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prairie u5
prairie unit 5
| Question | Answer |
|---|---|
| Current attitudes of society toward death and dying | Avoidance & Emphasis is on youth and staying young |
| Grief is the Emotional response to loss | When loss occurs unbalanced equilibrium occurs |
| loss causes unbalanced equilibrium occurs | We readjust our equilibrium by grieving |
| Hospice | Six months or less to live |
| Assisted euthanasia | MD order lethal dose of meds, Legal in Oregon & Washington |
| dying place for most people | 69% hospital, 31% home |
| Aging Concerns | Being a burden, Fear of pain, Being abandoned / alone |
| Shock and disbelief (engel) | "I can't believe my mother died of breast cancer. She was never ill in her life" |
| Developing awareness (engel) | " Every time I think of my mother I can't help but cry" |
| Restitution (engel) | Involve the rituals surrounding loss including funeral services |
| Restitution (engel) | "I go to mass to pray for my mother's soul to help me get over her death" |
| Resolving the loss (engel) | "I know I won't be having Sunday Dinner with my mother anymore, maybe my husband and I can eat out this Sunday" |
| Idealization (engel) | Exaggeration of qualities of the person or object lost, followed by acceptance of loss. |
| Idealization (engel) | "My mother was the perfect parent, I wish I could be more like her with my kids" |
| Outcome(engel) | The final resolution of the grieving process |
| Outcome(engel) | "I miss my mother, but now I can accept her death and try to get on with my life" |
| Denial (kubler-ross) | refusal to acknowledge that this is occurring and allows for mobilized defenses |
| Denial example (kubler-ross) | “ Not me you must have the wrong person” |
| Anger(kubler-ross) | anger about death (at doctors, family, higher power, etc…) Nurse should encourage clients to express themselves |
| Anger example(kubler-ross) | ” Why me what did I do wrong” |
| Bargaining(kubler-ross) | Willingness to undergo anything, make deals w/God for more time (bargains usually are just coping tactic) |
| Bargaining example(kubler-ross) | “I will go to church everyday if you let me live longer” |
| Depression (kubler-ross) | A profound sense of loss of hope, deep unhappiness, |
| Depression feeling (kubler-ross) | Spend time w/ patient/keep family informed, allow patient to express themselves, Nurse should pay attention to non-verbals |
| Acceptance feelings (kubler-ross) | usually emotional exhaustion, and being empty of feelings,The time when feelings are shared ( if time allows) |
| Acceptance (kubler-ross) | Client may be tired weak and withdraw, Non-verbals are important, Encourage family to talk to loved ones |
| Kubler-Ross Theory | These are usual stages of death but they vary, They may over lap & Vary, People may bounce between stages,progression dependant on time |
| affect of dying on family dynamic (Client) | Dying Patients might not want to share seriousness with family & upset family |
| affect of dying on family dynamic (patient) | Family may not want to tell patient & upset patient |
| Patient rights | Patient always has the right to know their condition, Client has right factual info, Patients right to make decision on their behalf |
| Hope | Once hope is gone death is not far behind “I hope for one more day” or" I hope I don’t have pain today" |
| Denial | Completely reject the thought or feelings “I can still run 5 miles" |
| Suppression | Vaguely aware of thought or feelings but try to hide it. |
| Repression | Unconscious painful experience are not conscious Example: Rape Victim |
| Reaction formation | Turn feelings into the opposite Socially acceptable feelings Example: Overly nice to someone you dislike |
| Projection | You think someone else has your thoughts or feelings “She talks behind peoples backs” When in fact you are doing the same |
| Rationalization | Justification of a situation with excuses “I drink because I had a bad day” |
| Displacement | When you redirect your feelings to another target when it is safe ( Taking it out on a safe target) Made at you wife so you beat the dog |
| Undoing | Trying to reverse or undo your feelings by doing the opposite: O.K. to lie because I had my fingers crossed |
| Regressions | Revert to old immature behavior to vent feelings Example: Adult sucking their thumb |
| Sublimination | Redirect feelings in a socially acceptable behavior /Aggressive person becomes a butcher |
| Compensation | Emphasizing a characteristic to make up for a real or imagined behavior Example: Dork with the red sports car |
| Identification | A mocking behavior Example: Little Girl dressing like mommy |
| Fantasy | A visualization, Daydreaming Example: Dreaming you won the lotto |
| Signs of nearing death | Appear confused, No hope left,They have spoken or speak to the dead,See things you cannot see,know exactly when they will die |
| Physical signs of death is near | Withdrawal – Sleeps more,less food = decreased need, distended stomach from decreased peristalsis, Dehydration Natural |
| comfort Physical signs of death is near | Irregular fast shallow breaths(Cheyne Stokes) Oral secretions collect in the back of throat (death Rattle) |
| Skin changes while dying | Temp will be cool, Mottling (dark purple spots Pooling of blood) Cyanosis: Face, nose, lips, nail bedsturns blue |
| Clinical signs of death | Total lack of: response, muscular movement,reflexes, Flat encephalogram, ventilator (stay 24 hr) |
| Clinical signs of death BPR | No bp, No respiration, No pulse |
| Five interventions for the dying client (1-3) | Educate and advocate for client,Use the multi disciplinary team,emotional support/Facilitate closure |
| Five interventions for the dying client(4-5) | Create space for the family and friend, Communicating with the dying person |
| Helping children cope with death | Do not shield children, Include kids, Describe death in direct simple correct terms,Do not use code words |
| 0-3yrs | . Unable to understand death, Separation anxiety / scared of abandonment |
| 3-5yrs (Magical Thinking) | Self awarness increased, Magical thinking,death is temporary/reversible,confuse death with sleep,difficulty eating sleeping, controlling bowel and bladder |
| Magical think (3-5yrs) | use fantasy to explain things they do not understand Can wish people away and then back,If they wish someone away and they die they |
| 5yrs to 9yrs | Know death is final and permanent, Personal death can be avoided |
| 9 yrs to 12yrs | Know death is final and permanent, Beliefs and ideas of death same as parent |
| Adolescent | Share adult concept of death, They fear a lingering death |
| Childs grief | Usually do not have the language to express grief Let them draw a picture / Doll play |
| Post Mortem Care (MD) | Notified by nurse,completes death cert, gets consent (Organ donation, Autopsy) |
| Post Mortem care MD Delegations to nurse | nurse will: call family, Get consent, Pronouncement of death, |
| Ways to Confirming death | No response to pain, Pupils fixed and dilated, Body color pale and waxen Body temp. cold, Eyes remain open, Jaws may fall open |
| BPR at Death | Pulse may be last to go, May still rise due to muscle contraction |
| Relaxation of sphincters at death | cause Release of urine and stool |
| Document at time of death | Patients condition prior to death, Advanced Directive (DNR, Living will), Who pronounced death and when the family was notified, Organ donation or autopsy referral, Whoe recieved valuables. |
| Care immediately following death | Prepare family,Explain processes and procedures,Gather equipment, Provide privacy (roommate) |
| Post mortem care | Check policy for tube removal, Bathe client, Change gown / linens, Comb hair,New pad under buttocks |
| Post mortem body postioning | Place body supine at 30-degree angle, Prevents blood from pooling in face, Cover with clean sheet up to chin,Place arms at side,Wristband on, Pillow under head, Close eyes, Put in dentures |
| After family views Body | Remove dentures, Wrap in shroud or body bag, Apply tags, Transfer to morgue |
| Reportable deaths | Homicide, Suicide, Accident, Violent, Sudden, Suspicious , Inmates not hospitalized, Death at work, Contagious Disease, Death after transfer from another institution, 24 hours of admission, Unattended ,in the ER, surgery death, |
| Living will | comes into effect only when life-sustaining treatment may be used to postpone the moment of death or maintain you in a permanent unconscious state, but will not provide a cure for the underlying condition. |
| Power of attorney | is not limited to terminal conditions but can be used to address all types of health-care decisions, including life-sustaining treatments, Living will doesn’t take effect as long as your agent under a power of attorney is available |
| necessary loss | Losses that every person experiences |
| actual loss | Loss of a person or object that an individual can no longer feel hear know or experience Ex: Relationship, Body part, Child |
| Perceived loss | any loss thatis uniquely defined by the grieving patient Ex:Loss of prestige loss of confidence |
| Maturational loss | a change in the developmental process that is normally expected during a a life time Ex: Mothers loss as a child goes to school for the first time. |
| Situational loss | sudden, unpredictable external event Ex:accident that leaves a person paralyzed, unemployed and grieving over loss of passenger. |
Created by:
rjh
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