Fun Ch. 43 Loss, Grief, and Dying

Question 1

loss that can be recognized by others as well as by the person sustaining the loss, such as loss of a limb or a spouse

Answer 1

actual loss

Question 2

process of planning for future care in the event a person becomes unable to make his or her own decisions

Answer 2

advance care planning (ACP)

Question 3

written directive that allows people to state in advance what their choices for health care would be if certain circumstances should develop

Answer 3

advance directive

Question 4

an order that no attempts are to be made to resuscitate a patient who stops breathing or whose heart stops beating

Answer 4

Allow Natural Death (AND) order

Question 5

condition in which a person displays loss and grief behaviors for a loss that has yet to take place

Answer 5

anticipatory loss

Question 6

state of grieving or going through the grief process

Answer 6

bereavement

Question 7

an order written to indicate that the goal of treatment is a comfortable, dignified death and that further life-sustaining measures are no longer indicated

Answer 7

Comfort Measures Only order

Question 8

an order specifying that there be no attempt to resuscitate a patient in the event of cardiopulmonary arrest

Answer 8

Do Not Resuscitate (DNR) order

Question 9

abnormal or distorted grief that may be either unresolved or inhibited

Answer 9

dysfunctional grief

Question 10

3 definitions of death

Answer 10

(1) irreversible cessation of all functions of circulatory and respiratory functions;
(2) irreversible cessation of all functions of the entire brain, including the brainstem;
(3) termination of life

Question 11

emotional response to loss.

Answer 11

grief

Question 12

person suppresses feelings of grief and may instead manifest somatic (body) symptoms, such as abdominal pain or heart palpitations

Answer 12

inhibited grief

Question 13

lengthy or denied grief reaction

Answer 13

unresolved grief

Question 14

short but genuine grief reaction

Answer 14

Abbreviated grief

Question 15

grief reaction before actual loss

Answer 15

Anticipatory grief

Question 16

care provided for people with limited life expectancy, often in the home.

Answer 16

hospice care

Question 17

inaccessibility or change in a valued person, object, or situation.

Answer 17

loss

Question 18

loss tangible to both the person sustaining the loss and to others.

Answer 18

Actual loss

Question 19

loss tangible only to the person sustaining it.

Answer 19

Perceived loss

Question 20

loss of life, limb, an object, person, pet, or job.

Answer 20

Physical loss

Question 21

loss that affects a person’s self-image.

Answer 21

Psychological loss

Question 22

loss behaviors displayed before the actual loss occurs.

Answer 22

Anticipatory loss

Question 23

MOLST

Answer 23

stands for Medical Order for Life-Sustaining Treatment, a medical order indicating a patient’s wishes regarding treatments commonly used in a medical crisis

Question 24

period during which a person learns to accept grief

Answer 24

mourning

Question 25

hospice care; taking care of the whole person—body, mind, spirit, heart, and soul—with the goal of giving patients with life-threatening illnesses the best quality of life they can have through the aggressive management of symptoms

Answer 25

palliative care

Question 26

the lowering of patient consciousness with medication for the express purpose of limiting the patient’s awareness of suffering that is intractable and intolerable

Answer 26

palliative sedation

Question 27

loss of youth, of financial independence, and of a valued environment experienced by a person, but intangible to others

Answer 27

perceived loss

Question 28

POLST

Answer 28

stands for Physician Order for Life-Sustaining Treatment, a medical order indicating a patient’s wishes regarding treatments commonly used in a medical crisis; must be completed and signed by a health care professional, not the patient

Question 29

illness from which there is no reasonable expectation of recovery or cure

Answer 29

terminal illness

Question 30

withdrawal of life-sustaining therapy with the understanding that death may result, generally after a decision is made that the therapy in question is medically futile or disproportionately burdensome

Answer 30

terminal weaning

Question 31

Engel’s six stages of grief

Answer 31

(1) shock and disbelief,
(2) developing awareness, (
3) restitution,
(4) resolving the loss,
(5) idealization, and
(6) outcome

Question 32

Stage of grief defined as refusal to accept the fact of loss, followed by a stunned or numb response: “No, not me.”

Answer 32

Shock and disbelief

Question 33

Stage of grief characterized by physical and emotional responses such as anger, feeling empty, and crying: “Why me?”

Answer 33

Developing awareness

Question 34

involves the rituals surrounding loss; with death, it includes religious, cultural, or social expressions of mourning, such as funeral services.

Answer 34

Restitution

Question 35

Stage of grief; involves dealing with the void left by the loss. Idealization is the exaggeration of the good qualities of the person or object, followed by acceptance of the loss and a lessened need to focus on it.

Answer 35

Resolving the loss

Question 36

Stage of grief; the final resolution of the grief process, includes dealing with loss as a common life occurrence.

Answer 36

Outcome

Question 37

Kübler-Ross 5 stages of grief and death reactions

Answer 37

(1) denial and isolation,
(2) anger,
(3) bargaining,
(4) depression, and
(5) acceptance

Question 38

The medical criteria used to certify a death are as follows:

Answer 38

• Cessation of breathing
• No response to deep painful stimuli
• Lack of reflexes (such as the gag or corneal reflex) and spontaneous movement
• Flat encephalogram (brain waves)

Question 39

heart–lung death

Answer 39

cessation of the apical pulse, respirations, and blood pressure.

Question 40

cerebral or higher brain death

Answer 40

when the cerebral cortex is irreversibly destroyed.

Question 41

Characteristics of a Good Death

Answer 41

A good death is one that allows a person to die on his or her own terms, relatively free of pain, with dignity, and free from avoidable distress and suffering for patients, families, and caregivers.

Question 42

Kübler-Ross 5 stages of grief and death reactions: The patient expresses rage and hostility and adopts a “why me?” attitude: “Why me? I quit smoking and I watched what I ate. Why did this happen to me?”

Answer 42

Anger

Question 43

Kübler-Ross 5 stages of grief and death reactions: The patient goes through a period of grief before death. The grief is often characterized by crying and not speaking much: “I waited all these years to see my daughter get married. And now I may not be here to see her walk down the aisle. I can’t bear the thought of not being there for the wedding—and of not seeing my grandchildren.”

Answer 43

Depression

Question 44

Kübler-Ross 5 stages of grief and death reactions: the patient feels tranquil. The patient has accepted the reality of death and is prepared to die. The patient may think, “I’ve tied up all the loose ends: made the will, made arrangements for my daughter to live with her grandparents. Now I can go in peace knowing everyone will be fine.”

Answer 44

Acceptance

Question 45

Kübler-Ross 5 stages of grief and death reactions: The patient tries to barter for more time: “If I can just make it to my son’s graduation, I’ll be satisfied. Just let me live until then.” Many patients put their personal affairs in order, make wills, and fulfill last wishes, such as trips, visiting relatives, and so forth.

Answer 45

Bargaining

Question 46

Kübler-Ross 5 stages of grief and death reactions: The patient denies the reality of death and may repress what is discussed. The patient may think, “They made a mistake in the diagnosis. Maybe they mixed up my records with someone else’s.”

Answer 46

Denial

Question 47

How may children respond to death of a loved one?

Answer 47

• delay development

- regress development

Question 48

How do older adults respond to death of a loved one?

Answer 48

• reminisce about life,
• put their lives and the purpose of living in perspective, and
• prepare themselves for their own inevitable death.

Question 49

Focused assessment for those experiencing loss, grief, and dying

Answer 49

• determining the adequacy of the patient’s and family’s knowledge,
• perceptions,
• coping strategies, and
• resources.