Concept of Grief and Loss

Question 1

death of a fetus or neonate from time of conception through end of newborn period of 28 days after birth

Answer 1

perinatal loss

Question 2

perinatal loss can also be referred to as ?

Answer 2

• fetal demise
• spontaneous abortion
• miscarriage

Question 3

What are the seven fetal factors that are involved in a a perinatal loss?

Answer 3

1. chromosomal disorder
2. birth defects
3. exposure to teratogen
4. infection
5. complication of multiple gestation or fetal growth restriction
6. maternal factors
7. placenta factors

Question 4

What are some of the common causes of perinatal loss in industrialized countries?

Answer 4

• maternal obesity
• advanced maternal age
• maternal smoking
• maternal substance abuse
• primiparity
• small for gestational age fetus
• abruptions
• maternal hypertension
• diabetes

Question 5

what are the causes of perinatal loss in developing countries?

Answer 5

• infections (both bacterial and viral)
• other organisms (lyme disease, Q fever, leptospirosis)
• untreated syphilis
• malaria

Question 6

what is the maternal physiologic implications associated with fetal demise?

Answer 6

• development of disseminated intravascular coagulation (DIC)
• release of thromboplastin

Question 7

what happens after the clotting system is activated ?

Answer 7

clotting system is activated –> triggers formation of tiny blood clots –> fibrinogen and factor V and VII depleted –> woman displays symptoms of DIC

Question 8

what is included in a postbirth evaluation?

Answer 8

• postmortem exam or studies can provide information related to death
• studies and tests are determined by parents past medical history and preferences
• chromosomal studies
• cultures of placenta and fetus
• IgM and IgG antibodies drawn
• visual inspection of stillborn babies
• inspection of placenta (send for pathology) and membranes
• umbilical cord inspection
• blood test, x-ray autopsy, magnetic resonance imaging (MRI)

Question 9

individual’s response to a loss

Answer 9

Grief

Question 10

period of adjustment to a loss

Answer 10

Bereavement

Question 11

What are the five stages of grief?

Answer 11

1. Denial
2. Anger
3. Bargaining
4. Depression
5. Acceptance

Question 12

What are the clinical manifestations of the first stage of grief (denial)?

Answer 12

• hope a second opinion may be different

- not convinced of the death

Question 13

What are the clinical manifestations of the second stage of grief (anger)?

Answer 13

• resulting from feelings of loss, loneliness, and guilt
• may be projected at others or absent when death is sudden or unexpected
• mother may blame self or event that caused the death

Question 14

what are the clinical manifestations of the third stage of grief (bargaining)?

Answer 14

• may or may not be present
• unanticipated death may not allow the time
• more common in expected death
• marked by parents making mental trade-offs in exchange for a healthy fetus

Question 15

what are the clinical manifestations of the fourth stage of grief (depression)?

Answer 15

• evidenced by preoccupation, weeping, and withdrawl

- changing hormonal level in first 24-48 hours may compound after birth

Question 16

what are the clinical manifestations of the fifth stage of grief (acceptance)?

Answer 16

• surfaces when resolution occurs
• highly individualized
• may take months to years to complete

Question 17

death of a woman while pregnant or within 42 days of the termination of pregnancy, irrespective of the duration and the site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes.

Answer 17

maternal death

Question 18

what are the causes of maternal death?

Answer 18

• hemorrhage
• hypertensive disorders
• embolism
• infection
• preexisting chronic conditions (diabetes, cardiovascular disease)
• obesity (due to medical conditions)

Question 19

What is true indicators of perinatal death?

Answer 19

• report of cessation of fetal movement by mother
• decrease in signs and symptoms of pregnancy
• fetal heart tones absent
• fetal movement not palpable
• assess family members ability to adapt to loss
• identify previous losses and coping mechanisms

Question 20

What are the nursing diagnoses associated with perinatal death?

Answer 20

• grieving related to imminent loss of child
• coping:family, compromised, related to death of a child/unresolved feelings regarding perinatal loss
• hopelessness related to sudden, unexpected fetal loss
• spiritual distress, risk for, related to intense suffering secondary to unexpected fetal loss

Question 21

what nursing interventions need to be done if a perinatal death occurs?

Answer 21

• provide a room for parents
• provide solace to couple without offering commentary
• consider cultural factors
• offer to contact hospital chaplain or another cleric
• let the family process their own beliefs and feelings about the meaning, purpose and significance of life and death of the baby
• provide discharge care
• provide counseling resources
• provide follow-up phone calls for family
• supply information for community support groups focus on perinatal loss