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grief & end of life care

Terms in this set (55)

grief is defined as
feelings or reactions an individual has to a loss in one's life (can be any loss or personal experiences)
normal grief
also known as uncomplicated grief, is caused by the loss of someone very close, through death or the ending of a relationship
anticipatory grief
grief that is experienced before the expected loss of someone or something
prolonged grief disorder (PGD)
Previously known as complicated grief; lasts >6 months and can be so significant, it affects the client's ability to function
disenfranchised grief
grief related to a relationship that does not coincide with that is considered by society to be recognized or justified loss
Grieving process
every person as their own unique way pf moving through the grieving process; overtime it gets better, but may relapse & that's ok
Kubler-Ross 5 stages pf grief
- Denial
- Anger
- Bargaining
- Depression
- Acceptance
Denial
Client refuses to believe the truth snd this helps to lessen the pain of loss
Anger
client is trying to adjust to the loss and is feeling server emotional distress, often asking "why me?" and suggesting "it's not fair"
Bargaining
Usually involves bargaining with a higher power by making a promise to do something in exchange foe a different, better outcome
Depression
reality sets in, and the loss of the loved one or thing is deeply felt
Acceptance
Client still fells the pain of the loss but realizes they will be alright' finding "resolution"
the dual process model of grief
Suggests that the process of grieving oscillates (shifts back and forth) between two types of stressors: loss-oriented and restoration grief.
during loss-oriented stressors
grief is conveyed through intense thoughts and feelings (triggers)
the restoration grief process involves
coping with others losses that come with the death of a loved one (secondary losses) and rebuilding one's life without the loved one
example of restoration grief
Getting remarried after the loss of a spouse or getting a new pet after the lost of a pet
Worden's 4 Grief Tasks Model
Task I: Accept the reality of the loss
Task II: Experience the pain of grief
Task III: Adjust to an environment without the deceased
Task IV: Create an enduring connection to the decreased loved one, while embarking on a new life
Common Grief reactions
- shock
- anger
- anxiety
- numbness
- denial
- guilt
- sadness
- relief (if death is expected)
- depression
The age of the person experiencing the grief will...
influence the grief response
The age of the person who is the deceased will also...
influence the grief response
religious-Spiritual rituals can
help a person who is grieving to deal with death and the grieving process
the NURSE technique
- Name: Identity what the client just stated
- Understand: Demonstrate understanding by recognizing the client's feelings and providing an opportunity for the client to discuss their feelings
- Respect: voice your respect for the client
- Support: inform the client that you are available to him or her
- Explore: ask open-ended questions to extend the conversation and provide a more detailed expression of the client's feelings and beliefs
Using the NURSE mnemonic
- Name: "this is overpowering"
- Understand: "There is a lot happening right now, what can I do to assist you"
- Respect: "I'm very impressed with your ability to manage everything"
- Support: "I'm here all day for you"
- Explore: "What is the most difficult aspect?"
Hospice care
the administration of medical care to support the client who has a terminal illness, so they can live the last days of their life as best as they can, as long as they can
Hospice care is provided
when treatment will no longer cure or control the illness
Hospice care was originally offered only to
clients diagnosed with terminal cancer but has grown to include any client with a life-limiting illness
Hospice care is an inter professional, holistic care that
treats the whole person, including caregivers and family members
Hospice care criteria
a client meeting specific criteria and having a diagnosis of a life expectancy of fewer than 6 months
Palliative care
Holistic care provided throughout the lifespan for clients experiencing severe medical illness and particularly for clients approaching end of life
Palliative care goal is to
improve quality of life
difference between hospice & palliative care
Palliative care is provided while the client is still engaging in curative treatment methods
Palliative services
- Paid by insurance, self
- Any stage of disease
- Same time as curative treatment
- Typically happens in hospital
Hospice services
- Paid by Medicare, Medicaid, insurance
- Prognosis 6 months or less
- Excludes curative treatment
- Wherever the patient calls home
Breathing & Respiratory Alterations
- Dyspnea
- Retention of secretions in the respiratory tract ("death rattle")
- Cheyne-Stokes Respirations
Cheyne-Stokes respiration
an irregular respiratory rate fluctuating between several quick breaths & periods of apnea
Pain alterations
- Experienced by nearly 60% of older adult hospice clients who have cancer
- Occurs as a result of nerve injury, organs being stretched & compresses, and/or bone pain
Main pain medication that is administered
Morphine; although its side effects decrease respirations
Temperature Alterations
- Ability of the nervous system to regulate body temperature diminishes, causing clients to experience both increased and decreased temperature
- also caused by infection, cancer, and cancer therapy
- Mottling occurs
Mottling occurs when and where?
- Hours or days before death
- With the upper and lower extremities becoming cool to the touch
Mottling occurs as result of the
heart's inability to pump blood effectively, leading to decreased blood perfusion throughout the body
Vision and Hearing Alterations
clients may experience hallucinations or report hearing and seeing those who have already died
- Happens hours before
- As a nurse, don't stop talking to clients until they actually pass
Dignity is regarded as
an everyday necessity, essential to the well-being of all clients
What is the most complaints related to nursing care at the end of life?
most complaints are associated with a lack of caring pertaining to dignity
As clients near the end of life...
illness contributes to a loss of control, which lessens their sense of dignity
- As a nurse, helps keep their dignity
Providing a "good death" generally includes
pain management, planning for death, closure at the end of life, clear decision making, and being able to contribute to others
- example: involving advance directives
Postmortem care is
physical care preformed after death to prepare a body for viewing, autopsy, or release to funeral home
Postmortem care includes
- washing the body
- accounting for the client's possessions
- removing invasive devices such as intravenous catheters and indwelling catheters
- placing identification tags in at least 2 areas (toe, arm, outside of body bag, etc.)
Postmortem care also includes documenting...
- the date and time of death
- the name of anyone notified
- location of belongings
- where the client's body is moved (funeral home name)
During postpartum care it is important to leave __________ in before body muscles begin to rigid.
dentures
As a nurse, when preforming postpartum care you do
not preform alone, it is done as a partnership to show support
As organ and tissue donation is voluntary, the donor must
give authorization before death, or a surrogate can give permission when the client has not previously consented
Relating to organ/tissue donation a nurse is
not allowed to begin a dialogue about organ or tissue donation with the client or a family member
Who is allowed to initiate the request for organ/tissue donation?
only health care professionals who have completed a course provided or endorsed by an organ procurement organization (OPO) are permitted to initiate the request of the client or surrogate
What is the nurse's role relating to organ/tissue donation?
is to assist families who are dealing with this challenging decision; example: ask for a consult
What does a client have to be in order to be pronounced brain dead?
client have to be warm and dead before calling time of death
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