Chapters 24 & 39
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
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| What is the age for infancy and developmental task? | Birth - 1 / Basic Trust vs. Mistrust
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| What is the age for toddler and developmental task? | 1-3 / Autonomy vs. Shame & Doubt
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| What is the age for preschool and developmental task? | 4-6 / Initiative vs. Guilt
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| What is the age for adolescence and developmental task? | 12-19 / Identity vs. Role Confusion
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| What is the age for young adult and developmental task? | 20-44 / Intimacy vs. Isolation
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| What is the age for middle adulthood and developmental task? | 45-65 / Generativity vs. Stagnation
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| What is the age for late adulthood and developmental task? | 65+ / Ego integrity vs. Despair
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| What do children often associate death with? | Sleep (they may fear going to sleep)
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| Who do adolescence talk to and process death with? | Peers/adults
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| What is important to a dying adolescent? | Want nurses to care about them
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| TRUE or FALSE: Many adults fear death, but this is normal | TRUE
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| TRUE or FALSE: Most elderly adults have not accepted death | FALSE
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| What is the final stage of human growth & development? | Dying
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| What must nurses be just as knowledgeable about just as much as the birth process? | Dying process
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| What is actual loss and example? | Easily perceived loss - woman has a mastectomy
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| What is perceived loss and example? | Less obvious loss - Loss of confidence
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| What is maturational loss and example? | Loss that results from normal life transitions - Loss of childhood dreams or failed adolescent romance
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| What is situational loss and example? | Loss that occurs suddenly in response to a specific external event - Death of a loved one
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| What is personal loss and example? | Significant loss that necessitates adaptation through the grieving process - When something/someone can no longer be seen, felt, heard, known, or experienced
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| What is grief? | Subjective response to actual or anticipated loss
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| What is bereavement? | Common depressed reaction to the death of a loved one
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| What is mourning? | Culturally defined patterns for the expression of grief
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| What are the task's that facilitate the passage from grief to closure? | Accepting reality of loss, experiencing the pain of grief, adjusting to an environment that no longer includes the lost person, object, or aspect of self, reinventing emotional energy into new relationships
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| What can unresolved grief lead to? | Incomplete task, incomplete relationships, and health problems
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| What are the common responses to sudden death? | Guilt, denial, anger, sorrow, or blame
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| What is anticipatory grief? | To expect, await, or prepare for the loss of a family member or significant other (when a pt. is diagnosed w/terminal illness)
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| What is denial? | Individual acts as though nothing has happened and may refuse to believe or understand a loss has occurred. This stage is a protective mechanism while our psyche works out alternative defense to cope
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| What is anger? | Individual resist the loss and may strike out an everyone and everything
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| What I bargaining? | Individual postpones awareness of reality of the loss and may try to deal in a subtle or over way as though the loss can be prevented
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| What is depression? | Individual feels overwhelmingly lonely and withdraws form interpersonal interactions
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| What is acceptance? | Individual accepts the loss and looks to the future
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| What do infants to 5 yr. believe about death? | Death is reversible, a temporary departure, or sleep
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| What do 5 - 9 yr olds believe about death? | Associate death with aggression or violence, believes wishes and unrelated actions can be responsible for death
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| What do 9 - 12 yr olds believe about death? | Concepts of death expressed as an interest in after life or as a fear of death
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| What do 12 - 18 yr olds believe about death? | Fear lingering death, fantasizes that death can be defied; views death in terms of religious/philosophic terms, rarely things about it
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| What do 18 - 45 yr olds believe about death? | Attitudes towards death is influenced by religious & cultural beliefs
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| What do 45 - 65 yr olds believe about death? | Accept own mortality, peaks of death anxiety; death anxiety diminishes with emotional well being
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| What do people over 65 believe about death? | Fear prolonged death, sees death as having multiple meanings (freedom from pain, reunion with already deceased family members)
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| What are the signs of dysfunctional/complicated grieving? | Getting stuck in grief process, unable to express feelings, can't find anyone to listen, suffers loss that stirs up other loss, lack reassurance & support, fail to believe they can work through loss
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| What is the goal of a terminally ill person? | Function optimally
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| What should the nurse do prior to approaching a grieving family member? | Assess the level of resolution
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| What does physical assessment include in death? | Sleep patterns, body image, ADL's, mobility, general health, medication use, and pain
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| What does emotional assessment include in death? | Patient/family's level of anxiety, guilt, anger, and acceptance
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| What do intellectual assessments of the patient/family include? | Education level, knowledge & abilities, and the expectations they have in regard to how & when death will occur
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| What is sociocultural assessment? | Assessing the support systems, ascertaining whether family members want to assist in the patients daily care
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| What does spiritual assessment include? | Finding out what significant rituals of the particular faith group have for the patient in dealing with death
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| What is the most important thing for a nurse to do when dealing with a pediatric dying patient? | Reassure them they will not be abandoned by their HCP, nurse, or family and won't be left alone
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| What are the two types of euthanasia? | Active and passive
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| What is passive euthanasia? | Permitting the death of a patient by withdrawing treatment that might extend life, such as medication, life-support systems, or feeding tubes
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| What is active euthanasia? | Assisting in such a death
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| What is DNR? | Do Not Resuscitate order, it does not mean to with-hold any other care such as hygiene, fluids, or medications
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| What are advance directives? | Signed & witnessed documents that provide specific instructions to heath care treatments in the event that a person is unable to make these decisions personally at the time they are needed
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| What are living wills? | Documents that direct treatment in accordance with the patients wishes in the event of a terminal illness or condition
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| What is a durable power of attorney? | Designates an agent, a surrogate, or a proxy to make health care decisions on a patients behalf
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| Why do organ donations occur? | Legally competent people donate their bodies or organs for medical use. In many states, adults can request organ donation by signing the back of their drivers license
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| What does the Uniform Anatomical Gift Act stipulate? | Health care providers who certify death shall not be involved in the removal or transplantation of the organs
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| What is the role of the nurse for end of life care? | Listen to patient & family, don't impose personal feelings, provide frequent care, family members are free to choose, allow family help with care of patient
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| What are the roles for nurse during palliative care? | Affirms life & regards dying as normal process, neither hastens or postpones death, integrates psychological & spiritual aspects of Pt. care, offer support system to pt & family, use team approach to address needs of pt. & family, enhances qual. of life
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| What are the changes in vital signs when death nears? | Slow, weak & thready pulse, lowered BP, rapid, shallow, irregular or abnormally slow respirations
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| What are Cheyne-Stokes respirations? | Abnormal periods of apnea and deep, rapid breathing
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| What is the death rattle? | Mucus collects in the patients throat, making noisy respirations
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| What are the clinical signs of death? | Unreceptivity & unresponsiveness, no reflexes, flat encephalogram (EEG), no movement or breathing, absences of apical pulse, cessations of respirations
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| What is important to remember when providing post mortem care if the patient is going to have autopsy? | DO NOT remove any tubes, dressings, drains, or other equipment
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| How do you prepare the body after death? | Make it look as normal as possible
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| Describe how you leave the body when providing post mortem care | Supine position with arms at side, palms down or across the abdomen, place pillow or towel under head, insert patients dentures to maintain normal facial features
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| What must you do after post mortem care? | Clear away soiled linens, all clutter, make sure patient is clean, spray room with deodorizer to help eliminate unpleasant odors
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| What is the philosophy of hospice? | Provide care & support to patients with terminal illness and their families
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| What are curative treatments? | Aggressive care in which the goal & intent is curing the disease and prolonging life at all cost
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| What is palliative care? | Not curative in nature but aims to relieve pain and distress and to control symptoms of the disease
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| What is the goal of hospice care? | Controlling or alleviating the patients symptoms, allowing the patient & caregiver to be involved in the decisions regarding plan of care, encouraging patient & caregiver continuous support
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| What is the optimal pain dose for a hospice patient? | Dose that provides relief
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| What is somatic pain? | Arises from the musculoskeletal system & described as aching, stabbing, or throbbing
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| What is visceral pain? | Originates from the internal organs
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| What is neuropathic pain? | Arises from the nerves & the nervous system
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| What are common reasons for ineffective pain management? | Myths & fears such as addiction, tolerance, and respiratory depression
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| What are long acting medications? | Morphine, oxycodone, or fentanyl patches
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| What may a dying person experience from chemo, obstruction, tumor, uncontrolled pain, constipation, food smells, anxiety, and/or pain medications? | Nausea & vomiting
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| How can you help patient with nausea & vomiting? | Encourage patient to take antiemetic's 30 mins. before meals & at bedtime. Also, eating slowly, in a pleasant atmosphere, with relaxation & rest periods after eating
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| What are common symptoms in a dying patient? | Constipation, anorexia, dyspnea & air hunger, and skin impairment
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| What are the causes of constipation in a dying patient? | Poor dietary intake, hypercalcemia, hypernatremia, tumor compression, use of narcotics such as opioids, and decreased physical activity
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| What are the causes of anorexia in a dying patient? | Nausea, vomiting, constipation, dysphagia, stomatitis, tumor invasion, general deterioration of the body, depression, and infections
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| What are the causes of skin impairment in a dying patient? | Weight loss and dehydration which lead to a decrease in soft tissue
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| What is cachexia? | Malnutrition marked by weakness and emaciation, usually in association with a serious disease such as cancer, and resulting in muscle weakness and weight loss
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