Ch 37. Loss and Grief and the Nursing Process EAQ – Flashcards

3 When the nurse anticipates death in a patient, the nurse should expose the hands of the patient. The nurse should lower the side rails of the bed. The nurse should place a chair close to the bedside. The nurse should encourage the family to continue touching the patient.

1, 2, 3 Dyspnea may occur due to fever, anxiety, or anemia. Fever increases metabolic demands and oxygen consumption. The body compensates for this increased demand by increasing the respiratory rate. Anxiety may cause hyperventilation and dyspnea. Anemia reduces tissue perfusion, and as a compensatory mechanism, the body increases the respiratory rate. Lack of fluid intake in the diet causes constipation. Stimulation of the trigeminal nerve does not cause dyspnea. Stimulation of the trigeminal nerve in the cheek decreases dyspneic sensation.

1, 2, 5

1 Critical thinking model for loss, death, and grief planning helps the nurse to plan the care for the patients. The attitudes approach in the critical thinking model helps the nurse to deliver high-quality supportive care. The standards approach is used to provide privacy for the patient and family and apply ethical principles of autonomy in supporting the patient's choice regarding treatment. The experience approach uses previous patient responses to planned nursing interventions for pain and symptom management or loss of a significant other. The knowledge approach uses spirituality as a resource for dealing with loss.

4 Experience is the critical thinking skill a nurse will use to evaluate the previous patient responses to planned nursing interventions for symptom management or loss of a significant other. A clinical symptom of an improved level of comfort is evaluated by using the critical thinking skill of knowledge. Perseverance in seeking successful comfort measures is evaluated using attitudes as a critical thinking skill. Characteristics of the resolution of grief in the patient are evaluated by using knowledge as a critical thinking skill.

4 Native Americans are diverse tribal groups with different practices, traditions, and ceremonies. According to their culture, after cleaning the body, an eagle feather is attached to symbolize a return home. Chinese cultural rituals involve bathing the body by the eldest son or daughter under the direction of priest or elder relative. Hispanic cultural rituals involve amulets or rosary beads, healing practices (folk medicine), and prayer. Buddhist cultural rituals involve not touching the body after death.

3 Holding the hand of a dying patient and stating "You're not alone" communicates concern and caring even if the patient is unable to respond. An actively dying person may not be able to interact, and telling the patient that death will occur soon may increase the patient's sense of anxiety. Discussing the process with family members does not focus on the patient.

3, 4, 5 A dying person's rights include the right to be free from pain, the right to peace and dignity, and the right to make decisions about care. The patient should not be left to die alone and should not be deceived.

2 While evaluating patient outcomes, the nurse should ask the patient a few questions to validate achievement of goals and expectations. Asking the patient about his or her comfort level talking about grief is an assessment question and would not help the nurse to validate the patient outcomes. Asking the patient if the standard of care is being met helps to evaluate the patient outcomes. Asking the patient about specific needs helps validate the achievement of goals and expectations. Asking the patient if needs are addressed in a timely manner helps to validate expected outcomes.

1, 2, 3, 4 The nurse should respect the family's wishes and decisions. In autopsy, all organs are assessed for the cause of death and will be replaced. The nurse should answer all the family's questions related to the autopsy and support their choices. The nurse should also take the permission for autopsy from the family members. Physicians or coroners sign some medical forms such as requests for autopsy, but the registered nurse gathers and records much of the remaining information surrounding a death. Nurses also usually witness or delegate the signing of forms (e.g., release of body or personal belongings forms).

1, 5 The nurse should offer family members the option to view the body and respect their decision to do so. The nurse should use periods of silence during the conversation to help the family members express their emotions. The nurse does not have to talk but can emotionally support the family simply by being present.

1 Individuals specially trained in requesting organ donations facilitate the process. They are skilled in talking compassionately to people who have suffered a tragic, sudden loss and have answers to many questions that people have regarding the donation process. Nurses do not request organ donations, although they do provide support and reinforce or clarify explanations to the deceased person's family during the request process. If the deceased person has not left behind instructions concerning organ and tissue donation, the family gives or denies consent at the time of death. Organ tissue donations are requested at every death.

1, 4, 5 In the hours or days before death, the patient will have decreased intake of food or fluids and inability to swallow. Additionally, just prior to death, the patient will experience increased periods of sleeping and coolness and cyanosis in extremities such as the nose and fingers. Hours or days before death muscle tone generally decreases, jaw muscles relax, and sagging of mouth is seen. Decreased urine output, dark-colored urine, and bladder incontinence are observed in the patients hours or days before death.

2, 5 Encouraging the patient to lie on the right side helps to relieve nausea, not constipation. Regular periods of ambulation may help to relieve constipation. Elevating the head of a patient to facilitate postural drainage helps to relieve noisy breathing or death rattle in terminally ill patients. Administering artificial tears or optical lubricants reduces corneal drying and irritation. Placing an indwelling catheter in the patients with decreased level of consciousness helps to relieve urinary incontinence. Encouraging patients who are on opioid medication to increase liquid intake helps reduce the risk of constipation due to opioid drugs.

4 Administering narcotic agents to a terminally ill patient would help relieve tachypnea. Turning the patient to a side would help reduce noisy breathing that may occur due to pooling of secretions. Providing oral care would also help reduce noisy breathing. The patient should be placed in fowler's position by elevating the head of the bed to reduce ineffective breathing patterns such as tachypnea.

1, 2, 4 Providing preferred foods might help the patient eat more. Arranging for the food to be delivered at home reduces discomfort for the patient. Social activities with friends that involve eating help the patient to have food with others. Parenteral nutrition should be given only to those patients who cannot take food orally. Patients should be encouraged to take small, frequent meals to improve food intake and nutritional status.

1, 4 Physical changes observed in a patient who is in his or her last hours of life include a sagging mouth and relaxed jaw muscles. Dark-colored urine, decreased urination, and decreased pulmonary secretions are physical changes observed in a patient who is in his or her last hours of life.

1, 4 The nurse should provide support to the family to help them adjust to their loss and to accept the reality of the loss. The family should be allowed to grieve, because it helps to come to terms with the loss. Use of alcohol to get over the crisis is an ineffective way of coping and should be discouraged. The nurse should not try to hurry the family but should allow time for grieving and continuity of care.

3, 4, 5 The care provided by the nurse after death changes with the cultural background of the patient. Allowing the family members to place the body on the floor with the head facing north is associated with cultural and religious rituals of the Hindu religion. Allowing the members of an extended family to stay with the deceased for up to 8 hours after death is associated with cultural and religious rituals of the Chinese. Explaining to family members that an autopsy does not deform the body and that all organs are replaced in the body is part of the care provided after death for people who believe that all of the body parts must remain with the person to enter into heaven. Providing safe and appropriate postmortem care is general care after the death of a patient of any cultural or religious background. Gathering and recording much of the remaining information surrounding a death is an action performed by the nurse as a part of general care provided after death.

2 Even seriously ill people want to carry on with life, doing what they can to maintain their identity and purpose. They know best how to regulate their energy and wishes for how to spend their time. The nurse should not encourage the patient to scale back on their most valued activities or suggest that the patient needs others to help them with things.

2, 3, 4 The task of caring of the body after death can be assigned to nursing assistive personnel (NAP). The NAP should identify the patient using two identifiers. The NAP should elevate the patient's head on one pillow to prevent discoloration of the face. The NAP should comb patient's hair or apply personal hairpieces. While caring for a body after death, the NAP should leave the dentures in the mouth to maintain facial shape. The NAP should ask the family members whether they wish to participate in preparation of the body.

1, 4, 5 As peripheral circulation fails, there may be mottling of the skin. The breath pattern may be altered in patients just prior to death. Cheyne-Stokes is a common breathing pattern seen in patients who are expected to die. As peripheral circulation fails, patches of varying colors of pallor in the skin may be found. The peripheral circulation will continue to fail as the death nears. The bowel movements may decrease or cease completely.

1, 2, 3 Treating the pain helps the patient gain hope. Setting up appropriate goals helps in prioritizing the problems, so matters of lesser importance will not receive much attention. An older adult with a debilitating disease will definitely require social support. Advising the patient to get a job may not be appropriate due to the patient's age, disease, and the associated pain. Heating pads can sometimes relieve pain but are a temporary measure.

3, 4, 5 Assessing family support helps the nurse understand whether the patient will be able to cope with the loss. The patient may exhibit behaviors indicating a grief response. The nurse should be watchful of a negative response. It is important to understand the loss from the patient's point of view to know the significance of the loss. The patient's religion and culture also affect the patient's coping. However, assessment of religion and culture is less important when coping with the loss of a body part and more important during death.

1, 4, 5 Nonverbal behavior such as sad expressions and closed eyes may indicate grief. Observing the patient's responses to care options can give an idea about her feelings and hopelessness. Her interactions with others may reveal a lack of interest and unwillingness to meet others. Observing the patient's relatives may not contribute in planning care for the patient. Assessment of the economic background may not be relevant to the grief response.

3 The patient is encouraged to lie on right side when he or she complains of nausea. The nurse should provide cool air in the room if the patient is suspected to have an ineffective breathing pattern. The nurse should massage the body of the patient at the site of pain. The nurse should provide background music of the patient's choice so that patient may divert his or her mind from pain by providing a soothing environment.

2, 3, 5 Hospice is a philosophy and a model for terminally ill patients. It tries to provide comfort and manages the patient's pain and suffering. The services are available at home as well as in a hospital setting. Hospice is not always a specific place for terminally ill patients and does not provide economic support.

3, 4 When prioritizing nursing diagnoses, the nurse should first get the patient's sense of the most important issue. Some patients do not fully understand the physiology or relationship among diagnoses. For example, one patient may not understand that pain contributes to a decreased appetite or depression. The nurse's knowledge, along with the patient's perceptions, helps to determine the diagnosis with the highest priority. Planning care should be patient centered. All nursing diagnoses affect the medical diagnosis, but the patient's perception of the most distressing symptom is most important.

2, 4 Palliative care is not reserved for people who are at the end of life. The goal of palliative care is to help relieve the symptoms of any illness and associated treatments at any time along the continuum of that illness.

4 The nurse can actively communicate with patients by asking open-ended questions. This helps patients to expand their thoughts and tell their stories. The nurse can obtain more information from patients with open-ended questions. The nurse should avoid asking close-ended questions, such as ones with a Yes/No response, because they will not help the nurse to understand the feelings and emotions of the patients. Being sympathetic will not necessarily allow patients to express feelings. Empathizing with patients will help them to relate with the nurse and express their feelings in the process. Discussing sensitive issues can create barriers to communication. Therefore, such issues should be avoided unless the patient brings them up.

4 By first determining what the patient believes is best, the nurse can then discuss that option in more detail and give realistic ways of reaching the desired goal. Discussing other possible options after identifying the patient's preferences helps family members know and understand the patient's wishes.

2 At the end of life, religious and cultural expectations are important for the lasting memories held by the family about the way their loved one's death occurred. Sensitive care contributes to feelings of closure, appropriateness of the death rituals, and fulfilled family obligations. A body should be placed in the morgue soon after death, but it is more important to provide sensitive and dignified care to the deceased.

1, 2, 4, 5 The patient who lacks hope due to deteriorating physical condition may sigh often and have a negative view of life. The patient usually has sad facial and voice expressions. The patient lacks energy and complains of vague pains. Interest is lacking, and communication is minimal. The patient does not want to undergo tests, feeling that it would be of no use.

3, 4, 5 Documentation is important in cases related to patient deaths because it carries legal implication. The information that must be documented includes the time and date of death, the medical devices left in the body, and the name of the health care provider certifying the death. The height and race of the deceased need not be documented.

2, 3, 5 Hospice is a patient- and family-centered approach to care. It provides therapeutic care, psychosocial care, and symptom management; it also promotes patients' dignity and self-esteem. In situations involving differences of opinion between the patient and the family members, the hospice team favors the patient's wishes. Hospice care does not end with death of the patient; there are frequent visits following the death of the patient to help the family members in the grieving process. Hospice is not a place, but a philosophy of care for the terminally ill.

2, 4, 5 Nausea in a terminally ill patient may be due to pain, medication, or decreased blood flow to the gastrointestinal (GI) tract due to the illness. Antiemetic agents may help to prevent nausea. Oral care helps to prevent halitosis, keeps the mouth moist and free of infection, and relieves nausea, and should be provided every 2 to 4 hours. Foods and medications that may cause nausea should be avoided. Administering them would increase the patient's discomfort by aggravating nausea. The nurse should offer the patient clear liquids to prevent dehydration. Liquids that increase stomach acidity should be avoided, because they can worsen the nausea.