (b) hiccups (c) cough (d) congestion (e) rattle (d) altered breathing pattern (2) interventions (a) if unconscious use Fowler’s position; throat suctioning for congestion not recommended as increases secretions use scopolamine patches, atropine & hyoscyamine (Levsin) to decrease secretions & “death rattle” (b) unconscious client use of lateral position (c) hypoxia: nasal admin of oxygen; use fan, open window (air) (d) admin of morphine as ordered in cases of acute air hunger |
| Common End Of Life Symptoms Functional Ability | (1) (a) fatigue (b) immobility (c) weakness (d) pathological fractures (2) interventions (a) helping client get in & out of bed as able (b) regular monitoring of client’s position (c) support client’s position w/pillows, towels & blankets (d) elevation of client’s legs when sitting (e) implementation of pressure ulcer prevention program (f) use of pressure-relieving surfaces as indicated |
| Common End Of Life Symptoms Mood & Cognition | (1) (a) anxiety (b) depression (c) insomnia (d) confusion (e) dementia (f) delirium (g) memory changes (2) intervention (a) provide verbal support (b) regulation of client’s environ (temp, light, sounds) (c) consistency of caregivers (d) admin of neuroleptics & benzodiazepines as ordered (e) provisions of family support |
| Common End Of Life Symptoms Sensory Changes | (1) (a) diminished sense of vision & touch (b) decrease in pain management (2) intervention (a) responding to the client’s preference for light or dark room (b) admin pain management protocol as needed |
| Common Sources Of Loss | (1) loss of an aspect of oneself involves a change in a person’s body image that may or may not be apparent to the outside world (2) loss of an external object occurs when a person loses something, such as a home or pet, that is of significant importance to him or her (3) loss of a familiar environment occurs when a person’s known environment changes in some way (4) loss of a loved one can occur through death, divorce, separation, or illness |
| Defining Death | (1) total lack of response to external stimuli (2) absence of muscular movement, especially that associated w/breathing (3) absence of reflexes (4) flat encephalogram |
| Delayed Grieving | (1) type of dysfunctional grieving in which a person’s emotional response is either consciously or unconsciously suppressed until a later time (2) survivor may engage in dangerous activities as a method of lessening the pain |
| Developmental Loss a | (1) loss related to normal transition in a person’s life (2) marriage of a child would be considered a developmental loss (normal transition in a person’s life). (3) such losses can be predicted/expected and a person can prepare for them |
| Disenfranchised Grief | (1) person is unable to acknowledge their loss to other people (2) often relates to situations that are generally considered socially unacceptable, such as having an abortion or giving up a child for adoption (3) relationship losses that are socially unsanctioned also apply here like loss of a homosexual partner or the loss of a person with whom one has had an extramarital affair |
| Dying Trajectories | (1) death different paths (a) car crash or industrial accident can lead to sudden death (b) CHF can result in gradual decline in health w/short terminal phase (c) cancers follow a slow torturous trajectory ending in death (d) chronic illnesses present w/periodic crises then death (2) each type of trajectory results in different responses from individuals & families |
| Dysfunctional Grieving | (1) unhealthy or pathological grieving occurs when strategies to cope w/loss are maladaptive (2) falls outside of normal response range d/t exaggerated, prolonged or absent grief (3) person “stuck” in one stage of grief process (4) person spends so much energy repressing or dealing w/grief that has little left over for normal functioning (5) contributing factors (a) cultural barriers to emotional expression of grief (b) sudden death of loved one (c) existence of strained relationship w/diseased (d) survivor guilt (e) prior traumatic loss (f) inadequate support for survivor |
| Dysfunctional Grieving Goals | (1) STG: Patient will, by the end of my shift: (a) acknowledge that she has experienced a loss (b) describe two feelings expected with loss (c) verbalize intent to seek professional help (d) verbalize intent to contact hospice (e) verbalize intent to contact a grief support group (2) LTG: Client will contact professional help |
| Dysfunctional Grieving Risk Factors | (1) uncertain, sudden, or complicated circumstances surrounding loss (2) history of depression, low self-esteem, guilt or previous complicated grief reactions (3) socially unspeakable, negated or disenfranchised losses (4) history of current or past substance abuse (5) decrease or loss of social support systems (6) cumulative grief over multiple unresolved losses |
| Dysfunctional Grieving Implementation | (1) assess for causative and contributing factors to dysfunctional grieving (2) promote a trust relationship (3) support the person and the family’s grief reactions (4) promote grief work with each response (5) provide health teaching and referral |
| Dysfunctional Grieving Types | (1) unresolved grieving (2) inhibited grieving (3) delay grieving |
| tend to change so continue ongoing assessment (1) revisit the client’s legal documents like DNR order, advanced directive, to be certain they still reflect the client’s wishes (2) continuous plans considering various factors influencing the patient’s grief & dying response, spiritual and cultural beliefs and values about death, knowledge of the patient’s coping strategies and the degree of effectiveness all help in planning care that is sensitive and appropriate to the patient’s needs | End-Of-Life Preferences |
| Engel’s Theory | (1) shock & disbelief (stunned; blocks out reality to protect self) (2) developing awareness (starts to understand effects of loss but anger, guilt & sadness present) (3) restitution (recognization of reality of loss; participation in rituals (funerals) to help coping w/feelings) (4) resolving the loss (begins to deal w/void; preoccupation w/loss) (5) idealization (focus on positive features of person or item lost) (6) outcome (grieving process complete w/remembering good & bad aspects of person or item lost) |
| Elder 65 and older | death has a variety of meanings for the individual, many of which are positive, such as reunion with loved ones and an end to physical and emotional suffering. The individual may fear prolonged, disabling conditions more than death |
| Factors Affecting Grief Response | (1) age (2) gender (3) nature (4) timing (5) support systems (6) relationship with deceased (7) coping mechanisms (8) previous grief experiences (9) physical condition (10) significance of the loss (11) culture (12) spiritual beliefs, (13) socioeconomic factors (14) cause of the loss |
| Function Of Grieving | (1) to make outer reality of the loss into an accepted reality (2) to serve the emotional attachment to the lost person or object (3) to make possible for the bereaved person to become attached to other people or objects |
| Gastrointestinal Function At End Of Life | some symptoms include anorexia, dysphagia, unpleasant taste, nausea, vomiting, weight loss, and ascites. Appropriate nursing interventions might include providing soft, bland foods and/or liquid diets as tolerated; offering smaller, more frequent meals; and elevating the patient’s head and torso during and after meals |
| Gender Roles | in the U. S., gender impacts on a person’s response to loss. Men are many times expected to be strong and stoic in the face of loss. It also has an impact when a person’s loss involves a change in body image. If a woman suffers a burn injury on her arm, she may see it as a significant challenge to her body image & experience a profound sense of loss. A man, on the other hand, may see this injury as unfortunate, but not as a significant loss to his self-image |
| Grief | (1) response a person has to loss, incl behaviors, thoughts, emotions, and physical reaction assoc w/overwhelming sorrow (2) accompanying symptoms may incl depression, anxiety, weight loss/gain, difficulty swallowing, vomiting, fatigue, headache, blurred vision, dizziness, menstrual disturbances, palpitations, chest pain, dyspnea, sleep disturbances, changes in libido, inability to concentrate and communicate |
| Heart-Lung Death | cessation of a person’s apical pulse, respirations, and blood pressure |
| Hospice Care | (1) palliative care of a dying person and support of family (2) goal is to facilitate a peaceful and dignified death of the patient (3) trend is not to think of grieving in terms of rigid stages but as a process that varies in terms of time, response & outcome (4) home or hospital setting focusing on symptom control not cure (5) is community based & provides 24 hr care 7days/wk |
| Hospice & Palliative Care Desired Outcomes | (1) self-determining life closures (2) safe & comfortable dying (3) effective grieving |
| Implementation Phase Of Nursing Process End-Of-Life is meant to move the patient toward the expected outcomes (the patient-centered goals). In end-of-life care, outcomes r/t self-determined life closure, safe & comfortable death, and effective grieving by survivors | (1) priority to achieve goals is to reduce or eliminate uncomfortable symptoms and promote the comfort of the patient & family (2) physical interventions: positioning, suctioning, bathing & oral care become increasingly important as client’s condition deteriorates (3) nutritional adjustments (solid to liquid foods) attention to dietary fiber as tolerated for comfort (4) incontinence, attend to physical & emotional care to maintain self-esteem & support family (5) assess & advocate proper pain management & titrate drugs to effect as there may be no dosage ceiling; monitor appropriate medications titration to control dyspnea, constipation, diarrhea, anxiety, nausea, & vomiting |
| Infancy | (1) infants lack sense of object permanence until around one year of age. (2) when parents leave child’s immediate presence infants fear they’re gone forever |
| Inhibited Grieving (1) type of dysfunctional grieving in which expected emotional and psychological responses are suppressed, and the person experiences other somatic symptoms. | Inhibited Grieving (1) type of dysfunctional grieving in which expected emotional and psychological responses are suppressed, and the person experiences other somatic symptoms |
| Kubler-Ross, Elizabeth Model | five stages assoc w/facing one’s own death: (1) denial (cannot or will not accept reality of current or coming loss) (2) anger (occurs when reality of impending loss sets in) (3) bargaining (promises made to God), (4) depression (occurs when it becomes impossible to deny impending loss), (5) acceptance (occurs when person loss is accepted & coped w/in healthy manner) |
| “Letting Go” | (1) refers to the ability of people who will be left behind to tell the dying client that they will be okay after their death (2) patients also let go manifested as detachment from surroundings & confusion, coma like state, withdrawal |
| Loss | (1) parting w/objects, person, belief or relationship that one values leaving a sense of sadness, loneliness, depression, etc (2) can be a person, sense of well-being, body image or body part resulting suddenly, catastrophically or slow decline of chronic illness to eventual death |
| Loss Of Pets | can help a person prepare for major life losses |
| Loss Theories | all begin w/period of shock & disbelief progressing thru stages of sadness, anger concluding w/some form of acceptance |
| Loss Types | (1) loss of an aspect of oneself (a limb/slight d/t diabetes) (2) loss of external objects (of home, pet) (3) loss of a familiar environment (move to college dorm/nursing home) (4) loss of loved one (death, divorce) |
| Martocchio Theory | (1) organized clusters of grief-related behaviors incl shock & disbelief; yearning & protest; anguish, disorientation & despair & reorganization & restitution (2) maintained that there was no single correct way or correct timetable thru which the grief process progresses (3) success at integrating loss depends on person’s development & personal makeup (4) believed persons responding to the same loss cannot be expected to resolve the loss in he same manner or w/in the same time period |
| Medicare | (1) after a physician certifies that a patient has only six months to live, the patient becomes eligible for hospice benefits thru medicare (2) care is always provided by a team of hcp & nonprofessionals & full range of services is offered (3) all individuals w/serious or life-threatening illnesses are considered eligible for palliative care |
| Middle-Aged Adults 45 to 65 | may experience some anxiety about death, but the frequency of this anxiety decreases as he or she experiences the death of others and accepts the concept of personal mortality |
| Medical Definitions Of Death | before technology allowed advanced life support, death was defined as the cessation of a person’s apical pulse, respirations, and blood pressure, referred to also as heart-lung death. With advancement of artificial means of maintaining life, the World Medical Assembly (1968) derived a new definition with four clinical criteria for the indication of death: (1) total lack of response to external stimuli (2) absence of muscular movement, especially that associated with breathing (3) absence of reflexes (4) flat encephalogram |
| Mourning | (1) behavioral process that helps resolve or alter a person’s grief (2) process is influenced by culture, spiritual beliefs, customs & individual personality |
| NANDA: Dysfunctional Grieving | (1) definition: experiences prolonged, unresolved grief & engages in detrimental activities (2) defining characteristics: unsuccessful adaptation to loss, delayed emotional reaction, prolonged denial & depression, inability to resume normal patterns (3) related factors: loss of person, independence function, possession, job, status, home, body parts |
| Normal Grieving | (1) healthy, non-dysfunctional grieving can lead a person to new insights, values, challenges, and a heightened sense of empathy for others (2) normal grieving is looked at as abbreviated or anticipatory |
| Nursing Care of the Deceased | (1) dignity for deceased & sensitivity to family (2) remove all unneeded medical equipment & supplies; clean, position & cover patient (3) organ donation: California law mandates notification of all deaths to organ donor center (4) autopsy: postmortem examination of body’s organs to determine cause of death. Consent required & obtained by MD (if death suspicious, autopsy required regardless of consent) |
| Nursing Diagnoses Appropriate | to end-of-life care (1) anticipatory grieving related to impending loss (2) hopelessness related to failing health and inevitable death(3) caregiver role strain related to ongoing responsibility for providing physiological, psychosocial, and economic care to the dying person |
| Palliative Care | (1) comprehensive approach to care of clients w/lifethreatening, severe or advanced illnesses & their families having rights to participate in informed decisions & make their own tx choices (2) focus of care is the total person incl physical, emotional, spiritual, & cultural needs (3) describes interdisciplinary provision of long-term illness care (4) hospice care is palliative care, but not all palliative care is hospice care (5) palliative care (but not hospice care) is provided to those w/chronic conditions who are not expected to die w/in the next six months (6) provides support to families & other loved ones employing interventions that help the client live life to fullest w/in the context of their illness (7) trend is not to think of grieving in terms of rigid stages but as a process that varies in terms of time, response & outcome |
| Palliative Care Guiding 5 Principles | (1) all individuals w/serious or life-threatening illnesses are considered eligible for palliative care (2) guiding principles are (a) respect for patient goals, preferences & choices (b) provisions of comprehensive care (c) utilization of interdisciplinary resources (d) acknowledgement of and attention to caregiver concerns (e) creation of support system & mechanisms |
| Parkes’ Model: Four stages of grief | associated with bereavement (numbness, yearning, disorganization, reorganization) |
| Perceived loss | (1) cannot be verified by other people (loss of an aspect of oneself) (2) often parents & other significant adults in a child's life are unavailable to the child after a traumatic event because parents are so involved w/other concerns (3) may be perceived to be unavailable because they don’t understand childrens' reactions, avoid or deny that such reactions are often intense and complex, or simply don’t observe the reactions (4) may be experienced when parents become consumed w/their own losses or reactions to trauma. It is difficult to cope w/impact of violence & comfort children at the same time. Some parents fall into behaviors where they assume a childlike role while their children take on adult roles |
| Peri-Death Period | (1) time immediately before death, the actual time of death, and the period immediately following death (2) person may sleep a great deal and appear unresponsive, unable to communicate, and at times, difficult to arouse (3) this is a normal change that occurs in response to alterations in metabolism (4) decreased need for food & fluid (may decline intake), use ice chips, glycerin swabs, gatorade or juice to refresh mouth, apply cool, moist washcloth to forehead (maybe comforting) |
| Peri-Death Signs & Symptoms | (1) body prepares itself for death & (hands, feet & legs are increasingly cool) begins to decrease in temperature (2) mottled color may appear on underside of body (3) mottled look is sign of body shunting blood to vital organs & decreasing the amount of blood supplied to extremities (4) rapid shallow panting different from Cheyne Stokes (5)incontinence (bowel & bladder) occurs as muscles begin to relax. A catheter is used if client needs to conserve energy; however, simply changing the pads & linens is effective |
| Planning Stage r/t end-of-life | (1) determines expected outcomes & formulates specific strategies w/the client, family, & hc team to achieve them. (2) expected outcomes incl self-determined life closure, a safe & comfortable death, & effective grieving sh/be carried out w /in boundaries of established nursing standards, protocols, the ANA Standards of Practice, state nursing practice acts, and the taxonomy of nursing interventions (4) plan measures in a manner to help move the client toward expected outcomes (5) it is critical these outcomes comply w/the Dying Patient’s Bill of Rights, the Clinical Practice Guidelines for Palliative Care, advance directives, health care proxies, living wills, ethical concerns r/t truth telling, DNR, withholding & withdrawing life-sustaining therapies, death certification and potential inquests (6) rationales for tx sh/be grounded evidence-based practice |
| Potential Nursing Dxs r/t end-of-life | (1) anticipatory grieving r/t impending loss (2) hopelessness r/t failing health/inevitable death (3) provider role strain r/t ongoing responsibility for providing physiological, psychosocial, & economic care to the client & family can ensure these needs are met in a respectful and appropriate manner |
| Pre-School To Age 5 | (1) child believes death is similar to sleep & immobility(do not refer to death as sleep because the child might be afraid to go to sleep) (2) death seen as reversible & temporary (3) at two years children begin to explore independence, autonomy & need constant reassurance their adult caregivers will be available when needed (4) death is thought of as a different state but not permanent |
| Pre-Adolescent 9 to 12 | marked by rapid cognitive and competency development (1) begins to understand the cycle of life & that death is inevitable, and that he or she will eventually die (2) shows interest in the afterlife and/or a fear of death |
| Restlessness (Perideath) | (1) admin antianxiety meds (2) do not restrain (3) gently massage limbs (4) read a story (5) play soft music (6) noise & activity can cause increased anxiety |
| Rondo’s Theory Proposed | (1) 3 Categories Of Grief (a) avoidance (b) confrontation (c) accommodation (2) avoidance & confrontation are similar to Kubler-Ross & Engel’s focusing on person’s immediate series of reaction to real or anticipated loss (3) in accommodation person begins to resume usual activities, feels better & puts loss in perspective |
| School- Age 5 to 9 (1) | young child believes their wishes can cause death & realizes death is permanent & irreversible (2) believe personal death can be avoided (3) believe what they think about something causes it to happen. Such egocentric thoughts may cause young children to believe that something they did or said caused the death of a love one (4) may use magical thinking to construct alternative realities when the world around them is painful |
| Rationales Nursing Process End Of Life | care when caring for a patient at the end of life, it’s particularly important to state the rationales for care because many care decisions may be ethically and legally charged. For example, if the choice is made to withdraw life-sustaining treatment, the nurse must be able to demonstrate that this decision is both ethical and in accord with the client’s living will or other legal documentation |
| Rigor Mortis | (1) temporary rigidity of muscles occurring approximately two to four hours after death from lack of adenosine triphosphate (ATP) which causes muscles to contract (2) begins in the involuntary muscles (heart) & progresses to the extremities (3) goes away after approx 96 hrs after death (4) before it sets in, it is important to position the body, insert dentures & close eyes & mouth |
| Robert Wood Johnson Foundation | funded a project called the Study to Understand Prognosis & Preferences for Outcomes and Risk of Tx (SUPPORT), which examined the process of dying patients in five American hospitals |
| Sanders Theory | (1) shock (disbelief of actual or impending loss manifested w/denial, confusion, restlessness & alarm) (2) awareness (acute awareness of loss effect produce separation, anxiety, prolonged stress & conflict) (3) conservation/withdrawal (for protection; despair & feelings of helplessness) (4) healing (turning point in grief process; assumes control & restructure identity in light of loss) (5) renewal (new sense of freedom & self-awareness; learned to live w/o person/thing) |
| Shroud | a large piece of plastic or cotton material used to enclose a body after death |
| Situational Loss | (1) are unanticipated passing (not anticipated) (2) inclu (a) death of a child (b) loss of functional ability due to an illness (c) a catastrophic accident |
| Unresolved Grieving | (1) type of dysfunctional grieving that involves the presence of chronic grief that is extended in length and severity (2) same signs are exhibited in normal grief but person may have difficulty expressing them & may deny loss |
| Understanding Palliative Care | (1) goal of palliative care is to improve the quality of life for clients & family who are facing the complications & problems assoc w/life-threatening illness accomplished thru prevention of (a) new problems (b) early identification of complication (c) tx of pain & existing complications (d) ongoing multidisciplinary management (2) holistic approach incl hcteam |
