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Loss, Grief, Death and Dying

1. Loss

a. an actual or potential situation in which something that is valued is changed, no longer available, or gone

b. types of loss
i. actual loss
ii. perceived loss
iii. anticipatory loss

c. categories of loss
i. loss of external objects
ii. loss of a known environment
iii. loss of significant others
iv. loss of an aspect of self
v. loss of life

2. Grief

a. grief

i. the totality of the subjective response and behavioral process experienced related to a loss
a. bereavement is the subjective response experienced related to a loss
b. mourning is the behavioral process experienced related to a loss

b. types of grief reactions

i. conventional
a. abbreviated
b. anticipatory

ii. dysfunctional
a. unresolved
b. inhibited

c. stages of grief reactions

i. Engel (1964)
a. shock and disbelief
b. developing awareness
c. restitution
d. resolving the loss
e. idealization
f. outcome

ii. Kubler-Ross (1969)
a. denial
b. anger
c. bargaining
d. depression
e. acceptance

d. signs of grief
i. repeated somatic distress
i. tightness in the chest
i. choking or shortness of breath
i. sighing
i. empty feeling in the abdomen

irregular.g.: a. common interventions for grieving clients i.g. intense subjective distress e. diminished body movement ii. respect racial. religious. relaxation of facial muscles a. plan time to be available for the client i. assess client well-being iii. cold skin iii. difficulty speaking a. e. loss of muscular control i. slowing of circulation. e. sleep disturbance i. death rattle iv. gradual loss of the gag reflex a. possible urinary and rectal incontinence a. Cheyne-Stokes respirations a. assure the client that intense feelings and reactions are normal initially iii. decreased blood pressure a. e.: . anger c. shallow. Kubler-Ross (1969) a.g. cultural. loss of muscle tone. difficulty swallowing a. bargaining d. or abnormally slow respirations a. decreased activity of the gastrointestinal tract a. Dying and death a. i. loss of appetite i. decelerated and weaker pulse a. encourage the client to explore support groups for individuals who have experienced a similar loss iii. denial b. mottling and cyanosis of extremities a. e. signs of impending death i. changes in vital signs. uncontrolled trembling i. provide information about the grieving process and what to expect iii. listen to the client’s grieving process iii. rapid.: a.: a. depression e. encourage the development of new relationships iii. diminished sensation a. acknowledge significant others in their own grief and desire to help the client iii. encourage the client to explore available resources iii. and personal values of the client and significant others in their expressions of grief iii. stages of dying and death i. sensory impairment. acceptance b. encourage the client to express grief with significant others iii. suggest that the client resume normal activities on a schedule that promotes physical and psychologic health 3.g.

whole brain death a. if desired. explain the client’s condition and treatment to both the client and significant others a. develop a trusting nurse-client relationship with client and significant others a. capacity for remembering. changes in the body after death i. developmental state b. unreceptive and unresponsive to external stimuli 1. the irreversible loss of all "higher" brain functions. heart-lung death i. enjoying. socioeconomic status g. uniqueness. relieve respiratory difficulties . no circulation to or within the brain evidenced by Doppler ultrasound for 24 hours 1. sex-role f. no spontaneous heart beat ii. judging. manifestations of heart-lung death: 1. manifestations of whole brain death: 1. and worrying d. rigor mortis ii. emerged from the historical idea that the flow of body fluids was essential for life i. grief. definitions of death i. emerged in the 1960s from the belief that neocortical functioning is the key to the definition of a human being a. livor mortis 4. culture d. algor mortis iii. emerged in the 1970s from the belief that the brain is more important than the spinal cord and that the critical functions are the individual’s personality. meet physiologic needs of dying clients i. flat electroencephalogram (EEG) for 24 hours 1. including the brain stem a. impaired senses of taste and smell c. no spontaneous respirations 1. and dying a. Common interventions for dying clients a. spiritual beliefs e. a. significance of the loss c. conscious life. teach client’s significant others how to assist in his/her care a. higher brain death a. blurred vision a. no reflexes 1. reasoning. cause of death 5. positive apnea test iii. provide personal hygiene measures ii. no muscular movement 1. the irreversible cessation of all functions of the entire brain. of cognitive function a. death. no spontaneous respirations 1. acting. Factors influencing loss.

listening to other clients’ grieving processes who were aware of the death of the client iv. allow significant others to see the body in private and perform any religious or cultural custom they wish b. listening to other nurses’ grieving processes who were involved in the client’s care i. assist with movement. if comfortable. prepare significant others for the reality of death h. place pads under the client’s hips and around the perineum to absorb feces and urine a. based on holistic concepts that emphasize care to improve the quality of remaining life rather than cure i. life review and framing memories iv. care of the client’s significant others a. if worn a. close the client’s eyes a. attach identification tags per agency policy ii. a nurse should arrange access to individual(s) who can provide spiritual care for the dying client f. four key features of hospice: . nutrition. comb and arrange the client’s hair a. wrap the client in a shroud 1. hydration. meet spiritual needs of dying clients i. wash the client if needed. listening to significant others’ concerns ii. clean up the client’s room or unit a. replace dentures or other dental appliances. care of the client’s body a. place a pillow under the client’s head a. prevent loss of control and dependency ii. prevent social isolation iii. prepare the client for transfer to either a morgue or funeral home 1. provide a private place for significant others to begin the grieving process b. if uncomfortable. provide postmortem care i. provide measures related to sensory changes v. if desired. care of other nurses a. guided imagery v. notify the hospital chaplain or appropriate community religious leader iii. focuses on support of the dying client and family with the goal of facilitating a peaceful and dignified death i. and elimination iv. straighten the client and lower the bed to a flat position a. meet pyschologic needs of dying clients i. care of other clients a. final wishes and saying good-bye g. iii. listening to significant others’ grieving process b. remove or cut all tubes and lines according to health care agency policy a. meet needs of the significant others of dying clients i. relieve pain e. remind significant others to care for themselves iii. a nurse can directly provide spiritual care for the dying client ii. hospice care i. if requested. honoring any religious or cultural rituals a.

inclusion of family as defined by the client a. interdisciplinary team a.a. or palliation (lessening) a. individuality and dignity . pain management and symptom control.