29 terms

1255 EOL - loss & final hours

what is loss?
- Absence of a possession or future possession
- person, thing, relationship, job
- real, perceived, anticipated
what is grief?
- The emotional response to the loss
- Feeling felt by the individual = anger, depression, powerlessness, regret, guilt, loneliness
what is mourning? (2)
- Outward social expression of loss
- Dictated by cultural norms, customs and practices
what is bereavement? (3)
- Includes grief and mourning
- inner feelings & outer reactions
- time to adjust to loss of person
what is the nurses role? (3)
1. Assess the grief = what type is being experienced?
2. Assist the patient with grief = loss of body part, control
3. Support survivors = let feel, express loss, complete task of grieving
What is the grief process? (5)
Begins before the death
Not orderly or predictable
Includes a series of stages or tasks
No one "gets over it"
Grief work leads to living with the loss
What is anticipatory grief? (4) ****
1. Grief before loss (**Ex. wife is crying)
2. Actual or fear of potential losses
3. Experienced by patient, family, professionals
4. Children have unique needs = fear of abandonment, contracting disease, they act out in school
What are the interventions of anticipatory grief? (6)
1. Education
2. Adaptive equipment
3. Reframing = minimize loss by finding gain
4. Life review = reminisce
5. Advanced directives = RN don't sign legal docs
6. Presence = active listening, touch & reassurance
What is normal grief (uncomplicated)? (3)
1. Normal feelings, behaviors and reactions to loss
2. Physical, emotional, cognitive and behavioral reactions
3. can take years to reconnect with the world
Complicated grief: chronic
doesn't subside
Complicated grief: delayed
avoids pain of loss, avoids reminders
Complicated grief: exaggerated
intense reactions, nightmare, suicides, calling out for deceased
Complicated grief: masked
not aware of abnormal behaviors, imitate deceased, replace loss quickly
what are four complicated grief risk factors
Sudden or traumatic death
Suicide, homicide
Death of a child
Multiple losses
what is disenfranchised grief & who is at risk?
When loss cannot be openly acknowledged or socially sanctioned
At risk- AIDS partners, ex-spouse, step-parent/child, terminated pregnancy
what are the three stages & tasks of grief?
Stage 1 Notification and shock = No, not me
Stage 2 Experience the loss =anger person who died or who cared for them. guilt, sadness
Stage 3 Reintegration = reorganize & restructure family, ↑ energy, participate in life events
what are eight interventions for grief?
1. Presence = attitude, non-judgemental
2. Honor cultural norms
3. Encourage story telling
4. Listen
5. express feelings
6. active listening
7. silence
8. support systems
what is cumulative loss? (4)
1. succession of losses
2. dont' have time to process the loss
3. personal life changes
4. expected to be in control
What are seven frequent symptoms in the last 48 hours?
1. death rattle
2. pain
3. agitation
4. urinary incontinence
5. dyspnea
6. N&V
7. Myoclonus
Nutrition & hydration in final hours (2)
1. Equated with caring by many people
2. Fasting and dehydration results in a more peaceful death = produces endorphins, almost mimics morphine
the death vigil/common fears (5)
1. Being alone with patient
2. Painful death
3. Time of death = on birthday, xmas
4. Giving "last dose"
5. don't want to watch pain & suffering
Nursing interventions: support (4)
1. Collaboration with physician/team
2. Reassurance and education in what to expect in the process of dying
3. Role model comforting = mouth care, symptom mgt
4. Spiritual care; honor culture
Resuscitation (4)
1. No advance planning = must do CPR
2. Unrealistic beliefs regarding survival
3. Outcomes are usually poor
4. Family presence during resuscitation
Five signs of death
1. Absence of respirations and pulse (heart beat)
2. fixed pupils
3. Skin color change = pale, cyanotic to waxy
4. decreased body temperature
5. Muscle relaxation
Communicating the death (5)
Open, honest in communication with family
Preparation of family is part of process
Care following death (4)
Preparing the family
Care after death
Plans for burial/embalming
Removal of the body
Assistance with calls and notification
Morgue care (4)
Tag body
Body bag or shroud
Tag bag
Tag belongings
Organ/tissue transplant (3)
Brain dead
Traditional death
Common questions
Nurse's responsibility
Death of parent...remember the children (4)
Be aware of the developmental stage of the child
Communicate openly and honestly
Children need opportunities to ask questions
Questions should be answered in terms that they can comprehend