NUR103 FINALE EXAM
Categorizing loss:
Actual
Anticipatory
Prolonged Grief Disorder
Disenfranchized
Actual LossA loss that can be recognized by others (ex: death, loss of
a limb, divorce, job loss).
Anticipatory LossExperiencing grief before the actual loss occurs (ex:
terminal illness).
Prolonged Grief DisorderGrief that is intense, persistent, and lasts
longer than expected; interferes with daily functioning.
Disenfranchised LossA loss that is not socially acknowledged or
supported (ex: miscarriage, loss of a pet, secret relationship).
Kulber-Ross 5 Stages of Grief
1. Denial- Avoiding or refusing to accept the loss.Example: “This can’t
be happening.”
2. Anger- Feeling frustration or resentment about the loss.Example:
“Why did this happen to us?”
3. Bargaining- Trying to make deals or promises to change the
outcome.Example: “If I do everything right, maybe things will
change.”
4. Depression- Deep sadness and withdrawal as the reality sets
in.Example: “I don’t know how to go on.”
5. Acceptance- Acknowledging the loss and beginning to move
forward.Example: “I’m at peace with what happened.”
,Worden's 4 Tasks of Mourning
1. Accept the reality of the loss. The person acknowledges the loss is
real.
2. Process the pain of grief. The person experiences and works
through emotional pain.
3. Adjust to a world without the deceased. The person adapts to
new roles, routines, and environment.
4. Find an enduring connection while moving forward. The person
maintains a healthy, lasting bond while continuing life.
The NURSE technique
Name: Identify what the client just stated
Understand: Demonstrate understanding by recognizing the client's
feelings and providing an opportunity for the client to discuss their
feelings
Respect: Voice your respect for the client
Support: Inform the client that you are available to him or her
Explore: Ask open-ended questions to extend the conversation and
provide a more detailed expression of the client's feelings and beliefs
Children and Conceps of Death:
Infants and toddlers
Preschool children
School-age children
Adolescents
Infants and toddlers- <6 months no conept of death, affected more
by change in lifestyle. They react to anciety and sadness
,Preschool children- death seen as sleep (temporary and reversible).
May see punishment for thoughts
School-age children- still see as punishemtn for bad thoughts, see
death as devil, understand logical eplanation of death, uncooperative
and may feel guilt
(9-10 yrs old have an adult concept of death)
Adolescents- mature understanding of death and have the most
difficulty in coping with death. They worry about physical changes
more than prognosis and may feel loneliness and guilt
What is the terminal phase of a client's life?
Activiely dying or imminent death
Physiological Alterations at End of Life:
Breathing and Respirations
Pain
Breathing and Respirations - dyspnea (SOB), retention of secretions
in the respiratory tract (death rattle). Cheyne-Stokes - irregular
respiratory rate with several quick breaths followed by periods of
apnea.
Pain- experience by nearly 60% of older adult hospice clients who
have cancer. It occurs as a result of nerve injury, organs being
stretched and compressed, and/or bone pain.
Physiological Alterations at End of Life:
Temperature
Mottling
Vision and Hearing
, Temperature- The ability to regulate body temperature diminishes,
leading to fluctuations in temperature for the client, who may
experience both increased and decreased body heat.
Mottling typically occurs hours or days before death, resulting in the
upper and lower extremities feeling cool to the touch. This happens
due to the heart's inability to pump blood effectively, which leads to
decreased blood perfusion throughout the body.
Vision and Hearing- clients may experience hallunications or report
hearing and seeing those who have already died
Vital sign changes during end of life care
Temperature
May increase (fever) or decrease
Skin becomes cool, clammy; extremities cold/mottled
Pulse
Weak, thready
Irregular
May be fast initially, then slows as death approaches
Respirations
Irregular, shallow, have SOB
Cheyne-Stokes pattern and congested or “wet” breathing sounds
Blood Pressure
Progressive decrease
Narrowing pulse pressure
Hard to palpate peripheral pulses as circulation fails
What is the nursing process?
Categorizing loss:
Actual
Anticipatory
Prolonged Grief Disorder
Disenfranchized
Actual LossA loss that can be recognized by others (ex: death, loss of
a limb, divorce, job loss).
Anticipatory LossExperiencing grief before the actual loss occurs (ex:
terminal illness).
Prolonged Grief DisorderGrief that is intense, persistent, and lasts
longer than expected; interferes with daily functioning.
Disenfranchised LossA loss that is not socially acknowledged or
supported (ex: miscarriage, loss of a pet, secret relationship).
Kulber-Ross 5 Stages of Grief
1. Denial- Avoiding or refusing to accept the loss.Example: “This can’t
be happening.”
2. Anger- Feeling frustration or resentment about the loss.Example:
“Why did this happen to us?”
3. Bargaining- Trying to make deals or promises to change the
outcome.Example: “If I do everything right, maybe things will
change.”
4. Depression- Deep sadness and withdrawal as the reality sets
in.Example: “I don’t know how to go on.”
5. Acceptance- Acknowledging the loss and beginning to move
forward.Example: “I’m at peace with what happened.”
,Worden's 4 Tasks of Mourning
1. Accept the reality of the loss. The person acknowledges the loss is
real.
2. Process the pain of grief. The person experiences and works
through emotional pain.
3. Adjust to a world without the deceased. The person adapts to
new roles, routines, and environment.
4. Find an enduring connection while moving forward. The person
maintains a healthy, lasting bond while continuing life.
The NURSE technique
Name: Identify what the client just stated
Understand: Demonstrate understanding by recognizing the client's
feelings and providing an opportunity for the client to discuss their
feelings
Respect: Voice your respect for the client
Support: Inform the client that you are available to him or her
Explore: Ask open-ended questions to extend the conversation and
provide a more detailed expression of the client's feelings and beliefs
Children and Conceps of Death:
Infants and toddlers
Preschool children
School-age children
Adolescents
Infants and toddlers- <6 months no conept of death, affected more
by change in lifestyle. They react to anciety and sadness
,Preschool children- death seen as sleep (temporary and reversible).
May see punishment for thoughts
School-age children- still see as punishemtn for bad thoughts, see
death as devil, understand logical eplanation of death, uncooperative
and may feel guilt
(9-10 yrs old have an adult concept of death)
Adolescents- mature understanding of death and have the most
difficulty in coping with death. They worry about physical changes
more than prognosis and may feel loneliness and guilt
What is the terminal phase of a client's life?
Activiely dying or imminent death
Physiological Alterations at End of Life:
Breathing and Respirations
Pain
Breathing and Respirations - dyspnea (SOB), retention of secretions
in the respiratory tract (death rattle). Cheyne-Stokes - irregular
respiratory rate with several quick breaths followed by periods of
apnea.
Pain- experience by nearly 60% of older adult hospice clients who
have cancer. It occurs as a result of nerve injury, organs being
stretched and compressed, and/or bone pain.
Physiological Alterations at End of Life:
Temperature
Mottling
Vision and Hearing
, Temperature- The ability to regulate body temperature diminishes,
leading to fluctuations in temperature for the client, who may
experience both increased and decreased body heat.
Mottling typically occurs hours or days before death, resulting in the
upper and lower extremities feeling cool to the touch. This happens
due to the heart's inability to pump blood effectively, which leads to
decreased blood perfusion throughout the body.
Vision and Hearing- clients may experience hallunications or report
hearing and seeing those who have already died
Vital sign changes during end of life care
Temperature
May increase (fever) or decrease
Skin becomes cool, clammy; extremities cold/mottled
Pulse
Weak, thready
Irregular
May be fast initially, then slows as death approaches
Respirations
Irregular, shallow, have SOB
Cheyne-Stokes pattern and congested or “wet” breathing sounds
Blood Pressure
Progressive decrease
Narrowing pulse pressure
Hard to palpate peripheral pulses as circulation fails
What is the nursing process?
