S3 M8/9 Grief/End of Life

Question 1

Grief

Answer 1

Multifaceted

Reaction to loss, real or perceived

Question 2

3 types of loss

Answer 2

Actual
Perceived
Anticipatory

Question 3

Kubler Ross
Stages of grief

test

Answer 3

Denial
Anger
Bargaining
Depression
Acceptance

Question 4

Acceptance should happen within _ months

Answer 4

6

Question 5

Maladaptive grief

Answer 5

Distorted or exaggerated

Chronic or prolonged

Delayed

Question 6

Anticipatory grief

Answer 6

anticipating a negative circumstance

Question 7

Nursing interventions for grief

Answer 7

Understand process

Develop Therapeutic communication

Active listening

Be non-judgmental

Question 8

Most important part of moving through grief stages

Answer 8

Be open and communicative

Question 9

Are grief stages definite

Answer 9

NO

pt can spend different amounts of time and go back and forth between stages

Question 10

3 Assessments of client

Answer 10

Perception
Support
Coping

Question 11

Still birth

Answer 11

Loss up to 1 month old

Question 12

With still birth provide memories

Answer 12

lock of hair
photograph (ask parent first)
name band
encourage hold/tough
dress infant

Question 13

With still birth pt may

Answer 13

have misplaced anger
need time
not want contact

be open minded

Question 14

Amputation may lead to

Answer 14

grief

Question 15

With amputations encourage contact with

Answer 15

residual limb

Question 16

To facilitate amputations ID

Answer 16

PT strengths and resources

Question 17

Goal of assistive devices

Answer 17

Independent function

Question 18

Goal with amputation patients and overall grief

Answer 18

Acceptance

Question 19

Myocardial infarctions and grief

Answer 19

Diet
Lifestyle
Life meds

pt stuck in unexpected changes
realization of mortality

Question 20

Associated problems with MI grief

Answer 20

Fears
Loss of employment
Strain on marriage
Hostility toward changes 
Fear of another MI

Question 21

Terminal illness grief

Answer 21

Anticipatory and mourning

Question 22

Normal emotions of terminal grief

Answer 22

Denial 
Sadness
Anger
Fear
Anxiety

Question 23

With terminal illness _ is not always reached

Answer 23

Acceptance

Question 24

Emotions in terminal illness _ daily

Answer 24

fluctuate

Question 25

Nursing with terminal illness

Answer 25

support family unit encourage meaningful interactions professional support (Chaplin, grief counselor)

Question 26

Defined recommendations to improve end of life care

Answer 26

coverage communication planning education

Question 27

DNR/POLST

Answer 27

DNR only good in hospital | POLST out of hospital DNR

Question 28

Advanced directive

Answer 28

Umbrella term for legal documents

Question 29

Living will

Answer 29

written while in good health | outlines medical care to be given

Question 30

Proxy directive

Answer 30

person authorized to make medical decision on your behalf when you cant

Question 31

Durable power of attorney

Answer 31

IDs the proxy decision maker for financial/general decisions sometimes medical but not always recommended to have a separate medical

Question 32

Assisted suicide legislation

Answer 32

10 states in the US

Question 33

Palliative

Answer 33

comprehensive symptom management of illness

Question 34

Hospice

Answer 34

Prep for death

Question 35

4 levels of hospice

Answer 35

routine home care - routine visits inpatient respite care - spend short times in hospice facility, gives fam a break continuous care - hospice providers provide 24h care general inpatient care - pt moved to impatient care till symptoms are managed

Question 36

Hospice care principles

Answer 36

acceptance of death pt and fam viewed as a single unit pain and symptoms managed for pt bereavement managed for fam

Question 37

Nursing management at end of life

Answer 37

COMMUNICATION is center ``` Develop comfort in communication about death Tailor understanding to values of pt/fam Time arrangements Create right setting Seat all at eye level ```

Question 38

Effective listening

Answer 38

Allow for silence Ask if pt needs time Assess understanding

Question 39

Things to avoid with comms

Answer 39

Distractions Impulse to give advice Canner responses "I know how you feel"

Question 40

Focus of End of Life

Answer 40

Pain assess pain level Manage Break through pain Rescue dosing

Question 41

Hospice analgesics are given

Answer 41

Around the clock not PRN

Question 42

End of life physiological changes

Answer 42

Dyspnea Anorexia/Cachexia Excess secretions

Question 43

Emotional fall throughs in end of life

Answer 43

Agitation Delirium Anxiety

Question 44

Preactive phase of dying

Answer 44

``` restless confusion withdrawal lack of appetite breathing changes ```

Question 45

Active phase of dying

Answer 45

sleep anger, laughing, agitation pill rolling breathing problems

Question 46

Death breathing

Answer 46

Chayne stokes pattern

Question 47

Body deterioration

Answer 47

``` dark urine BP drop cold/numb extremities body rigid jaw drop ```

Question 48

Death

Answer 48

Cessation of resp Cessation of cardio HEARD

Question 49

Grief vs mourning

Answer 49

Feeling expression of it

Question 50

Bereavement

Answer 50

Time for grieving