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D/D
| Question | Answer |
|---|---|
| In America, death is viewed as: | negative and unacceptable |
| Americans tend to be more youth and __________ oriented. In other societies, death is viewed as a _____________. | beauty; natural, normal event |
| Types of losses: | actual (death), perceived (loss of self esteem), maturational (leaving home - empty nest), situational (divorce) |
| Nurses come into contact daily with people who are suffering: | loss |
| To be able to help others deal with loss, the nurse must acknowledge their ________________. | own feelings of death (Have your own belief/faith before coming into situations with other beliefs.) |
| Death began being studied in depth in the _________. | 1960's |
| Special needs for the dying are no longer denied and ignored because of: | the research done on death and dying |
| Movement has been toward __________ care, providing care, not treatment. This allows for death in a pain-free and symptom-free enviroment usually outside the hospital setting. | palliative (comfort) |
| family focused, physician directed end of life care; established in the 1960's in England and came to US in 1970's; deal with entire person, a holistic approach that involves families as well as the patient | hospice |
| Hospice helps __________ of life, not just quantity. | quality |
| Hospice accepts patient with less than _________ to live for inpatient and less than ______ for outpatient. | 6 months; 2 years |
| Hospice is __________________ - offers inpatient, home visiting nurses, and grief counseling. | |
| A client may withdraw from hospice care if treatment is desired that is not included in the plan of care, or if the client no longer meets ________________. | Medicare criteria |
| Terminal illness must be certified by a ___________ for hospice care. | physician |
| The hospice program is Medicare-__________. | certified |
| care in hospitals, long-term care facilities, separate facilities; 24-hour care; no restruction on visiting hours, ages of visitors; families should be encouraged to bring personal items for patient | institutionally based palliative care |
| 24-hour staff (nurses, medical personnel); readily available resuscitative equipment; greater variety of medications; most expensive; limited time and attention; supportive care of dying clients | acute care |
| something happens to people or things we value | real loss |
| what might occur if persons or objects are lost | potential loss |
| Real and potential losses may have: | similar feelings |
| loss - changes in self esteem | body image, lifestyle changes, uncertainty and insecurity establishes a perceived loss of roles |
| loss - developmental changes | milestones result in insecurities, fears, and feelings of loss; includeds normal developmental changes from infancy to old age |
| loss - loss of possessions | may not be apparent to others; causes people to lose identity |
| loss - loss of significant other | may occur through death, separation (distance or emotional), growth, moving, divorce, or lack of communications. |
| When dealing with loss, all people do not: | act the same |
| normal, natural response to a loss; emotional reaction necessary to maintain quality in emotional and physical well being; involves total person experience associated with thoughts, feelings and behaviors | grief |
| individual responses to loss of a significant person | bereavement |
| helpful or assists person in accepting reality of death - healthy | adaptive grief |
| prolonged unresolved or disruptive to the person | maladaptive/dysfunctional grief |
| anticipatory grief usually related to loss or death and before the loss occurs | adaptive response |
| grief that occurs immediately after the loss | reactive grief |
| delayed or exaggerated grief (didn't deal with issues at the appropriate time; may disrupt person's life; keeping rooms exactly as was prior to death | dysfunctional/pathologic |
| Emotions seen in all types of grief: | anger, sadness, guilt, and denial |
| activities involved in grieving (burial, etc) | grief work |
| Grief response periods: | shock and disbelief; developing physical and emotional responses (crying, tight chest, anxiety); restitution period (recognizing loss); idealization (exaggerating good qualities of deceased) |
| Common s/s of grief (physical symptoms experienced in reaction to stress): | tighness in chest; sensations of dypsnea; suffocation; generalized weakness; intense tightening of the abdomen; churning of the stomach (look at table on pg. 193) |
| doesn't recognize the severity of illness; doesn't acknowledge impending death; closed off to the situation | closed awareness |
| all know the prognosis, but no one mentions it; avoids the subject - changes subject if it comes up | mutual pretense |
| preferred in most situations; freely discussed; aids in the preparation by the patient for final arrangements; may not be appropriate for all | open awareness |
| establishes nurse-client bond of honesty; upholds autonomy and right to determine remainder of life; allows client to complete unfinished business; may initiate internal stores "will to live"; initiates communication between client and family | honesty |
| usually informs clients of seriousness of illness | physician |
| Honesty is usually the best policy. Patients deserve to _________ their future. Families sometimes ____________ to patient being told the truth. | know; object |
| Fears associated with terminal illness and death: | fear of pain; fear of being alone or dying alone; fear of meaninglessness |
| _________ should be given to control pain in dying. | Medications |
| The nurse can show support and quality patient care by: | holding hands, touching, and listening |
| Fear of meaninglessness - | review of life, intentions, actions and expresses regrets about life; should be encouraged to look positively at life; prayer, thoughts and feelings provide comfort; nurses should remain nonjudgmental |
| Nurses need to be __________ about personal attitudes about death and dying. | knowledgeable |
| Attitudes of _________________ will affect the dying process. | family, patient and nurse |
| Nurses need to understand the various ____________ of dying in order to provide appropriate care. | aspects |
| Each person is different and responds differently and may not be the same way the nurse would __________________ | respond or believe |
| Things that affect reactions to death and dying: | culture, religious beliefs, and age (see Table 10-1, pg 90 Med-Surg) |
| America's work ethic comes from ____________ belief which emphasizes self reliance, hard work and individualism. Death is considered a _____________ occurrence only shared with close family. They tend to suppress feelings. | protestant; private |
| African Americans and Latinos express feelings more ___________. Both are close knit groups. Expression of feelings of loss is _________________. | openly; encouraged and accepted |
| Children 0-5 view on death: | it is temporary and reversible, like sleep |
| Children 6-9 view on death: | it is final; own death can be avoided; it is related to violence; wishing or hoping for death can make it happen |
| children 10-12 view on death: | inevitable end to life; grasps own mortality by discussing fear of death or life after death; expresses feelings of death based on adult attitudes |
| children 13-18 view on death: | afraid of prolonged death; may act out defiance for death through dangerous or self-destructive actions; seldome things about death |
| shaped by varying coping mechanisms; individuals "deal" with loss and grief differenly; sometimes coping skills are ineffective and clients need extra support if willing to accept it | phychsocial perspective |
| may add additional stress on top of loss or during grief; resources may not be available to overcome a tragedy | socioeconomic status |
| determines level of grieving r/t "closness" of individual's loss; support systems | personal relationships |
| most prominent and popular studies from 1969, she identified 5 stages of grieving | Kubler-Ross |
| Stages of grieving are/are not always followed in order and everyone does/doesn't go through each stage? | are not/doesn't |
| 1st stage of grieving | denial |
| refuses to acknowledge loss and pretends everything is okay; serves as a buffer to client to develop coping mechanisms; "no, not me"; "there must be a mistake"; will acquire 2nd, 3rd, and 4th opinions | denial |
| 2nd stage of grieving | anger |
| becomes angry with family, situations, staff, or God; may refuse treatment; "why me"; "leave me alone" | anger |
| 3rd stage of grieving | bargaining |
| patient wishes for more time to avoid the loss; often bargains with God; trying to buy more time; promises seldom kept | bargaining |
| 4th stage of grieving | depression |
| most common emotion; becomes less talkative; feelings of sadness and grief - internal struggles about life and death; may attempt suicide; "nothing I can do"; "what's the use"; begins to accept death | depression |
| 5th stage of grieving | acceptance |
| loss is inevitable and may want to plan; peaceful acknowledgement of loss; struggle is over; hope continues in some - sometimes unrealistically; business is taken care of (legal and spiritual) | acceptance |
| Greek for "easy death"; acti of inducing a gentle painless death; in recent decades the term has come to mean deliberately terminating life to prevent unavoidable suffering | euthanasia |
| putting to death a person who, due to disease or extreme age, can no longer lead a meaningful life; also called mercy killing; serious crime in the US | active euthanasia |
| discontinuing life-sustaining treatment for the ill or stopping so-called extraordinary treatment; controversial; in 1977, right to die bills were introduced into state legislatures | passive euthanasia |
| In 1990, the Supreme Court ruled that people who have made their wishes know, have a constitutional right to have treatment: | withdrawn |
| See Rights of the Dying Patient, pg 195 Box 15-3 | |
| written statement identifying a competent person's preferences regarding terminal care; patient Self-Determination Act 1990; can refuse treatment | advanced directives |
| determines personal preferences regarding medical interventions to use or not to use | living will |
| designates a proxy for making medical decisions when the client becomes incapacitated | durable power of attorney for health care |
| In the dying process (throughout a terminal illness and immediately before death) nurses must meet the clients needs for: | hydration, nourishment, elimination, hygiene, positioning, and comfort (provides self esteem for patient) |
| involves the maintenance of an adequate fluid volume; if swallow reflex is present, offer fluids frequently; suching is one of the last reflexes to disappear as death approaches (provide cloth with ice); may require IV fluids | hydration |
| some terminally ill have little interest in eating; n/v may interfere; give nausea meds 30 minutes prior to scheduled meals;malnutrition leads to weakness, infection and pressure sores; client may eventually need tube feeding or total parenteral nutrition | nourishment |
| some terminally ill are incontinent of urine and stoll; others experience urinary retention and constipation; skin care is important | elimination |
| dignity of clients is related largely to their personal appearance; nurses should strive to keep dying clients well groomed and free of unpleasant odors; frequent mouth care may be necessary; lips may need lubrication for mouth breathing patients | hygiene |
| later position helps to prevent choking and aspiration; nurse should change position every two hours to promote comfort | positioning |
| relieving pain may be most challenging problem caring for dying patients; goal -keep clients free from pain, not dull consciousness, suppress respirations, or inhibit ability to communicate; analgesia may be more effective when given on routine schedule. | comfort |
| transdermal patches are often used; doses may need to be increased if client develops tolerences; fear of addiction should not interfere with efforts to relieve pain | comfort |
| Family members may ______________ involvement in the client's care because they often feel helpless. It may help them deal with ___________. Don't bog family down with major _____________. | appreciate; grief; responsibilities |
| As client shows signs of approaching death, the nurse must: | make family aware that the end is near. |
| If death has already occurred, the ____________ is responsible forreleasing that information. | physician |
| see Nursing Care Plan 10-1 pg 93 (Med-Surg) | |
| ______________ is the first sign that a client's condition is worsening. | Failing cardiac function |
| At first the heart rate ___________ in a futile attempt to deliver oxygen to the cells. | increases |
| Cardiac output _____________. | decreases |
| Decreasing cardiac output diminishes the blood flow to the heart itself, which causes the heart to slow and the blood pressure to: | fall |
| Reduced cardiac output compromises _________________ and impaired cellular metabolism produces less heat. | peripheral circulation |
| When peripheral circulation decreases |
Created by:
akgalyean
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