Chapter 43 Loss, Grief, and Death

wukafame's version from 2015-11-18 23:11

Section 1

Question Answer
perceived lossexperienced by one person but cannot be verified by another. Example is a psychologic loss.
actual lossloss that can be recognized by others
anticipatory lossexperienced before the loss actually occurs
depelopmental lossloss that occurs during normal development of life, most likely anticipated and prepared for. Ex.: retirement, kids leaving home, death of aged parents
situational lossunexpected loss, Ex. illness, injuury, death of child, loss of job
4 sources of loss1. loss of an aspect of oneself, 2. loss of an object external to oneself, 3. separation from an accustomed environment, 4. loss of a loved one or a valued person
grieftotal response to the emotional experience related to loss
bereavementsubjective response experienced by the surviving loved ones after death of person with whom they had relationship
mourningbehavioral process through which grief is eventually resolved or altered; influenced by culture, beliefs, custom.
Kubler-Ross stages of grieving1. denial, 2. anger, 3. bargaining, 4. depression, 5. acceptance
Denial stage of griefFirst stage. refuses to believe that loss is happening. Intervention: support client, do not reinforce denial.
Anger stage of griefSecond stage. anger at nurse or staff. Intervention: help client understand that anger is a normal response to feelings of loss; avoid retaliation; do not take anger personally
Bargaining stage of griefThird stage. seeks to bargain to avoid loss. Feelings of fear, guilt, punishment. Intervention: listen, encourage client to talk, offer support
Depression stage of grief4th stage; grieves over what happened, may talk freely or may withdraw; Intervention: allow to express sadness, communicate nonverbally by sitting quietly, convey caring by touch
Acceptance stage of grief5th stage of grief, client comes to terms with loss, Intervention: help client participate in treatment program.
Engel's Stages of grieving1. shock and disbelief; 2. developing awareness; 3. restitution; 4. resolving the loss; 5. idealization; 6. outcome
Sander's stages of bereavement1. shock, 2. awareness of loss; 3. conservation/withdrawal; 4. healing; 5. renewal
Martocchio clusters of grief1. shock and disbelief, 2. yearning and protest, 3. anguish, disorganization, despair, 4. identification in bereavement, 5. reorganization and restitution
Rondo's categories of responseavoidance, confrontation, accomodation
Normal clinical signs of griefverbalization of loss, crying, sleep disturbance, loss of appetite, difficulty concentrating
complicated grieving (abnormal)extended time of denial, depression, severe physiologic symptoms, suicidal thoughs
factors affecting grief responseage, significance of loss, culture, spiritual beliefs, gender, socioeconomic status, support systems, cause of death
measures that facilitate the grieving processExplore and respect ethnic, cultural, religious, personal values. Teach what to expect. Encourage to express and share grief. Teach family to encourage client's expression of grief. Encourage to resume activities
Diagnoses for grievingGrieving, complicated grieving, interrupted family processes, risk for loneliness, risk-prone health behavior.
Impeding death (signs that death is near)loss of muscle tone, slowing of circulation, changes in respiration, sensory impairment
factors affecting grief responseAge, Significance of the loss, Culture, Spiritual beliefs, Gender, Socioeconomic status, Support systems, Cause of death
Measures that Facilitate the Grieving ProcessExplore and respect ethnic, cultural, religious, and personal values. Teach what to expect in the grief process. Encourage the client to express and share grief with support people. Teach family members to encourage the client ᾼs expression of grief. Encourage the client to resume activities on a schedule that promotes physical and psychologic health
Traditional Clinical Signs of DeathNo apical pulse, no BP, no respirations
World Medical Assembly Guidelines for DeathTotal lack of response to external stimuli, No muscular movement, especially during breathing, No reflexes, Flat encephalogram, In instances of artificial support, absence of brain waves for at least 24 hours
Cerebral DeathOccurs when cerebral cortex is irreversibly destroyed. Permanent loss of cerebral and brainstem function. Absence of responsiveness to external stimuli. Absence of cephalic reflexes. Apnea. Isoelectric EEG for at least 30 minutes in the absence of hypothermia and poisoning by CNS depressants.
Strategies to Facilitate Discussions About DeathIdentify personal feelings about death. Focus on client's needs. Determine client's usual ways of coping, Establish communication relationship. Determine what client knows about illness. Respond with honesty and directness.
Assisting Families or Caregivers of Dying ClientsUse therapeutic communication, Provide an empathetic and caring presence, Explain what is happening and what to expect, Have a calm and patient demeanor, Encourage to participate in the physical care as they are able: Assist with bathing, Speak or read to the client, Hold hands

Section 2

Question Answer
Why is it important to work though one's grief?Bereavement have potentially devastating effects on health. Anxiety, depression, weight loss, fatigue, fainting, blurred vision, vomiting, etc.