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Chapter 10 Objectives

1. [Explain the role of loss in the grief reaction]: grief is a natural response to
2. [discuss how changes in the health care system have affected nursing
interventions for the dying patient]: prior to 1950 most people died in
their homes without medical care only to cared for by family members.
From 50-80’s most died in institutions. After DRG’s became implemented,
care and hospital stay was only given to those with a medical condition or
those needed to recover from a surgery or traumatic event.
3. [describe the stages of dying]: denial/individual acts as though nothing
has happened may refuse to believe or understand that loss has occurred.
Anger/individual resists the loss and may strike out at anything and
everyone. Bargaining/ ind. Postpones awareness of reality of the loss and
act as though it can be prevented. Depression/ ind. Feels overwhelmed and
lonely, withdraws from interpersonal interaction. Acceptance/ind. Accepts
the loss and looks to that future.
4. [identify the needs of the grieving patient and family]: need for support,
before patient is discharged full educate care needed to be given, arrange
for hospice to visit the home.
5. [discuss principles of palliative care]: provide pain and comfort, neither
hasten nor postpone death, affirm life and regard death as a normal life
process, offer a support system to the patient and family, enhance the
quality of life.
6. [recognize the 5 aspects of human functioning and how each interacts
with each other during the grieving-dying process.]: physical, spiritual,
emotional, intellectual, sociocultural/the nurse will do a complete
assessment of each area during the dying grieving process.
7. [identify unique signs and symptoms of the near death patient.]: pain,
confusion and resp. distress./discoloration or arms and legs due to lack of
O2/slow weak thready pulse/lowered bp/rapid, shallow breaths.
8. [discuss nursing interventions for the dying patient]: control of pain
levels/eye care/oral care/maximize o2 intake/meet all basic hygiene care a
priority/care with dignity
9. [describe techs. In assisting the dying patient to say good bye]: provide a
private comfortable environment/role playing/letter writing or
audio&visual videos or recordings
10. [list nursing interventions that may facilitate grieving in special
circumstances[perinatal, pediactric, older adult, and suicide]: perinatal/
refer to the child by its given mane, encourage the parents to hold the
child. Pediatric/ reassure the child will not suffer during their death. group
therapy. Suicide/ grief counseling. Older adult/ treat and assess just as any
other patient/implement their adv. Directives and manage pain levels.
11. [describe nursing responsibilities in care of the body after death]: gather
all material in room/ wash hands/ don gloves/ close patients eyes and
mouth if needed/ remove tubes if needed/ put in supine position/replace
soiled dressings with clean ones/bathe patient if needed/brush or comb
hair/apply clean gown/care of valuables/allow family to view the
body/document death
12. [discuss approaches to facilitate the grieving process]: accepting the
reality of the loss, experiencing the pain of grief, reinvesting emotional
energy into new relationships, adjusting to a new environment that no
longer includes the lost person, object, or self aspect
13. [explain process of euthanasia, DNR, organ donations, fraudulent
methods of treatment, and the dying persons bill of rights]:
14. [discuss support for the grieving family]: be compassionate, understanding
and caring, use appropriate touch when necessary, contact clergy, other
loved ones , friends to be with the grieving survivor
15. [explain adv. Directives, which include living will and the durable power
of attorney]: ADV DIRECTIVES/ signed witnessed documents providing
specific health care instructions for treatment in the event that the patient
is unable to make the decisions for themselves. Living will/ written
document that determines care if the patient becomes terminally ill or
develops a condition. Durable power of attorney/ for health care
designates an agent , surrogate, or proxy to make health care decisions on
patient’s behalf based on their health care wishes.
16. [discuss complicated grieving]: also referred to as dysfunctional
grieving/unresolved grief or complicated mourning/stuck in grieving
process and becomes depressed/unable to express one’s feelings