Death and dying

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Author:
gemlnl862004
ID:
88571
Filename:
Death and dying
Updated:
2011-06-02 12:54:09
Tags:
grief dying death rtw care
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Description:
Care of patients facing loss, grief, dying and death
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  1. pattern of physical and emotional responses to bereavement, seperation, or loss
    grief
  2. presence of illness/disease
    morbidity
  3. legal inquiry into the cause or manner of death
    inquest
  4. examination to confirm or determine cause of death
    autopsy
  5. type of listening, or action that indicates you are focusing soley on the individual speaking to you or having care provided to
    attending behavior
  6. general muscle weakness and physical detoriation
    cachexia
  7. culturally defined pattern for expressing grief
    mourning
  8. reaction to death of a loved one
    bereavement
  9. temporary in home care, can be part of hospice
    respite care
  10. turn rate of something up/down

    can be a med adjustment based on data collection
    titrate
  11. care for someone after death
    postmortem care
  12. study of death and dying
    thanatology
  13. give an example of an actual loss
    death of someone close
  14. give an example of a percieved loss
    expecting a baby girl, but get a baby boy
  15. give an example of a maturational loss
    normal life transitions such as hair loss
  16. give an example of a situational loss
    loss due to a specific external event such as car accident, house burning, death, etc.
  17. give an example of an individual loss
    loss felt to individual, but not to others such as menopause
  18. normal process of resolution interrupted
    unresolved grieving
  19. delayed or exaggerated response to loss; real or percieved
    dysfunctional grieving
  20. What can happen to a nurse when there are multiple deaths during their shifts over a short period of time?
    bereavement overload
  21. What can happen when your job is more stressful than the rewards it provides?
    burnout
  22. How can you prevent bereavement or becoming burned out?
    take breaks off of the floor, take a vacation and completely leave work behind, talk about feelings, try keeping work and the home seperate
  23. type of care to provide comfort care, help decrease symptoms, but does not cure
    palliative care
  24. type of care to maintain physical integrity, such as ROM, skin care, nutrition and hydration, repositioning, preventative care, safety, pain control, etc.
    physical care
  25. greyish purple marbling of the skin
    results from shut down of circulation
    generally on legs and fingers and moves inward
    mottling
  26. Who is a potential hospice patient?
    someone who has a limited life expectancy, and is no longer receiving treatment toward a cure, but requires very close attention. The patient must choose hopice care with a clear understanding of its philosophy and services.
  27. is a physicians order needed for hospice to provide care?
    yes
  28. The dying experience: one to three months
    • withdrawal from the world and people
    • decreased food intake
    • increased sleep
    • going inside of self
    • less communication
  29. The dying experience: one to two weeks
    • disorientation
    • agitation
    • talking with th unseen
    • confusion
    • picking at clothes
    • decreased BP
    • pulse increase/derease
    • skin color changes: pale, bluish
    • increased perspiration
    • respiration irregularities
    • congestion
    • sleeping but responding
    • complaints of body feeling tired and heavy
    • not eating, taking little fluids
    • body temp: hot/cold
  30. The dying experience: days or hours
    • intensification of one to two weeks signs
    • surge of energy
    • decrease in BP
    • eyes glassy, tearing, half open
    • irregular breathing: stop, start (apnea)
    • restlessness or no activity
    • purplish, blotchy knees, feet, hands (mottling)
    • pulse weak and hard to find
    • decreased urine output
    • may urinate or have BM in bed
  31. The dying experience: minutes
    • "fish out of the water" breathing
    • cannot be awakened
  32. Would it make a pain med more effective to give an antianxiety med to an anxious patient prior to giving the pain med?
    yes
  33. List the 5 stages from the Kubler-Ross Model of Grief in the correct order
    • denial
    • anger
    • bargaining
    • depression
    • acceptance
  34. hospice requirments
    • less than 6 months to live
    • doctor has diagnosed terminal illness
  35. when a patient dies, when do you stop documenting?
    after funeral home has taken the body away
  36. Hospice interdisciplinary team
    • Medical director
    • Nurse coordinator/hospital aide
    • social worker
    • spiritual coordinator
    • volunteer/bereavement coordinator
    • hospice pharmacist/dietician
  37. possible meds used for palliative care:
    nausea and vomiting
    constipation
    death rattle
    • anti-emetics-helps with nausea and vomiting
    • fluids, fiber-helps with constipation
    • scopolamine-dries up secretions, preventing death rattle
  38. serves as a buffer to the patient to shield self until the indiviual is able to mobilize alternate defenses
    denial stage
  39. hostility may be directed toward caregivers or loved ones
    anger stage
  40. bargaining is often made with god. it is an attempt to postpone death and is a postivie way to maintain hope
    bargaining stage
  41. sadness and grief. time of introspection. usually request only significant others to be with them. the patient struggles with painful realities of life and preparing for death
    depression stage
  42. resolved to the fact that death is imminent. peaceful acceptance and positive feelings are often present.
    acceptance stage
  43. cessation of life
    death
  44. condition of being subject to death
    mortality
  45. loss resulting from normal life transitions
    maturational loss
  46. loss occuring in response to a specific event
    situational loss
  47. mental treatment aimed at helping a patient deal with the pain of loss
    grief therapy
  48. to expect, await, or prepare oneself for the loss of a family member or significant other
    anticipatory grief
  49. sudden death of someone who is not "supposed to die"
    out-of-sequence death
  50. 5 causes of dysfunctional grief
    • gets 'stuck' in the grief process and becomes depressed
    • unable to express feelings
    • cant find anyone in daily life to act as the listener they need
    • suffers a loss that stirs up other, unresolved losses and causes them to explore long-standing feelings or emotional concerns
    • lacks the reassurance and support to trust the grief proces and fails to believe that they can work through the loss
  51. physical interventions are aimed at what?
    • energy conservation
    • pain reduction
    • comfort measures
    • promotion of sleep and rest
    • increasing self-esteem through body image acceptance
  52. emotional interventions are aimed at what?
    • offer encouragement and support
    • offer assistance in saying good-bye
  53. intellectual interventions are aimed at what?
    • education and support of patient and family
    • keeping everyone informed of procedures, changes in condition, and hospital policies so that well-informed decisions can be made
  54. perinatal death interventions
    • when possible, have parents see, touch, and hold the infant so that the reality of it can be faced and grief can be worked through
    • encourage parents to express feelings
    • refer to the baby by name, or 'your baby' or 'your boy/girl' to reinforce that the baby was a unique individual that was loved and will be missed
    • ask if the parents would like a lock of hair, blanket the baby was wrapped in, or ID bracelet as mementos
  55. What type of death is the most difficult to bear? give an example
    • out-of-sequence
    • pediatric death
  56. pediatric death interventions
    • explain whats going on in language they can understand
    • allow them to share fears, feelings, and opinions
    • supportive group therapy (during and after)
  57. gerontologic death interventions
    • include patient in self-care and in decisions about treatment
    • pain control
    • treat patient as an individual and asses needs just as you would for a terminally ill patient
  58. DNR
    • do not resuscitate
    • decision should be a joint decision of patient, family, and health care providers
    • withholds no care, ONLY means not to resuscitate
  59. DNRCC-Arrest
    recieves resuscitive efforts until the patient experiences a cardiac or respiratory arrest. Once an arrest is confirmed, resuscitive efforts are withdrawn and comfort care is given
  60. DNRCC
    • do not resusitate
    • comfort care ONLY
  61. signed and witnessed documents providing specific instructions for health care treatment in the even that a person in unable to make these decisions at the time needed
    advance directives
  62. written documents that direct treatment in accordance with a patients wishes in the even of a terminal illness or condition.
    living will
  63. What is generally needed for a living will and durable power of attorney?
    2 witnesses that are not related, and not a physician
  64. If a healthcare provider follows a living will, can they still be held liable?
    no
  65. patient designates an agent, surrogate, or proxy to make health care decisions on his or her own behalf
    durable power of attorney
  66. List some organs that can be donated
    • Vital organs: kidney, heart, lung, liver, pancreas
    • Nonvital organs: cornea, long bones, skin, middle ear bones
  67. 6 clinical signs of death:
    • unreceptivity and unresponsiveness
    • no movement or breathing
    • no reflexes
    • flat encephalogram
    • absence of apical pulse
    • cessation of respirations
  68. collection of mucous occurs in throat, noisy respirations heard
    death rattle
  69. 4 signs of impending death
    • slow, weak, and thready pulse
    • lowered BP
    • rapid, shallow, irregular or abnormally slow respirations
    • mottling of lower extremities
  70. public official, appointed or elected to inquire into causes of death when appropriate
    coroner
  71. physician, usually with advanced eduaction in pathology or forensic medicine
    medical examiner
  72. person trained in the care of the dead
    mortician
  73. Put these in the correct order: (from pg 211)
    A. Close clients face and mouth if needed
    B. Bathe client as necessary
    C. Wash hands and don gloves
    D. Place client in supine condition
    E. Allow family to view body and remain in room
    • C. Wash hands and don gloves
    • A. Close clients face and mouth if needed
    • D. Place client in supine condition
    • B. Bathe client as necessary
    • E. Allow family to view body and remain in room
  74. 4 major concerns/fears of a dying patient
    • fear of abandonment
    • fear of loss of control
    • fear of pain and discomfort
    • fear of the unknown
  75. If a shroud is used, how is it applied?
    • place the body on the shroud in the dorsal recumbent position, arms straight at the sides and pillow under head and shoulders
    • bring top of the shroud down over head
    • fold bottom over feet
    • fold the sides over body, taping or pinning the sides together.
    • Attach ID tag

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