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fundamentals of nursing > final exam: chapter 44 (loss, grief, and dying) > Flashcards

final exam: chapter 44 (loss, grief, and dying) Flashcards

1
Q

spirituality is an essential part of __ (holistic/hospice/perioperative) care

A

holistic

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2
Q

daily living habits | general frame of reference (thinking about oneself and world) | health and illness | relationships | required and prohibited behaviors are all __ and __ of a person’s life in spirituality

A

beliefs; practices

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3
Q

how has dying in america changed over the years?
a. better management of acute illness (tech, med, process and settings)
b. complex decisions - life sustaining treatment
c. cost of care at end of life
d. family involvement

A

a-d

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4
Q

the 4 selected recommendations for dying in the us are: __ (hint: cdpp)

A

clinician-pt communication and advanced care planning | delivery of care | professional education and development | public education and engagement

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5
Q

the types of loss are: __ (hint: aampps)

A

actual | anticipatory | maturational | physical vs. psychological | perceived | situational

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6
Q

match the types of loss with their appropriate definition:
a. actual
b. anticipatory
c. maturational
d. perceived
e. situational
1. experienced bc of an unpredictable event
2. experienced as a result of natural development process
3. recognized by others
4. loss has not yet taken place
5. less obvious to others; individual experience

A

a. 3
b. 4
c. 2
d. 5
e. 1

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7
Q

grief is:
a. the state of grieving
b. the internal emotional reaction to loss
c. actions and expressions of grief - outward expressions

A

b. the internal emotional reaction to loss

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8
Q

mourning is:
a. the state of grieving
b. the internal emotional reaction to loss
c. actions and expressions of grief - outward expressions

A

c. actions and expressions of grief - outward expressions

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9
Q

bereavement is:
a. the state of grieving
b. the internal emotional reaction to loss
c. actions and expressions of grief - outward expressions

A

a. the state of grieving

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10
Q

dysfunctional grief is an abnormal response. true or false?

A

true (there is unresolved and inhibited grief)

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11
Q

unresolved grief is:
a. trouble expressing feelings or loss
b. suppressed feelings that can lead to somatic symptoms (e.g. abdominal pain)

A

a. trouble expressing feelings or loss

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12
Q

inhibited grief is:
a. trouble expressing feelings or loss
b. suppressed feelings that can lead to somatic symptoms (e.g. abdominal pain)

A

b. suppressed feelings that can lead to somatic symptoms (e.g. abdominal pain)

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13
Q

death can be defined by an individual who has either irreversible cessation of ALL (1) __ or (2) __

A

circulatory and respiratory function; brain function (including brain stem)

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14
Q

a person is “dead” based on these 3 criteria:

A
  1. cessation of breathing
  2. no response to deep, painful stimuli
  3. lack of reflexes (e.g. gag, corneal)
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15
Q

clinical signs of death include: __ (hint: cdddlnnruw)

A

clotting, mottling, and cyanosis of extremities & dependent areas | decreasing bp | decreasing body temp w/cold or clammy skin | difficulty talking or swallowing | loss of movement, sensation, & reflexes |nausea, flatus, abdominal distention | noisy, irregular, or cheyne-stokes respirations | restlessness and/or agitation | urinary and/or bowel incontinence or constipation | weak, slow, or irregular pulse

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16
Q

the 5 stages of grief are: __ (hint: dabda)

A

denial and isolation | anger | bargaining | depression | acceptance

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17
Q

true or false. terminal illness can be defined as an illness w/expected death w/in a limited space of time

A

true

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18
Q

mark the correct options about terminal illness:
a. physician is responsible for this decision
b. pt knows what to do
c. most pts want to know their prognosis and what to do
d. culture influences how much info and who is involved

A

a, c, d

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19
Q

in terms of the pt view for terminal illness, most pts __ about their condition while competent pts have the right to __ and __ treatment, even life-sustaining ones

A

know; consent; refuse

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20
Q

in terms of the family view of terminal illness, the family of a pt should be __ to participate in planning pt’s care plan, and needs to be able to __ the pt’s status w/health care providers. the nurse can provide __ and __ as the family begins the grieving process.

A

encouraged; discuss; support; care

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21
Q

what is the difference between palliative and hospice care?

A

palliative care enhances the quality of life for a pt, while hospice care focuses on “care” rather than “cure”

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22
Q

which of the following are NOT true about palliative care:
a. enhances quality of life
b. requires life expectancy
c. expenses covered by philanthropy, fee-for-service, and direct hospital support
d. ideally begins at diagnosis of terminal illness
e. peds pts are covered by the mandates from the Affordable Care Act

A

b. requires like expectancy (does NOT require life expectancy)
d. ideally beings at diagnosis of terminal illness (ideally begins at diagnosis of a serious illness)

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23
Q

which of the following are NOT true about hospice care:
a. pts have 6+ to live
b. expenses are paid by Medicaid, Medicare, and most private health insurers
c. pt/family chooses not to receive aggressive, curative care

A

a. pts have 6+ to live

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24
Q

durable power of attorney for healthcare indicates what?

A

who’‘ll make decisions for the pt when pt is unable

25
Q

an advanced directive indicates the kind of __ treatment the pt wants or doesn’t want

A

medical

26
Q

polst stands for __

A

physician order for life sustaining treatment

27
Q

molst stands for __

A

medical order for life sustaining treatment

28
Q

you do not resuscitate a pt on these 2 conditions:
(1) __
and/or
(2) __

A

pt stops breathing
heart stops breathing

29
Q

what is the standard of care?

A

resuscitate a pt if there is no order

30
Q

what age groups are impacted by advanced directives? molst?

A

advanced directive: 18yo+
molst: anyone w/serious illness at any age

31
Q

an advanced directive has instructions for __ (current/future) treatment, while molst has instructions for __ (current/future) treatment

A

future; current

32
Q

does an advanced directive guide emts? does molst?

A

no; yes (when available)

33
Q

does an advanced directive guide inpatient care? molst?

A

yes (when available)

34
Q

death certificate must be completed with __ signature (depending on state’s laws) and __ (in special circumstances)

A

clinician; pathologist

35
Q

a pt who has died is qualified for organ donation, what does this mean?

A

identified on license (some states); family decides after pt’s death

36
Q

when conducting an autopsy, __ is needed because some __ refuse it and __ are determined by the coroner

A

consent; religions; legal cases

37
Q

the main purpose of talking with a dying client is __

A

keeping communication open

38
Q

when is it the most appropriate to talk to a dying pt?

A

at night

39
Q

what nursing interventions can you take when supporting the hope of a dying client? (hint: abdff)

A

assess what they know about the disease/prognosis | build trusting relationships | determine their meaning of hope | focus on quality of life | follow pt’s lead to determine informational needs

40
Q

what should you do to meet the needs of the family with a dying family member? (hint: elpp)

A

explain steps of grieving | listen to their concerns | pacing visits so pt is not overwhelmed or gets too tired | prepare them ahead of time

41
Q

during postmortem care, the nurse should position the deceased pt into which position?
a. semi-fowler’s
b. high-fowler’s
c. normal anatomical position

A

c

42
Q

should the nurse wash the body of a deceased pt?

A

most likely not, some religions prohibit it or a special person does it

43
Q

what is the nurse responsible for in postmortem care?

A

identification - body, shroud, and belongings

44
Q

the 5 common symptoms of end-of-life are: __ (hint: cddfp)

A

constipation | delirium |. dyspnea | fatigue | pain

45
Q

you should increase fluid intake by how much in a dying pt with constipation?

A

1500-2000 mL/day

46
Q

how much fiber should you increase when fluid intake reaches 1500 mL?

A

25-30g/day

47
Q

besides fluid intake and fiber, what else can you give the pt with constipation?

A

laxatives

48
Q

a pt has delirium in hospice. what med do you administer?

A

haldol

49
Q

what non-pharma management would you carry out for a hospice pt with delirium?

A

monitor sleep protocols and environment strategies

50
Q

a hospice pt has dyspnea. what med can you administer?

A

opioids (morphine, fetanyl) in smaller doses than pain management

51
Q

a hospice pt is anxious about dying. what med can you give them?

A

benzodiazepine

52
Q

what non-pharma interventions would you manage for a hospice pt experiencing dyspnea?

A

use a fan (cool and dust free), pursed lip breathing, dme (portable o2, commode, hospital bed, etc.), relaxation, music, thoracentesis or chest tube placement

53
Q

a hospice pt is experiencing fatigue. what can you manage for them?

A

set their bedtime and awake time, routine rest period and after exertion, exercise (reduce or increase fatigue)

54
Q

a hospice pt is experiencing pain. what med is the golden standard for cancer pts?

A

oral morphine

55
Q

what other meds besides morphine can you give a hospice pt undergoing pain?

A

local anesthetics, corticosteroids, and tricyclic antidepressants

56
Q

why is acetaminophen a concern for pain management?

A

it is contraindicated with liver disease

57
Q

why are nsaids a concern for pain management?

A

they put pts at risk for renal failure and gi bleeding. risk is greater in older pts

58
Q

why is demerol a concern for pain management?

A

they’re not used often due to metabolite accumulation = anxiety, tremors, or seizures

59
Q

what non-pharma interventions can the nurse manage for a hospice pt experiencing pain? (hint: ccmmt)

A

cognitive-behavioral techniques | complementary and alternative meds | massage | music therapy | transcutaneous electrical nerve stimulation

fundamentals of nursing (17 decks)

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