GRIEF AND GRIEVING PROCESS

What is grief?

Grief is the experience of coping with loss. Most of us think of grief as happening in the painful
period following the death of a loved one. But grief can accompany any event that disrupts or
challenges our sense of normalcy or ourselves. This includes the loss of connections that define
us. You may grieve the loss of:

 A friend, family member, partner or pet.

 A marriage, friendship or another form of kinship.
 Your home, neighborhood or community.
 Your job or career.
 Financial stability.
 A dream or goal.
 Good health.
 Your youth.
 Fertility.

FIVE STAGES OF GRIEF

Denial
In the first stage of the grieving process, denial helps us minimize the overwhelming pain of loss.
As we process the reality of our loss, we are also trying to survive emotional pain. It can be hard
to believe we have lost an important person in our lives, especially when we may have just
spoken with them the previous week or even the previous day. During this stage in grieving, our
reality has shifted completely. It can take our minds time to adjust to our new reality. We reflect
on the experiences we've shared with the person we lost, and we might find ourselves wondering
how to move forward in life without this person.
This is a lot of information to explore and a lot of painful imagery to process. Denial attempts to
slow this process down and take us through it one step at a time, rather than risk the potential
of feeling overwhelmed by our emotions.
Anger
The second stage in grieving is anger. We are trying to adjust to a new reality and are likely
experiencing extreme emotional discomfort. There is so much to process that anger may feel like
it allows us an emotional outlet. Keep in mind that anger does not require us to be very
vulnerable. However, it may feel more socially acceptable than admitting we are scared. Anger
allows us to express emotion with less fear of judgment or rejection. Anger also tends to be the
first thing we feel when starting to release emotions related to loss. This can leave us feeling
isolated in our experience. It can also cause us to be perceived as unapproachable by others in
moments when we could benefit from comfort, connection, and reassurance.
Bargaining

When coping with loss, it isn't unusual to feel so desperate that you are willing to do anything to
alleviate or minimize the pain. During this stage in grieving, you may try to bargain to change
the situation, agreeing to do something in return for being relieved of the pain you feel.
When bargaining starts to take place, we often direct our requests to a higher power, or
something bigger than us that may be able to influence a different outcome. Bargaining during
the grieving process can come in the form of a variety of promises, including:

 "God, if you can heal this person, I will turn my life around."
 "I promise to be better if you will let this person live."
 "I'll never get angry again if you can stop him/her from dying or leaving me."

Bargaining comes from a feeling of helplessness and gives us a perceived sense of control over
something that feels so out of control. During bargaining, we tend to focus on our personal faults
or regrets. We might look back at our interactions with the person we are losing and note all the
times we felt disconnected or may have caused them pain. It is common to recall times when we
may have said things we did not mean and wish we could go back and behave differently. We
also sometimes make the drastic assumption that if things had played out differently, we would
not be in such an emotionally painful place in our lives.
Depression
During our experience of processing grief, there comes a time when our imaginations calm down
and we slowly start to look at the reality of our present situation. Bargaining no longer feels like
an option and we are faced with what is happening. In this stage of grieving, we start to feel the
loss of our loved one more abundantly. Our panic begins to subside, the emotional fog begins to
clear, and the loss feels more present and unavoidable. In those moments, we tend to pull inward
as the sadness grows. We might find ourselves retreating, being less sociable, and reaching out
less to others about what we are going through. Although this is a very natural stage in the
grieving process, dealing with depression after the loss of a loved one can be extremely isolating
and one of the most difficult stages.
Acceptance
The last of the 5 Stages of Grief is acceptance. When we come to a place of acceptance, it is not
that we no longer feel the pain of loss. Instead, we are no longer resisting the reality of our
situation, and we are not struggling to make it something different. Sadness and regret can still
be present in this phase. But the emotional survival tactics of denial, bargaining, and anger are
less likely to be present during this phase of the grieving process.
CARDIOPULMONARY RESUSCITATION (CPR): AIRWAY, BREATHING,
CIRCULATION RESUSCITATION
Cardiopulmonary resuscitation (CPR) is a hands-on emergency intervention used to restore
heartbeats and breathing in someone who has gone into cardiac arrest. Common causes of
cardiac arrest are a heart attack or near-drowning.
CPR involves manual chest compressions and, in some cases, rescue ("mouth-to-mouth")
breathing. If available, a device called an automated external defibrillator (AED) may be used to
restart the heart. These interventions can keep blood flowing to the brain until emergency
medical assistance arrives. CPR can be performed on people of any age.

CPR is needed when a person has the four signs of cardiac arrest:

 The person has collapsed.

 The person is non-responsive.
 Breathing has stopped.
 There is no pulse.

Performing CPR on someone with cardiac arrest doubles or triples their chances of
survival.
WHAT TO DO BEFORE PERFORMING CPR

Before starting CPR:

1. Make sure that you and the victim are well away from traffic, fire, or any other hazard.
2. Ask the person loudly if they are OK to see if they are responsive.
3. If not, call 911(ambulance) or ask a bystander to do so.
4. If available, ask someone to get or find an AED( automated external defibrillator) (often
available in public facilities).
5. Turn the person on their back and check if they are breathing by listening for breathing
sounds or seeing if their chest rises and falls.
6. Check for a pulse on the person's neck (carotid pulse).
7. If there is no pulse, start CPR.

All of these tasks can be performed in less than a minute.

CPR in Adults and Older Children

The following steps apply to adults and children over 8 years old.

1. Place one hand on the middle of the person’s chest just below the nipples. Place the other
hand on top, locking fingers.
2. Using your body weight, push hard with the heel of your hand. You need to push hard
enough to compress the chest to a depth of around 2 inches. Keep your arms straight.
3. Keep compressing at a rate of 100 to 120 beats per minute. 
4. If you are qualified to give rescue breaths, do chest compressions for 30 seconds,
followed by two rescue breaths, followed by another set of chest compressions, and so
on. If you are not, keep doing chest compressions without rescue breaths.
5. If another person is available to help, they can take over if you get tired.

CPR for Children 1 to 8 Years

The procedure for giving CPR to a child is essentially the same as that for an adult.

1. Place one hand in the middle of the child’s chest on the breastbone.
 2. Push hard with your hand, compressing the chest to a depth of around 2 inches.
3. Keep compressing at a rate of 100 to 120 beats per minute.
4. If you are qualified to give rescue breaths, do chest compressions for 30 seconds,
followed by two rescue breaths, followed by another set of chest compressions, and so
on. If not, keep doing chest compressions without rescue breaths.

Continue until emergency medical help arrives or the child revives.

CPR for Infants

With infants, check for responsiveness by flicking the bottom of their foot. If the infant is non-
responsive and there are no signs of breathing or a heartbeat, proceed as follows:

1. Place two fingers in the center of the infant's chest.

2. Firmly compress the chest about 1-1/2 inches deep at a rate of around 120 beats per
minute.
3. If you are qualified to give rescue breaths, do chest compressions for 30 seconds,
followed by two rescue breaths, followed by another set of chest compressions, and so
on. If, do chest compressions without rescue breaths.

Continue until emergency medical help arrives or the infant revives.

NOTE:

Use CPR when an adult is not breathing at all. For a child or infant, use CPR when they are not
breathing normally. Always use CPR if the adult or child is not responding when you talk to
them or tap them. If someone is not breathing, giving CPR can ensure that oxygen-rich blood
reaches the brain. This is important, as without oxygen, someone can sustain permanent brain
damage or die in under 8 minutes. A person might need CPR if they stop breathing in any of the
following circumstances:

 a cardiac arrest or heart attack

 choking
  a road traffic accident

 near-drowning

 suffocation

 poisoning

 a drug or alcohol overdose

 smoke inhalation

 electrocution

 suspected sudden infant death syndrome

Only perform CPR if the adult is not breathing, or in children and infants, when they are not
breathing normally, and their blood is not circulating. This is why it is important to ensure that
the person does not respond to verbal or physical calls to attention before starting the CPR
process.

ADVANCED CARDIOVASCULAR LIFE SUPPORT (ACLS)

Advanced cardiac life support (ACLS) is a group of procedures and techniques that treat
immediately life-threatening conditions, including cardiac arrest, shock, stroke, and trauma.
ACLS procedures and techniques are arranged into algorithms. Algorithms are a set of standard
guidelines that improve the speed, effectiveness and outcomes of ACLS. The goal of ACLS is to
stabilize your condition. This includes restoring normal vital signs and alertness. ACLS and
other types of intensive medical care save lives. ACLS generally does not reverse or cure an
underlying end-stage or life-threatening condition. It is not successful in all cases. 

Types of ACLS treatments

Some conditions and diseases require many ACLS procedures and techniques, while others may
only use a few. ACLS includes:
 Airway stabilization and treatment including placing a breathing tube in the
windpipe (intubation). Mechanical ventilation using a ventilator assists or performs
breathing.
 Arterial line insertion to take continuous blood pressure readings. It also provides a
catheter in an artery to draw blood for necessary lab tests.
 Breathing treatments to open constricted airways  due to asthma, allergic reactions,
or COPD (chronic obstructive pulmonary disease)
 Cardiopulmonary resuscitation (CPR) to keep oxygenated blood pumping through the
body until the heart and lungs can perform this on their own. This requires pushing
down fast and firmly on the chest.
 Cardioversion to treat certain cardiac arrhythmias (abnormal heartbeats). A common
example is atrial fibrillation. Cardioversion uses medications or low-energy electrical
shocks to restore a normal heartbeat.
 Chest tubes or needle decompression to re-inflate a collapsed lung
 Defibrillation to restore a normal heartbeat using a high-energy electrical shock
 Intravenous (IV) or central venous catheter placement to deliver fluids,
medications, and blood transfusions
 IV medications to treat many conditions. IV medications can reverse life-threatening
allergic reactions, correct acidosis, and suppress abnormal heartbeats. They can reduce
the workload on the heart, reduce fluid buildup, and dissolve a clot that is causing
a heart attack. They can also improve blood pressure and vital signs.

 Oxygen therapy to increase the amount of oxygen in the blood

 Pacing to correct certain abnormal heartbeats

Why is advanced cardiac life support (ACLS) performed?

Advanced cardiac life support (ACLS) treats severe or life-threatening conditions including: 

 Coma including coma due to stroke, head injury, seizures, meningitis, or diabetes

 
 Drug toxicity and chemical exposure including overdose, poisoning, or serious
adverse effects of medications and street drugs
 Electrolyte imbalance including abnormal amounts of potassium, calcium or
magnesium in the bloodstream

 Heart conditions including cardiac arrest, heart attack, certain congenital heart defects
(birth defects), congestive heart failure, and cardiac arrhythmias (abnormal heartbeats).
 Arrhythmias include ventricular fibrillation, ventricular tachycardia, supraventricular
tachycardia, and rapid atrial fibrillation
 Respiratory failure including problems due to asthma, pulmonary edema (fluid in the
lungs), and pulmonary embolism (blood clot in the lung)


 Severe allergic reactions including anaphylaxis, a life-threatening allergic reaction

 Shock including shock due to severe bleeding, spinal cord injury, heart conditions,
and sepsis (a body-wide reaction to infection)
 Terminal illnesses including end-stage liver failure and advanced cancer
 Trauma and injuries including severe burns, major cuts, head and spinal cord injuries,
multiple trauma, and smoke inhalation

Who performs advanced cardiac life support (ACLS)?

 A team of specially trained healthcare providers performs advanced cardiac life support
(ACLS). ACLS teams generally include doctors, nurses, and respiratory therapists.

The following doctors perform advanced cardiac life support (ACLS):

 Cardiac surgeons specialize in the surgical treatment of conditions of the heart and its
blood vessels. Cardiac surgeons may also be known as cardiothoracic surgeons.
 Cardiologists specialize in the medical treatment of heart disease.
 Critical care medicine doctors specialize in the diagnosis and management of life
threatening conditions.
 Emergency medicine and trauma doctors specialize in rapidly diagnosing and
treating acute illnesses, conditions, injuries, and complications of chronic diseases.
 Thoracic surgeons specialize in the surgical treatment of diseases of the chest,
including the blood vessels, heart, lungs and esophagus. Thoracic surgeons may also be
known as cardiothoracic surgeons.s

How is advanced cardiac life support (ACLS) performed?

ACLS is performed anywhere it is needed in a hospital or clinic. This includes the intensive care
unit (ICU), emergency room (ER), operating room (OR), recovery area, and general medical
units. Paramedics perform ACLS in pre-hospital settings under the guidance of a doctor. 

The ACLS procedure varies, depending on a patient’s condition. ACLS always includes
continuous monitoring of your vital signs, heart rhythm, and other important body functions.
ACLS generally includes these steps, which occur very rapidly and often at the same time:

1. The ACLS team assesses the patient, including alertness, airway (windpipe),
respirations, and pulse and heart rhythm to determine the need for ACLS.
2. The ACLS team performs CPR if needed until equipment is available to defibrillate or
cardiovert the patient. This involves applying electrodes or paddles to the chest and
shocking the heart to convert an arrhythmia (abnormal heartbeat) to a normal rhythm.
Most defibrillator devices can also provide temporary pacemaker functions.
3. The ACLS team re-analyzes the heart rhythm and provides more shocks as needed. The
team continues CPR during this time as needed.
4. The ACLS team inserts a tube through the mouth or nose if the patient isn’t breathing
effectively. The team attaches the tube to a ventilator or other device that provides
oxygen and assists with breathing.
5. The ACLS team starts IV lines and possibly a central venous line to give medications,
fluids, and blood transfusions. The team may start an arterial line in a wrist artery to
monitor blood pressure. It also provides a catheter to draw blood for lab tests.
6. Breathing treatments are used to open the airways for certain conditions, such as
severe asthma and chronic obstructive pulmonary disease (COPD).
7. The ACLS team or other specialized teams will perform other treatments as needed.

NOTE:

The patient’s comfort is important to both the patient and the care team. Some ACLS procedures
and techniques are uncomfortable or painful. Patients are often unconscious and unaware of
ACLS procedures. The patient will get sedatives and pain medication so that they stay
comfortable if they are alert. The patient should tell a member of your ACLS team if you are
uncomfortable.

What are the risks and potential complications of advanced cardiac life support (ACLS)?

There are risks of advanced cardiac life support (ACLS), but the life-saving benefit of ACLS
generally outweighs potential complications. Risks and complications vary depending on the
procedure or technique:

 CPR can cause broken ribs and chest pain

 Defibrillation or cardioversion can cause skin burns or irritation,
myocardial necrosis (death of heart muscle tissue), and cardiac arrhythmias (abnormal
heartbeats). Cardioversion can displace a blood clot that has developed due to a type of
arrhythmia called atrial fibrillation. A blood clot can travel to the brain and cause
a stroke.
 IVs, central venous catheters, and arterial lines can cause hematomas (large
bruises), bleeding, blood clots, and infection. An arterial line can also block the artery
and reduce blood supply to tissues.
 Medications can cause allergic reactions and side effects that can be serious in some
cases.

Reducing your risk of complications

You can reduce the risk or severity of some complications of ACLS by:
  Following activity, dietary and lifestyle restrictions and recommendations during your
recovery
 Notifying your doctor right away of any concerns, such as bleeding, fever, increase in
pain, chest pain, shortness of breath, or dizziness
 Taking your medications exactly as directed
 Wearing a medical ID bracelet or other identification that lists your allergies and
medical conditi

ASSIGNMENT

1) Paediatrics Advanced Life Support(PALS)

2) What is Last office and procedures for performing last office

EQUIPMENTS USED IN SUPPORTING RESPIRATORY FUNCTION

Respiratory equipment assists with the removal of mucus from the airways and improves
pulmonary functions. Many devices are user-friendly and allow the user to enjoy a higher
level of independence than they would without it.

Air Cleaners

This type of device is also known as an air purifier and can improve the quality of air an individual
breathes. It can be used in the home or office due to respiratory disease, illness, allergies, and
asthma. It can also be used if you live or work in an area with poor air quality. Air cleaners may
use a filter system or an ionic cleaning process.
CPAP Machines

CPAP is short for continuous positive airway pressure. These machines are a major factor for
people with sleep apnea or a respiratory illness, like chronic obstructive pulmonary disease
(COPD). The machine sends pressurized air from the machine to a mask that covers the user’s
nose.

It is designed to prevent the airways from closing during sleep.

 CPAP Accessories. Over time, the CPAP machine may need replacement parts or repairs to
keep it running smoothly. Take notice of the filters, humidifier unit, airway connector valves
and tubes, tubing for the climate controlled air delivery, water tub, and all straps or cushions.
Ensure these parts are in working order to maintain the quality of air being delivered to the
user.
 CPAP Masks. For high-quality treatment and management of obstructive sleep apnea, it is
important to have a mask that is properly fitted. There are different masks to fit both men
and women, and numerous styles for individual comfort.

BiPAP Machines

BiPAP (or BPAP) stands for Bilevel Positive Airway Pressure. A BiPAP machine is similar to a
CPAP machine in design and function. It is a noninvasive therapy primarily used for patients with
sleep apnea. The main difference is that a CPAP machine provides a singular airway pressure,
while a BiPAP machine provides two levels of air pressure. With a singular level, it can be difficult
for patients to exhale against the incoming air. BiPAP machines allow for two pressure settings:
the prescribed pressure for inhalation (ipap) and a lower pressure for exhalation (epap). This allows
the patient to get more air in and out of their lungs, which can be a more comfortable experience.

Portable Emergency Oxygen Systems

These systems consist of durable casing that contains medically pure oxygen, a mask, and tubing.
The system is designed to administer oxygen to a person during an emergency until medical
professionals arrive. It is best to keep these units stored where they can be easily and quickly
reached during an emergency. They may be particularly useful during a stroke or heart attack.

Nebulizers

This is a small device that gives aerosol medication to an individual through a mouthpiece, tubing,
and medicine cup. They are commonly used for individuals with COPD, asthma, and other
respiratory conditions.

Pulse Oximetry Meters

A person can use this small, clip-like device easily by themselves. It is painless and noninvasive.
Most often, an oximetry meter is placed on a finger. A pulse oximetry meter measures how well
your heart is pumping oxygen through your body. The machine identifies your pulse rate and blood
oxygen saturation reading.

 A pulse oximetry meter can be useful for people with: COPD, asthma, pneumonia, lung
cancer, anemia, chronic diseases, heart attack or heart failure, and congenital heart defects.

Home Oxygen Concentrators

Concentrators provide people that have a respiratory illness with medical-grade oxygen. They are
generally used in the home and powered with a wall outlet.
Portable Oxygen Cylinders

These cylinders are used in oxygen therapy. They come in many different sizes and styles. The
product is intended for us in the office, car, and home, and it runs off of battery power.

Suction Machines

These machines can be portable or powered by an outlet. They assist the body with removing
secretions from an individual’s airways to help them breathe. The machine consists of tubing, a
face mask, and generator to provide plenty of pressure to clear the lungs.