Loss Grief & Death

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  1. Loss
    When a valued person, object, or situation is changed or inaccessible
  2. Actual Loss
    Loss that can be recognized by others as well as by the person sustaining the loss

    • Examples
    • loss of a limb, child, job, financial savings, job
  3. Perceived Loss
    Loss that is experienced by the person but intangible to others

    • Examples
    • Youth (loss of physical athleticism)

    • Financial Independence
    • (unemployed adult moving back in with parents)

    • A Valued Environment
    • (Forced to relocate away from hometown cross country because of spouse's job)
  4. Anticipatory Loss
    • Person displays loss & grief behaviors for loss
    • that has yet to take place

    Common in families of patients with life threatening / terminal illness

    May lessen effect when actual loss occurs

    • Often seen in
    • Mastectomy patients
    • Patients receiving new colostomy bags
  5. Grief
    Internal emotional reaction to loss caused by separation or death

    Also caused by loss of body part, job, house, pet, spouse (via divorce)
  6. Actions & expressions of grief

    Process of going thru the phases of grief until loss can be accepted or resolved

    Include symbols & ceremonies
    (funeral or celebration of life)
    Mourning or Bereavement
  7. Chronic Sorrow
    Recurrent feelings of grief, loss, & fear

    Commonly exhibited by family members of lost child
  8. Mourning of an excessive duration that interferes with returning to a normal living after the death of a significant person
    Chronic Grief
  9. Abnormal or distorted grief that is unresolved or inhibited
    Dysfunctional Grief
  10. Unresolved Grief
    Type of Dysfunctional Grief

    Trouble expressing feelings of loss

    State of bereavement extends over a lengthy period
  11. Inhibited (Inhibitory Grief)
    Type of Dysfunctional Grief

    • Person suppresses feelings & it manifests as
    • somatic symptoms

    • Examples
    • abdominal pain
    • heart palpitations
  12. Identify the (clinical) signs of impending death
    • Difficulty talking or swallowing
    • Nausea, flatus, abdominal distension
    • Urinary / bowel incontinence or constipation
    • Loss of movement, sensation, & reflexes
    • Elevated body temperature but cold or clammy skin
    • Weak, slow, or irregular pulse
    • Decreasing blood pressure
    • Noisy, irregular, or Cheyne-Stokes  respirations
    • Restlessness and or agitation
    • Cooling, mottling, and cyanosis of extremities & dependent areas
    • Pitting edema
    • Neurological compromise
    • Decreased levels of consciousness or agitated delirium
  13. Uniform Definition of Death Act (1991) states death as one of the following
    Irreversible cessation of all functions of the circulatory & respiratory functions

    Irreversible cessation of all functions of the brain (including brain stem)
  14. List the five stages of dying as identified by
    • Denial / Isolation
    • “the diagnosis is a mistake or a mix-up”

    •  Anger
    • “Why me? I quit smoking, watched what I ate”
    • Patient will exhibit rage, hostility
    • Bargaining
    • “If I can just make it to my son’s graduation…”
    • Patient exhibits a will to live a certain amount of time
    • Patient puts personal affairs in order allowing to later stage (finalize will, buck list, last wishes)

    • Depression
    • Period of grief before death
    • Not being able to see things to come (weddings, grandchildren)

    • Acceptance
    • Tranquility sets in
    • Patient has accepted reality & is prepared to go in peace
    • “Will is written, daughter will live with my parents”
  15. Terminal Illness
    Illness in which death is expected within a limited space of time

    Under Medicare, terminal illness is within 6 months
  16. DNR
    Do-Not-Resuscitate or No-Code Order

    No attempts are to be made to resuscitate the patient if breathing or heart stops

    • Physician is reluctant to write order if
    • Conflict exists between patient & family
    • Disagreement of use between individual members of the family

    Parents or children of the patient may change minds several times regarding DNR order

    DNR order can be revoked anytime
  17. Those in nursing homes that do not want to be sent to hospital for treatment
    Do Not Hospitalize Order
  18. Comfort Measures Only Order
    Goal of treatment is a comfortable dignified death

    No further life-sustaining measures are indicated
  19. Terminal Weaning
    • Gradual withdrawal of mechanical ventilation
    • For patient with terminal illness or poor prognosis
    • Spontaneous respiration after removal can occur for hours or days
    • Patients & families must be prepared for the span of time it takes
  20. The two types of Euthanasia are
    • Active Euthanasia
    • Doing something to end patient’s life
    • Assisted Suicide is a form of active
    • euthanasia

    • Passive Euthanasia
    • NOT doing something to end patient’s life
  21. What are the physiologic needs of the dying patient?
    Personal hygiene, pain control, fluids, nutrition, oral care

    Movement (prevention of pressure sores)

    Elimination needs

    Respiratory care & oxygen care

    Keep mouth & throat free of mucus
Card Set:
Loss Grief & Death
2014-12-14 07:09:27
Loss Grief Death

Module III, Unit E
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