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DISCHARGE CARE AND • Mourning- behavioral process c. 9-12 yrs.

- fear of death;
REHABILITATION through which grief is eventually understands own mortality
resolved or altered d. 12-18 yrs.- may fantasize that
DEFINITION OF TERMS • Dysfunctional Grieving- consists death can be defied and therefore act
• Death-cessation of Life of an extended time of recklessly
• Rehabilitative Care-process of depression, severe physiologic e. 18-45 yrs.- attitudes towards death
restoring the highest level of symptoms, suicidal thoughts may be affected by religious and
possible wellness and returning after a loss cultural beliefs
the person’s ability to live and • Loss- any actual or potential f. 45-65 yrs.- accepts own mortality
work as normally as possible situation in which valued g. 65 and up- perceives death in their
• Postmortem Care-care of body objects/persons has changed or own understanding
after death to prevent is no longer accessible to the
discoloration and other individual CLINICAL SIGNS OF IMPENDING DEATH
processes that occur after death • Loss of muscle tone
and preserve dignity of the MODES OF DISCHARGE • Slowing of Circulation
deceased 1. As Ordered by Doctor • Changes in Respiration
• Grief- total response to the 2. Against Medical Advice • Sensory Impairment
emotional experience related to 3. Death
loss SIGNS OF EMOTIONAL DEATH
• Bereavement- subjective CONCEPT OF DEATH • Withdrawal/Preparing to let go
response experienced by the a. infancy to 5 yrs.- death is reversible • Vision-like experiences
surviving loved ones after loss b. 5-9 yrs.- death is final but can be • Letting go
avoided • Saying goodbye

PHYSIOLOGIC CHANGES AFTER DEATH


what? when?/rate? IX others
Rigor stiffening 2-4 hrs position body properly; place due to loss of ATP
Mortis dentures; close eyes and mouth
Algor cooling 1 degree place blanket over patient cessation of metabolism
Mortis Celsius/hr
Livor lividity 30 mins. then 6-10 due to accumulation of blood in
hrs. after small blood vessels
Putrefactio softening/decompositio 24-30 hrs. embalming due to bacterial action
n n

END OF LIFE CARE 5. Difficulty concentrating witnessed by 2 people and is


1. Cooling of Extremities- provide TYPES OF LOSS notarized
blanket 1. Actual- verified by others a. Health Care Proxy
2. Decreased Appetite- offer 2. Perceived- verified by self only b. Living Will
glycerin swabs • Autopsy
3. Incontinence- provide diaper CATEGORIES OF LOSS • Certification of Death
4. Congestion and Gurgling- • External Object- thing is lost • DNR
elevate head, suction • Familiar Object- environment • Euthanasia
secretions changed • Inquest
5. Sleepiness- allow adequate rest • Aspect of Self- physical or
6. Sleeplessness- soothing music; psychological TYPES OF GRIEF
reduce no. of visitors • Significant Others 1. Abbreviated-brief but genuinely
felt
MANIFESTATIONS OF GRIEF LEGAL ASPECTS OF DEATH 2. Anticipatory- occurs before loss
1. Verbalization of loss
2. Crying • Advance Directives/Durable
3. Disenfranchised- unable to
acknowledge grief to others
3. Sleep disturbance Power of Atty.-must be
4. Dysfunctional- unresolved and
4. Loss of appetite inhibited

KUBBLER ROSS STAGES OF GRIEF


STAGE IX
Denial verbally support but do not reinforce denial
Anger do not take anger personally; help client understand that anger is normal
Bargaining listen attentively and encourage client to talk to relieve guilt or irrational
fear
Depression allow client to express sadness; convey caring by touch
Acceptance encourage participation in tx program