FUNDAMENTALS FINAL EXAMINATION STUDY GUIDE
Chapter c37: cThe cExperience cof cLoss, cDeath, c& cGrief
1. Discuss cthe cnursing cdiagnoses cpertaining cto cDeath cand cDying. c(Pg. c757)
• Compromised cFamily cCoping
• Death cAnxiety
• Grieving
• Complicated cGrieving
• Risk cfor cComplicated cGrieving
• Hopelessness
• Pain c(Acute cor cChronic)
• Spiritual cDistress
• You ccannot cmake caccurate cnursing cdiagnoses con cthe cbasis cof cjust cone cor ctwo
defining ccharacteristics. cCarefully creview cyour cpts. cassessment cdata cto cconsider cif
more cthan cone cdiagnosis capplies.
2. Discuss cthe ctypes cof cgrieving. c(Pg. c752)
• Normal cGrief: c(uncomplicated cgrief) cis ca ccommon c& cuniversal creaction
ccharacterized cby ccomplex cemotional, ccognitive, csocial, cphysical,
cbehavioral, c&
spiritual cresponses cto closs c& cdeath. cSome cnormal cfeelings cof cgrief care cdisbelief,
cyearning, canger, c& cdepression.
• Anticipatory cGrief: ca cperson cexperiences canticipatory cgrief cbefore cthe cactual closs
cor
death coccurs, cespecially cin csituations cof cprolonged cor cpredicted closs csuch cas
ccaring
for cpatients cdiagnosed cw/ cdementia cor camyotrophic clateral csclerosis c(ALS). cThey
cexperience cintense cresponses cto cgrief c(shock, cdenial, ctearfulness) cbefore cactual
cdeath coccurs c& coften cfeel crelief cwhen cit cfinally chappens.
• Disenfranchised cGrief: cpeople cexperience cdisenfranchised cgrief cwhen ctheir
relationship cto cthe cdeceased cperson cis cnot csocially csanctioned, ccannot cbe cshared
openly, cor cseems cof clesser csignificance. cEx: cdeath cof cformer cspouse, cmarried
clover, cincarcerated cperson, cor cterminated cpregnancy.
• Ambiguous closs: ca ctype cof cdisenfranchised cgrief, ccan coccur cwhen cthe clost cperson
, cis
physically cpresent cbut cnot cpsychologically cavailable. cEx: ccases cof csevere cdementia
cor
brain cinjury. cOther ctimes cperson cis cgone c(after ckidnapping, cprisoner cof cwar,
clost chiker, cor c9/11 cwhere cbody cwas cnever cfound), cbut cthe cgrieving cperson
cmaintains can congoing, cintense cpsychological cattachment, cnever csure cof cthe
creality cof cthe csituation.
• Complicated cGrief: cin ccomplicated cgrief ca cperson chas ca cprolonged cor
csignificantly
difficult ctime cmoving cforward cafter ca closs. cHe/she cexperiences ca cchronic c&
disruptive cyearning cfor cthe cdeceased; chas ctrouble caccepting cdeath c& ctrusting
cothers; cfeels cexcessively cbitter, cemotionally cnumb, cor canxious cabout cthe cfuture.
Specific ctypes cof ccomplicated cgrief:
• Chronic cGrief: ca cperson cw/ cchronic cgrief cexperiences ca cnormal cgrief
cresponse, cexcept cthat cit cextends cfor ca clonger cperiod cof ctime c(years cto
cdecades).
• Exaggerated cGrief: ca cperson cw/ cexaggerated cgrief cresponse coften cexhibits
cself- cdestructive cor cmaladaptive cbehavior, cobsessions, cor cpsychiatric
cdisorder c(risk cfor
, suicide).
• Delayed cGrief: cperson’s cgrief cresponse cis cunusually cdelayed cor cpostponed
cb/c cthe closs cis cso coverwhelming cthat cperson cmust cavoid cthe cfull crealization
cof cthe closs
(frequently ctriggered cby ca csecond closs).
• Masked cGrief: csometimes ca cgrieving cperson cbehaves cin cways cthat cinterfere
cw/ cnormal cfunctioning cbut cis cunaware cthat cthe cdisruptive cbehavior cis ca cresult
cof cthe closs
& cineffective cgrief cresolution. cEx: cclubbing cor cdrinking ctoo cmuch
3. How cdoes cthe cnurse cassist ca cfamily cduring ca cterminal cillness cof ca cfamily
cmember? c (Pg. c763-765)
• Offer cholistic, cfamily-centered csupport, ccompassion, c& ceducation cthat cincorporates
the cuniqueness cof ceach cpt.
• Educate cfamily cmembers cin call csettings cabout cthe csymptoms cthat cthe cpt. cwill
clikely cexperience c& cthe cimplications cfor ccare.
• During cthe cdying cprocess ccheck cfrequently con cfamilies, coffering csupport, cinfo,
c&, cif cappropriate, cencouragement cto ccontinue ctouching c& ctalking cw/ ctheir
cloved cones.
• Nurses care cprimary csource cof cfamily csupport.
• Nurses coften cprovide coptions cthat cfamily cmembers cdo cnot cknow care cavailable c&
care
advocates cfor cpts. c& cfamily cmembers cmaking cdecisions cat cthe cend cof clife cin cthe
cform
of can cadvanced cdirective.
4. Discuss cthe cstages cof cKubler-Ross cfor cdeath cand cdying. c(Pg. c753)
Stages cof cDying: c(can cwork cfor csomeone cexperiencing csomeone celse’s cdeath cor cdeath cof
ctheir cown)
• Denial: cthe cperson ccannot caccept cthe cfact cof cthe closs. cIt cis ca cform cof
cpsychological
protection cfrom ca closs cthat cthe cperson ccannot cyet cbear.
• Anger: cthe cperson cexpresses cresistance cor cintense canger cat cGod, cother cpeople,
cor cthe csituation.
• Bargaining: cthe cperson ccushions c& cpostpones cawareness cof cthe closs cby
ctrying cto cprevent cit cfrom chappening. c(Ex: cpromises)
• Depression: cthe cperson crealizes cthe cfull cimpact cof cthe closs.
• Acceptance: cthe cperson cincorporates cthe closs cinto clife, cand cfinds ca cway cto cmove
forward.
5. Discuss cwhat cHospice ccan caccomplish cfor cpatients cwho care cdying cand ctheir
cfamilies. c(Pg. c761)
• Hospice ccare cis ca cphilosophy c& cmodel cfor cthe ccare cof cterminally cill cpts. c& ctheir
families cat cthe cend cof clife. cIt cgives cpriority cto cmanaging ca cpts. cpain c& cother
symptoms, ccomfort; cquality cof clife; c& cattention cto cphysical, cpsychological, csocial,
c& cspiritual cneeds c& cresources.
• A ctrusting crelationship cbetween cthe chospice cteam c& cthe cpt. c& cfamily.
• Hospice cservices cprovide cbereavement cvisits cmade cby cthe cstaff cafter cthe cdeath cof
cthe
pt. cto chelp cfamily cmove cthrough cthe cgrieving cprocess.
• Home ccare caides coffer chelp cw/ chygienic cneeds, c& ca cnurse cis cavailable cto
ccoordinate c& cmanage csymptom crelief.
• Nurses cproviding chospice ccare cuse ctherapeutic ccommunication, coffer cpsychosocial
, care c& cexpert csymptom cmanagement, cpromote cpt. cdignity c& cself-esteem, cmaintain
ca ccomfortable c& cpeaceful cenvironment, cprovide cspiritual ccomfort c& chope,
cprotect cagainst cabandonment cor cisolation, coffer cfamily csupport, chelp cw/
cethical cdecision cmaking, c& cfacilitate cmourning.
• Hospice cteam cmembers coffer c24-hr caccessibility c& ccoordinate ccare cb/w cthe chome
c&
inpatient csetting.
6. How cdoes cthe cnurse cassist cthe cpatient cto cbe cmore ccomfortable cwith cthe csymptoms
crelated cto cdying? c(Pg. c763)
Symptoms c& cNursing cImplications:
• Pain: ccollaborate cw/ cteam cmembers cto cidentify c& cimplement cappropriate
cpharmacological c& cnonpharmacological cinterventions cto creduce cpain c&
cpromote
comfort.
• Skin cdiscomfort: ckeep cskin cclean, cdry, c& cmoisturized. cMonitor cfor cincontinence.
• Mucous cmembrane cdiscomfort: cprovide coral ccare cat cleast cevery c2-4 chrs. cApply
ca
light cfilm cof clip cbalm cfor cdryness. cApply ctopical canalgesics cto coral clesions cprn.
• Corneal cirritation: coptical clubricants cor cartificial ctears creduce ccorneal cdrying.
• Fatigue: cprovide cperiods cof crest c& ceducate cpt. cabout cenergy cconservation.
• Anxiety: cprovide copportunity cfor cpt. cto cexpress cfeelings cthrough cactive clistening.
Provide ccalm, csupportive cenvironment. cConsult cmembers cof chealth ccare cto
cdetermine
if cpharmacological cinterventions care cappropriate.
• Nausea: cdetermine ccause cof cnausea c& cwork cto creduce cnausea ctriggers csuch cas
cstrong csmells. cAdminister cantiemetics cor cpromotility cagents. cEncourage cpts. cto
clie con ctheir
right cside. cProvide coral ccare cat cleast cevery c2-4 chrs.
• Constipation: cincrease cfiber cin cdiet cif cappropriate. cAdminister cstool csofteners
cor claxatives cif cneeded. cIf cpossible cencourage cincreased cliquid cintake c&
cregular cperiods
of cambulation.
• Diarrhea: cconsult cw/ cmembers cof cthe chealth ccare cto cdetermine cthe ccause c&
cmake cappropriate cchanges. cProvide cskin ccare c& ceasy caccessibility cto cthe
ctoilet cor cbedside
commode.
• Urinary cincontinence: cprovide cgood cskin ccare c& cfrequent
cassessment cfor cincontinent curine. cPlace cFoley ccatheter cas
cappropriate.
• Altered cnutrition: cencourage cpts. cto ceat csmall, cfrequent cmeals cof cpreferred
cfoods. cPts. cshould cnever cbe cforced cto ceat.
• Dehydration: creduce cdiscomfort cfrom cdehydration; cgive cmouth ccare cat cleast
cevery c2-4 chrs; coffer cice cchips cor cmoist ccloth cto clips. cKeep clips c& ctongue
cmoist.
• Ineffective cbreathing cpatterns c(dyspnea, cSOB): ctreat/control cunderlying
ccause. cUse cnonpharmacological cinterventions csuch cas celevating chead cof cbed
cto cpromote
lung cexpansion. cProvide coxygen cas cneeded. cKeeping cair ccool cprovides cease c&
ccomfort cfor cterminal cpt. cUsing cnarcotic cto ctreat ctachypnea cis csometimes
cappropriate.
• Noisy cbreathing c(death crattle): celevate chead cto cfacilitate cpostural cdrainage. cTurn
cpt.
Chapter c37: cThe cExperience cof cLoss, cDeath, c& cGrief
1. Discuss cthe cnursing cdiagnoses cpertaining cto cDeath cand cDying. c(Pg. c757)
• Compromised cFamily cCoping
• Death cAnxiety
• Grieving
• Complicated cGrieving
• Risk cfor cComplicated cGrieving
• Hopelessness
• Pain c(Acute cor cChronic)
• Spiritual cDistress
• You ccannot cmake caccurate cnursing cdiagnoses con cthe cbasis cof cjust cone cor ctwo
defining ccharacteristics. cCarefully creview cyour cpts. cassessment cdata cto cconsider cif
more cthan cone cdiagnosis capplies.
2. Discuss cthe ctypes cof cgrieving. c(Pg. c752)
• Normal cGrief: c(uncomplicated cgrief) cis ca ccommon c& cuniversal creaction
ccharacterized cby ccomplex cemotional, ccognitive, csocial, cphysical,
cbehavioral, c&
spiritual cresponses cto closs c& cdeath. cSome cnormal cfeelings cof cgrief care cdisbelief,
cyearning, canger, c& cdepression.
• Anticipatory cGrief: ca cperson cexperiences canticipatory cgrief cbefore cthe cactual closs
cor
death coccurs, cespecially cin csituations cof cprolonged cor cpredicted closs csuch cas
ccaring
for cpatients cdiagnosed cw/ cdementia cor camyotrophic clateral csclerosis c(ALS). cThey
cexperience cintense cresponses cto cgrief c(shock, cdenial, ctearfulness) cbefore cactual
cdeath coccurs c& coften cfeel crelief cwhen cit cfinally chappens.
• Disenfranchised cGrief: cpeople cexperience cdisenfranchised cgrief cwhen ctheir
relationship cto cthe cdeceased cperson cis cnot csocially csanctioned, ccannot cbe cshared
openly, cor cseems cof clesser csignificance. cEx: cdeath cof cformer cspouse, cmarried
clover, cincarcerated cperson, cor cterminated cpregnancy.
• Ambiguous closs: ca ctype cof cdisenfranchised cgrief, ccan coccur cwhen cthe clost cperson
, cis
physically cpresent cbut cnot cpsychologically cavailable. cEx: ccases cof csevere cdementia
cor
brain cinjury. cOther ctimes cperson cis cgone c(after ckidnapping, cprisoner cof cwar,
clost chiker, cor c9/11 cwhere cbody cwas cnever cfound), cbut cthe cgrieving cperson
cmaintains can congoing, cintense cpsychological cattachment, cnever csure cof cthe
creality cof cthe csituation.
• Complicated cGrief: cin ccomplicated cgrief ca cperson chas ca cprolonged cor
csignificantly
difficult ctime cmoving cforward cafter ca closs. cHe/she cexperiences ca cchronic c&
disruptive cyearning cfor cthe cdeceased; chas ctrouble caccepting cdeath c& ctrusting
cothers; cfeels cexcessively cbitter, cemotionally cnumb, cor canxious cabout cthe cfuture.
Specific ctypes cof ccomplicated cgrief:
• Chronic cGrief: ca cperson cw/ cchronic cgrief cexperiences ca cnormal cgrief
cresponse, cexcept cthat cit cextends cfor ca clonger cperiod cof ctime c(years cto
cdecades).
• Exaggerated cGrief: ca cperson cw/ cexaggerated cgrief cresponse coften cexhibits
cself- cdestructive cor cmaladaptive cbehavior, cobsessions, cor cpsychiatric
cdisorder c(risk cfor
, suicide).
• Delayed cGrief: cperson’s cgrief cresponse cis cunusually cdelayed cor cpostponed
cb/c cthe closs cis cso coverwhelming cthat cperson cmust cavoid cthe cfull crealization
cof cthe closs
(frequently ctriggered cby ca csecond closs).
• Masked cGrief: csometimes ca cgrieving cperson cbehaves cin cways cthat cinterfere
cw/ cnormal cfunctioning cbut cis cunaware cthat cthe cdisruptive cbehavior cis ca cresult
cof cthe closs
& cineffective cgrief cresolution. cEx: cclubbing cor cdrinking ctoo cmuch
3. How cdoes cthe cnurse cassist ca cfamily cduring ca cterminal cillness cof ca cfamily
cmember? c (Pg. c763-765)
• Offer cholistic, cfamily-centered csupport, ccompassion, c& ceducation cthat cincorporates
the cuniqueness cof ceach cpt.
• Educate cfamily cmembers cin call csettings cabout cthe csymptoms cthat cthe cpt. cwill
clikely cexperience c& cthe cimplications cfor ccare.
• During cthe cdying cprocess ccheck cfrequently con cfamilies, coffering csupport, cinfo,
c&, cif cappropriate, cencouragement cto ccontinue ctouching c& ctalking cw/ ctheir
cloved cones.
• Nurses care cprimary csource cof cfamily csupport.
• Nurses coften cprovide coptions cthat cfamily cmembers cdo cnot cknow care cavailable c&
care
advocates cfor cpts. c& cfamily cmembers cmaking cdecisions cat cthe cend cof clife cin cthe
cform
of can cadvanced cdirective.
4. Discuss cthe cstages cof cKubler-Ross cfor cdeath cand cdying. c(Pg. c753)
Stages cof cDying: c(can cwork cfor csomeone cexperiencing csomeone celse’s cdeath cor cdeath cof
ctheir cown)
• Denial: cthe cperson ccannot caccept cthe cfact cof cthe closs. cIt cis ca cform cof
cpsychological
protection cfrom ca closs cthat cthe cperson ccannot cyet cbear.
• Anger: cthe cperson cexpresses cresistance cor cintense canger cat cGod, cother cpeople,
cor cthe csituation.
• Bargaining: cthe cperson ccushions c& cpostpones cawareness cof cthe closs cby
ctrying cto cprevent cit cfrom chappening. c(Ex: cpromises)
• Depression: cthe cperson crealizes cthe cfull cimpact cof cthe closs.
• Acceptance: cthe cperson cincorporates cthe closs cinto clife, cand cfinds ca cway cto cmove
forward.
5. Discuss cwhat cHospice ccan caccomplish cfor cpatients cwho care cdying cand ctheir
cfamilies. c(Pg. c761)
• Hospice ccare cis ca cphilosophy c& cmodel cfor cthe ccare cof cterminally cill cpts. c& ctheir
families cat cthe cend cof clife. cIt cgives cpriority cto cmanaging ca cpts. cpain c& cother
symptoms, ccomfort; cquality cof clife; c& cattention cto cphysical, cpsychological, csocial,
c& cspiritual cneeds c& cresources.
• A ctrusting crelationship cbetween cthe chospice cteam c& cthe cpt. c& cfamily.
• Hospice cservices cprovide cbereavement cvisits cmade cby cthe cstaff cafter cthe cdeath cof
cthe
pt. cto chelp cfamily cmove cthrough cthe cgrieving cprocess.
• Home ccare caides coffer chelp cw/ chygienic cneeds, c& ca cnurse cis cavailable cto
ccoordinate c& cmanage csymptom crelief.
• Nurses cproviding chospice ccare cuse ctherapeutic ccommunication, coffer cpsychosocial
, care c& cexpert csymptom cmanagement, cpromote cpt. cdignity c& cself-esteem, cmaintain
ca ccomfortable c& cpeaceful cenvironment, cprovide cspiritual ccomfort c& chope,
cprotect cagainst cabandonment cor cisolation, coffer cfamily csupport, chelp cw/
cethical cdecision cmaking, c& cfacilitate cmourning.
• Hospice cteam cmembers coffer c24-hr caccessibility c& ccoordinate ccare cb/w cthe chome
c&
inpatient csetting.
6. How cdoes cthe cnurse cassist cthe cpatient cto cbe cmore ccomfortable cwith cthe csymptoms
crelated cto cdying? c(Pg. c763)
Symptoms c& cNursing cImplications:
• Pain: ccollaborate cw/ cteam cmembers cto cidentify c& cimplement cappropriate
cpharmacological c& cnonpharmacological cinterventions cto creduce cpain c&
cpromote
comfort.
• Skin cdiscomfort: ckeep cskin cclean, cdry, c& cmoisturized. cMonitor cfor cincontinence.
• Mucous cmembrane cdiscomfort: cprovide coral ccare cat cleast cevery c2-4 chrs. cApply
ca
light cfilm cof clip cbalm cfor cdryness. cApply ctopical canalgesics cto coral clesions cprn.
• Corneal cirritation: coptical clubricants cor cartificial ctears creduce ccorneal cdrying.
• Fatigue: cprovide cperiods cof crest c& ceducate cpt. cabout cenergy cconservation.
• Anxiety: cprovide copportunity cfor cpt. cto cexpress cfeelings cthrough cactive clistening.
Provide ccalm, csupportive cenvironment. cConsult cmembers cof chealth ccare cto
cdetermine
if cpharmacological cinterventions care cappropriate.
• Nausea: cdetermine ccause cof cnausea c& cwork cto creduce cnausea ctriggers csuch cas
cstrong csmells. cAdminister cantiemetics cor cpromotility cagents. cEncourage cpts. cto
clie con ctheir
right cside. cProvide coral ccare cat cleast cevery c2-4 chrs.
• Constipation: cincrease cfiber cin cdiet cif cappropriate. cAdminister cstool csofteners
cor claxatives cif cneeded. cIf cpossible cencourage cincreased cliquid cintake c&
cregular cperiods
of cambulation.
• Diarrhea: cconsult cw/ cmembers cof cthe chealth ccare cto cdetermine cthe ccause c&
cmake cappropriate cchanges. cProvide cskin ccare c& ceasy caccessibility cto cthe
ctoilet cor cbedside
commode.
• Urinary cincontinence: cprovide cgood cskin ccare c& cfrequent
cassessment cfor cincontinent curine. cPlace cFoley ccatheter cas
cappropriate.
• Altered cnutrition: cencourage cpts. cto ceat csmall, cfrequent cmeals cof cpreferred
cfoods. cPts. cshould cnever cbe cforced cto ceat.
• Dehydration: creduce cdiscomfort cfrom cdehydration; cgive cmouth ccare cat cleast
cevery c2-4 chrs; coffer cice cchips cor cmoist ccloth cto clips. cKeep clips c& ctongue
cmoist.
• Ineffective cbreathing cpatterns c(dyspnea, cSOB): ctreat/control cunderlying
ccause. cUse cnonpharmacological cinterventions csuch cas celevating chead cof cbed
cto cpromote
lung cexpansion. cProvide coxygen cas cneeded. cKeeping cair ccool cprovides cease c&
ccomfort cfor cterminal cpt. cUsing cnarcotic cto ctreat ctachypnea cis csometimes
cappropriate.
• Noisy cbreathing c(death crattle): celevate chead cto cfacilitate cpostural cdrainage. cTurn
cpt.
