ATI Chapter 36: Grief, Loss, and Pallative Care

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Necessary Loss
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This is a loss related to a change that is part of the cycle of life that is anticipated but still may be intensely felt. This type of loss can be replaced by something different or better
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Actual Loss
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This is any loss of a valued person, item, or status, such as loss of a job
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Perceived Loss
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This is any loss defined by the client that is not obvious or verifiable to others
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Maturational or Developmental Loss
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This is any loss normally expected due to the developmental processing of life. These losses are associated with normal life transitions and help to develop coping skills
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Situational Loss
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This is any unanticipated loss caused by an external event
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Grief
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is the inner emotional response to loss and is exhibited in as many ways as there are individuals
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Bereavement
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includes both grief and mourning(the outward display of loss) as the individual deals with the death of a significant individual in their life
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Advance directives
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legal documents that direct EOL issues
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Living wills
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directive documents for medical treatment per the client’s wishes
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Health care proxy
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durable power of attorney for health care—a document that appoints someone to make medical decisions when the client is no longer able to do so on his own behalf
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What are Kubler-Ross 5 stages of Grief
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Denial, Anger, Bargaining, Depression, Acceptance
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Denial
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The client has diffculty believing a terminal diagnosis or loss
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Anger
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The client lashes out at other people or things
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Bargaining
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The client negotiates for more time or a cure
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Depression
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The client is overwhelmingly saddened over the inability to change the situation
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Acceptance
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The client acknowledges what is happening and plans for the future
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Factors influencing loss, grief, and coping ability
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-The individual’s current stage of development -interpersonal relationships and soical support networks -type and significance of the loss -culture and ethnicity -spiritual and religious beliefs and practices -prior experience with loss -socioeconomic status
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Factors that may increase and individuals risk for dysfunctional grieving
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-being exceptionally dependent upon the decreased -the decreased dying unexpectedly at a young age, through violence, or in a socially unacceptable manner -Inadequate coping skills or lack of social changes -lack of hope or preexisting mental health issues, such as depression or substance use disorder
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Normal Grief
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-uncomplicated -acceptance evident w/i 6 mths -somatic complaints-chest pain, palpitations, HA,, nausea, changes in sleep patterns, and fatigue
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Anticipatory Grief
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-this grief implies the ‘letting go’ of an object or person before the loss, as in a terminal illness -individuals have the oppurtunity to start the grieving process before the actual loss
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Complicated Grief
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-difficult progression through the expected stages -manifestations are more severe -suicidal ideation, intense feeling of guilt, and lowered self-esteem -somatic complaints persist for an extended period of time
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Disenfranchised Grief
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-an experienced loss that cannot be publicly shared or is not socially acceptable, such as suicide
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Pallative Care
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improved the quality of life of clients and their families facing EOL issues
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Hospice Care
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comprehensive care delivery system implemented when a client is not expected to live longer than 6 mths. Further medical care aimed toward a cure is stopped, and the focus becomes, enhancing quality of life and supporting the client toward a peaceful and dignified death
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Characteristics of discomfort
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-Pain -Anxiety -Restlessness -Dyspnea -N/V -Dehydration -Diarrhea or constipation -Urinary incontinence -Inability to perform ADLs
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Clinical Manifestations of Approaching Death
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-Decreased level of consciousness -Muscle relaxation -Labored breathing -mucus collecting in large airways -incontinence -Mottling -pupils no loger reactive to light -cool extremities
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Children <7
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usually perceive death as separation, they may feel abandoned and scared
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Ages 7-12
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perceive death as a threat to their personal safety
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Teens
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perceive death much like adults but may express their feelings in dramatic way
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NDX associated w/ grief
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-Anticipatory grieving -Dysfunctional -Interrupted family process -impaied judgement -risk for loneliness
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Bowbly’s Attachment Theory (4 stages)
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-numbing -yearning and searching -disorganization and despair -reorganization
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EOL
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Generally refers to the final phase of a patient’s illness when death is imminent
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Ethical Issues w/ EOL
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-Organ and tissue donations -Advance directives -Health Proxy -Resuscitation -Euthanasia–only legal in OREGAN
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A nurse is caring for a client who has terminal lung cancer. The nurse observes the client’s family assisting with all ADLs. Which of the following rationales for self-care should the nurse communicate to the family? A. Allowing the client to function independently will strengthen her muscles and promote healing. B. The client needs to be given privacy at times for self-reflecting and organizing her life. C. The client’s sense of loss can be lessened through retaining control of certain areas of her life. D. Performing ADLs is required prior to discharge from an acute care facility.
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C
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A nurse is caring for a client who has stage 4 lung cancer and is 3 days postoperative following a wedge resection. The client states, “I told myself that I would go through with the surgery and quit smoking, if I could just live long enough to attend my daughter’s wedding.” Based on Kübler-Ross’ Five Stages of Grief, which stage is the client experiencing? A. Anger B. Denial C. Bargaining D. Acceptance
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C
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A nurse is consoling the partner of a client who just expired after a long battle with liver cancer. The partner is displaying grief and states, “I hate him for leaving me.” Which of the following statements by the nurse successfully facilitate mourning for the grieving partner? (Select all that apply.) A. “Would you like me to contact the chaplain to come speak with you?” B. “You will feel better soon. You have been expecting this for a while now.” C. “Let’s talk about your children and how they are going to react.” D. “You know, it is quite normal to feel anger toward your husband at this time.” E. “Tell me more about how you are feeling.”
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A, D, E
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A nurse is caring for a client who has a terminal illness. Death is expected within 24 hr. The client’s family is at the bedside and asks the nurse what are anticipated clinical findings at this time. Which of the following is an appropriate response by the nurse? A. Regular breathing patterns B. Warm extremities C. Increased urine output D. Decreased muscle tone
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D
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A nurse is assisting a newly licensed nurse with postmortem care of a client. The family wishes to view the body. Which of the following statements by the newly licensed nurse indicate an understanding of the procedure? (Select all that apply.) A. “I will remove the dentures from the body.” B. “I will make sure the body is lying completely flat.” C. “I will apply fresh linens and place a clean gown on the body.” D. “I will remove all equipment from the bedside.” E. “I will dim the lights in the room.”
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C, D, E

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