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Actual versus percieved loss
- Actual loss: includes the death of a loved one, theft, deterioraion, natural disaster.
- Perceived loss: is internal, it is identified only by the person experiencing it.
Physical loss versus phychological loss
- Physical loss: includes injuries, removal of an organ, loss of function
- Psychological losses: challenge our belief system. Commonly seen in the areas of sexuallity, control, fairness, meaning, and trust.
External versus internal loss
- External losses: are actual losses of objects that are important to the person because of their cost or sentimental value.
- Internal loss: another term for perceived or psychological loss.
is the physical, phychological, and spiritual responses to a loss.
consists of actions associated with grief (wearing black clothing)
is a period of moarning and adjustment time after a loss
Types of griefs
- Uncomplecated grief: normal grief is th enatural response to a loss. Some emotions will be present, but the intensity will change.
- Complicated grief: different by lenth of time and intnsity of emotions. 3 types of complicated grief.
- 1. Chronic grief: begins as normal grief but continues long term, with little resolution of feelings and inability to rejoin normal life.
- 2. Masked grief: occurs when the person is gieving but expressing the grief through other types of behavior
- 3. Delayed grief: is grief is put off until a later time
- Disenfranchised grief: is experienced in connection with a loss that is not socially supported or acknowledged by theusual rites or ceremonies. ex. whos wife have had a miscarriage.
- Anticipatory grief: is experienced before a loss occurs.
What is death?
- Uniform determination of death act 1981:
- Irreversible cessation of circulatry and respiratory functions
- Irreversible cessation of all functions of the entire brain including brain stem, is dead.
- comfort care: is nothing more can be done to cure your loved one, althogh certain symtpoms (nausea) will be treated.
- It is actually aggressively planned, holistic comfort care. General issues for most end-of-life care patients:
- Supporting families and caregivers
- ensuring continuity of care
- Ensuring respect for person
- Esnuring informed decision-making
- Attending to emotional and spiritual concersn
- Supporting function and survival duration
- Managing symptoms
focuse on holistic care of pt who are dying or debilitated and not expceted to improve. PHysician must certify that the patient is likely to die within 6 months.
How to involve famiy members in palliative care?
team plans care with the patient and family. Family member are encouraged to be an active part of the team as much as they are able. Familes are taught what to expect as the disease progressess.
- is a group of instructions (written or oral) stating a person's wishes relative to his healthcare if he were incapacitated or unable to make that decision.
- Living will: document provides specific instructions about the kinds of healthcare the person would wish or would wish not to have in particular situations. Ex. no artiricial foods administered.
- Durable power of attorney (DPOA): when a competent person names another individual to make decisions regarding his healthcare choices under certain conditions when he is unable to do so.
- DNAR order: do not attempt resuscitation
making available that which is needed for the pt to end his own life.
- "good death". It refers to the deliberate ending of a life of someone sufferingfroma terminal or incurable illness.
- Active euthanasia: occur as a result of a direct action (ex. giving an overdose of medication). Can be voluntary (pt consents), involuntary (pt refuses), or nonvoluntary (pt is unable to consent, or someone else makes the decision and the pt is unaware of it). Active ehutanasia goes a step further thatn assisted suicide. The assistantalso serves as the direct agaent of death(administers the medication)
- Passive euthanasia: occurs as a result of a lack of action ( ex. withholding medications or food necessary to sustain life.
medical examination of the body to determine the cause of death.
Explain the guidelines for organ donation
many institutions will not procure organs from the deceased if there is strong family objection. If pt. is planning to donate organs or tissues, bu sure that he discusses these wishes with family members. transplant coordinator will call the family and makes the request for organ and tissue donation.
Influence of culture and religious beliefs upon death and dying
most cultural groups engage in some type of religious ceremony that helps the bereaved begin the grieving process. Nevertheless, some death rituals and epxressions of grief may be culture based but not necessarily inbolve religion.
Nursing responsibilities in postmortem care
- includes care of the patient's body after death and fulfilling any legal obligations, such as arranging transportation to the morgue or funeral home. Make the pt. look as natural as possible.
- Rigor mortis: sets in 2-4 hr after death and disapears about 96 hr after death