question

How people respond to illness is shaped by _

answer

personality, psychological makeup, family patterns, and social environment

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T/F Religious faith and spiritual beliefs can be important allies in coping with life-threatening illness

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True

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Four major dimensions i coping with dying

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physical- involves satisfying bodily needs and minimizing physical distress in ways consistent with other values psychological- involves maximizing psychological security, autonomy, and richness in living. social- involves sustaining and enhancing significant interpersonal relationships and addressing the social implication of dying. spiritual- identifying, developing, or reaffirming sources of spiritual energy or meaning and, in so doing, fostering hope. not just religion, encompasses a person's basic values and sources of meaning about life and death.

question

According to Arthur Frank, critical illness teaches us that to be alive is to be constantly at risk, but the risk greater than dying is _

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living less than well.

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closed awareness

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the dying person is not aware of his or her impending death, although others my know. lack of communication about the person's illness.

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suspected awareness

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a person suspects his or her prognosis, but this suspicion is not verified by those who know.

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T/F: In a suspected awareness context, a dying person has no desire to verify his or her prognosis

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False

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Mutual pretense

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participants sidestep direct communication about the patient's condition. Can lead to complicated though usually unspoken rules of behavior intended to sustain the illusion that the patient is getting well.

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open awareness

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death is acknowledged and discussed. does not make death easier to accept, but allows possibility of sharing support in ways that are no readily available with the other awareness contexts.

question

"living-dying"

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living with a life threatening illness. patients and families fluctuate between denial and acceptance.

question

middle knowledge

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individuals seek balance between sustaining hope and acknowledging the reality.

question

reactive depression

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a response to disruptions cause by disease

question

preparatory depression

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related to the awareness that on is dying and must prepare for death

question

Kubler-Ross's model

answer

denial anger bargaining depression acceptance

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Kenneth Doka's model of the chronology of living-dying

answer

-acute phase: initiated by diagnosis -chronic: living with the disease -terminal: coping with impending death two additional phases may occur first: -pre-diagnositc: during which a person suspects the illness and may seek medical attention -recovery phase: follows the cure or remission of a previously life-threatening disease.

question

Avery Weisman's 3 tasks

answer

-confronting the problem & revising one's plans as necessary -keeping communication open & wisely using the help offered by others -maintaining a sense of optimism & hope

question

Weisman's 3 phases of coping with terminal illness

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1. from the time symptoms are noticed until the diagnosis is confirmed 2. the time between diagnosis and the final decline 3. from decline to death

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ID the landmarks that characterize the journey through terminal illness

answer

Mitigation & accommodation existential plight preterminality & terminality

question

existential plight

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a crisis of self-identity begins with the initial shock of diagnosis a the person attempts to come to terms with the life-altering news

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mitigation and accommodation

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when treatment begins, the reality of the illness becomes part of the person's life as adjustments and accommodations are made.

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preterminality and terminality

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when no cure or extension of life is in the offing, the individual confronts progressive decline and deterioration as the limits of life become increasingly clear.

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Theresa Rando's 3 major psychological and behavioral patterns that individuals use in coping with the threat of death

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1. retreat and conservation of energy 2. exclusion from the threat of death 3. attempting to master or control the threat of death

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emotion focused coping

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-helps regulate the level of distress -allows a person to escape the impact of the stressful situation by reframing it or distancing himself from it.

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problem focused coping

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-deals with managing the problem that is causing distress. -an individual who seeks out information about a diagnosis and takes an active role in determining options -pursuit of personally meaningful goals -greater sense of control

question

meaning based coping

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-helps maintain a person's sense of positive well-being -giving up goals that are no longer achievable and formulating new ones, making some sense of what is happening, and finding benefit in the distressing situation. -people often turn to spiritual beliefs for insight in making the best of a bad situation.

question

From the moment one notices unusual symptoms, through the ups and downs of treatment, and on the final moments of life __ are often delicately balances.

answer

hope and honesty honesty to face reality as it is, hope that the outcome is positive

question

coping potency can be reflected by __

answer

The capacity to maintain a sense of self-worth, to set goals and strive to meet them, to exercise choice out of an awareness of one's power to meet challenges, to engage in active interactions with one's environment. sustains the will to live in the face of death.

question

dignity defined as

answer

Harvey Max Chochinov: the quality or state of being worthy, honored, or esteemed. dignity provided an overarching framework that may guide the physician, patient, and family in defining the objectives and therapeutic considerations fundamental at the end of life.

question

The options for treating life-threatening illness vary with the _

answer

nature of the disease and a patient's particular situation

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staging

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denote the extent of disease and helps determine treatment decisions as well as prognosis

question

The classification of cancer according to how it has spread in the body is called _

answer

staging

question

tumors are assessed in three ways:

answer

1. extent of the primary tumor 2. absence of presence of lymph node involvement 2. absence or presence of distant metastases

question

metastasis

answer

cancer may spread by invading adjacent tissues... a process whereby diseased cells travel in the blood or lymphatic system or though body tracts to more distant parts of the body.

question

adjuvant therapy

answer

an auxiliary remedy which aids or assists another

question

Surgery

answer

usually involves removing the malignant organ or tissue and the adjacent healthy tissue. primary treatment for many types of cancer & sometimes used as a therapeutic option in treating pain.

question

radiation therapy

answer

uses ionization radiation to preferentially destroy cells that divide rapidly. used as adjunct to chemotherapy in some or as key role in treatment. may be used as palliative therapy to receive symptoms and improve quality of life.

question

The key to life-saving help for a heart attack victim is a

answer

rapid emergency response

question

successful treatment of cancer requires that all cancerous tissue be

answer

destroyed or removed

question

Nausea, vomiting, tiredness, and general weakness are some of the side effects that a patient needs to withstand to undergo _

answer

radiation therapy

question

chemotherapy involves the use of _ to kill cancer cells

answer

toxic drugs

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Despite the fact that it usually causes distressing side effects, __ is an important treatment in many types of cancers

answer

chemotherapy

question

The conventional medical system is based on describing health-related phenomena by using scientific explanations that are:

answer

-empirical: based on evidence of the senses and objective observation -rational: follow rules of logic and are consistent with known facts -parsimonious: explain phenomena by use of fewest causes -rigorously evaluated: capable of verification -tentative: open to new or better evidence

question

The techniques that help patients mobilize their inner healing resources by imagining the diseased parts of the body becoming well again are called

answer

adjuvant mehtods

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Method that include psychotherapy, and other mind-body interventions, as well as physical therapy and other forms of manual healing are called

answer

adjuvant methods

question

physicians have realized that practices other than the "culture of biomedicine" _

answer

can be effective

question

Placebo

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defined by Perlmutter: a substance with no known specific pharmacologic activity for the condition being treated

question

impure placebo

answer

substances that have known therapeutic actions but not for the disease in question example: antibiotic for nonbacterial infection. sham procedure for surgery.

question

placebo effect

answer

the positive response to a treatment that a person believes to be an effective therapy

question

Researchers believe that simply believing in a treatment can be

answer

as effective as the treatment

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symbolic healing

answer

the varied therapies known under such names as faith healing, supernatural healing, and folk healing. (term used by Shupe & Hadden)

question

one of the most important diagnostic tools used today is the type and severity of __

answer

pain -most common symptom in terminally ill patients

question

accuse pain

answer

an essential biological signal of the potential for or the extent of injury a protective mechanism that prompts the sufferer to remove or withdraw from the source of the pain.

question

chronic pain

answer

pain that persists longer than 3-6 months -when pain lasts this long, it loses its adaptive role. -may be accompanied by sleep disturbances, loss of appetite, weight loss, and depression.

question

the most useful agents of the treatment of pain associated with advanced diseases are _

answer

opioid analgesics

question

morphine

answer

the gold standard of analgesics and a cornerstone for management of serious pain works effectively to manage pain because it taps into the body's own pain relief system- neurotransmitters.

question

a variety of medical techniques, included nerve blocks, electrical stimulation of nerves, and neurosurgery are used to treat

answer

pain

question

expected trajectory

answer

an individual ma res a sudden exit, as in accidents or other emergency situations when life or death hangs in the balance

question

lingering trajectory

answer

a patient's life fades away slowly and inevitably applies to people with progressive chronic illnesses who are receiving palliative care

question

3 distinct trajectories of lingering trajectory:

answer

trajectory 1: short period of evident decline. steady progression and usually a clear terminal phase. usually no time to anticipate palliative needs and plan for end-of-life care. typically the case with cancer. acute stroke 2: long-term limitations with intermittent serious episodes. gradual decline, periods of acute deterioration and some recovery, unexpected "sudden" death. heart failure and respiratory illness series of smaller stroked and recovery 3: prolonged gradual decline or "dwindling" progressive disability from an already low level of cognitive or physical functioning. death in old age form illnesses like Alzheimer's or other dementia, or from generalized frailty of multiple body systems. gradual decline due to stroke sequelae

question

T/F Biological death may be preceded by social death when we focus on the passing of the person rather than the death of the body.

answer

False: when we focus on the death of the body and neglect the passing of the person, biological death may be preceded by social death.

question

physical phenomenon

answer

the death of the body

question

nonphysical phenomenon

answer

the passing of the person

question

near the end of life, an individual may attend to a variety of interrelated concerns and activities, such as:

answer

-re-examining beliefs -reconciling life choices -exploring lifetime contributions -examining loving relationships -exploring ideas and beliefs about an afterlife -discovering meaning

question

The only task that matters in being with someone who is dying is to

answer

sit still and listen to their stories

question

Defense mechanisms

answer

occur unintentionally and without conscious effort or awareness function to change a person's internal psychological states, not the external reality

question

coping strategies

answer

involve conscious, purposeful effort, are employed with the intention of solving a problem situation. both defense and coping involve psychological processes that can help ease a distressful situation

question

Problems faced by patients with life-threatening illnesses

answer

costs related to hospitalization, outpatient therapy, office visits and medications costs of transportation, support services, child care, and temporary housing time off from work = lost earnings

question

assuming oneself responsible for anything, though not clear just how is called ____ ____

answer

magical thinking

question

Cancer

answer

refers to malignant, or potentially lethal, growths that occur in the body

question

ID Charles Corr's primary dimensions in coping with dying

answer

physical, psychological, social, and spiritual

question

The object of __ changes over time while maintaining a coping potency

answer

hope

question

Mutual pretense can be a useful strategy for coping with a ____

answer

difficult and painful situation

question

__ are interdependent, each supplementing the others

answer

coping strategies

question

Mutual pretense may be carried on __

answer

until the death of a patient

question

Bioenergetics, homeopathic medicine, and yoga are what form of cancer treatment option

answer

complementary and alternative therapies

question

What did Eric Cassell write about the social role of the dying patient

answer

The death of the body is a physical phenomenon whereas the passing of the person is nonphysical

question

which of the following are spiritual needs of dying patients

answer

*1. need for hope and creativity* 2. need to complete a will for loved ones *3. need to give and receive love* *4. need for meaning and purpose*

question

What is the aim of meaning based coping

answer

to maintain a person's sense of positive well-being

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