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Actual loss can be recognized by others
Perceived loss is felt by person but intangible to others
Maturational loss experienced as a result of natural developmental process
Anticipatory loss loss has not yet taken place
Situational loss experienced as a result of an unpredictable event
Loss Physical loss versus psychological loss
Grief —internal emotional reaction to loss
Bereavement —state of grieving from loss of a loved one
Mourning —actions and expressions of grief that make up outward expression of grief
Engel’s Six Stages of Grief Shock and disbelief,Developing awareness,Restitution, Resolving the loss,Idealization,Outcome
Definition of Death One Uniform Definition of Death Act: An individual who has sustained either (1) irreversible cessation of all functions of circulatory and respiratory functions or
Definition of Death One (2) irreversible cessation of all functions of the entire brain, including the brain stem, is dead.
Medical criteria used to certify a death: cessation of breathing, no response to deep painful stimuli, and lack of reflexes (such as the gag or corneal reflex) and spontaneous movement
Components of a Good Death Pain and symptom management,Clear decision making,Preparation for death,Completion,Contributing to others, affirmation of the whole person
Clinical Signs of Impending Death - Part 1 Difficulty talking or swallowing,Nausea, flatus, abdominal distention,Urinary and/or bowel incontinence or constipation, Loss of movement, sensation, and reflexes,Decreasing body temperature with cold or clammy skin
Clinical Signs of Impending Death - Part 2 Weak, slow, or irregular pulse,Decreasing blood pressure, Noisy, irregular, or Cheyne-Stokes respirations,Restlessness and/or agitation,Cooling, mottling, and cyanosis of the extremities and dependent areas
Kubler-Ross’s Five Stages of Grief Denial and isolation,Anger,,Bargaining,Depression, and Acceptance
Advance directive can minimize difficulties by allowing individuals to state in advance what their choices would be for healthcare should certain circumstances developed. Anger Bargaining Depression Acceptance
Living will provies specific instructions about the kinds of healthcare that should be provided or foregone in particular situations.
Durable power attorney for healthcare appoints an agent the person trusts to make decisions in the event of subsquent incapacity
Five wishes Decide who will make decisions for the patient . the kind of medical treatment the patient wants or doesn’t want. how comfortable the patient wants to be. how the patient will be treated by others. what the patient wants loved ones to know
Do-not-resuscitate (DNR) or no-code means that no attempts are to be made to resucitate a patient who stops breathing or whose heart stop beating. However, many dr. are reluctant to write thes order especially when there is conflict in family
slow code in case of cardiopulmonary or respiratory arrest, calling a code and resuscitating the patient are to be delayed until these measures will be ineffective.
Comfort measures only which indicates that the goal of treatment is a comfortable, dignified death and that further life-sustaining measures are no longer indicated.
Do-not-hospitalize being used for patients in nursing homes and other residential setting who have elected not to be hospitalized for further aggressive treatment.
Developmental Factors Affecting Grief and Dying Children under 5 years do not understand the concept of death. Adolsences who lose a peer are hit hard and can use grief consuling.
Death Certificate U.S law requries that d.c be prepared for each person that dies. Requiers Dr signature. Sent to local health departments.
Dying Patients Physiologic need —physical needs, such as hygiene, pain control, nutritional needs
Dying Patients Psychological needs —patient needs control over fear of the unknown, pain, separation, leaving loved ones, loss of dignity, loss of control, unfinished business, isolation
Dying Patients Sexual needs —patient needs ways to be physically intimate that meets needs of both partners
Dying Patients Spiritual needs —patient needs meaning and purpose, love and relatedness, forgiveness and hope
Developing a Trusting Nurse–Patient Relationship Explain the patient’s condition and treatment,Teach self-care and promoting self-esteem,Teach family members to assist in care, and Meet the needs of dying patient. Meet family needs.
Socioeconmic Factors around death Bereaved families will suffer more acutely if there is no health or life insurance or pension after death . Older people more at rish since death of spouse lose income.
Cultures Factors private about grief. Other cultures may dictate a public display of grief and mourning.
postmortem care of the body The body is placed innormal anatomic positon to avoid pooling of blood , soiled dressings ae replace. and tubes removed. Some religions forbid washing of the bodie and other there is special person. Discharging legal responsibility
labeling of body 2 pieces of id - on the zipper of the shrowd and ankle/ toe of victim
Providing Postmortem Care Reviewing organ donation arrangements if any (required request in PA)
postmortem care of the family nurse provides and care t the patient's family . This involves listening to families expression of grief, loss, and helplessness. It is appropriate for the nurse to attend the funeral and make a follow-up visit to the family.
postmortem care Care of other patients Other patient are aware of the death of a patient and may need to be consoled. This particulary true of patient who has shared a room withe the deceased patient .
postmortem care of infectious patient Follow local law if patient died of communicable disease.
sudden death Need to call coroner and he will decide if an autopsy should be performed. All tubes must stay connected to patient. For the family. provide a private place for their grieving.
The Nurse Offers Support to a Patient’s Grieving Spouse Arrange for family members to view the body
Created by: cjnnovak