NSG6440 EXAM PRACTICE REVIEWS

NSG6440 EXAM PRACTICE REVIEWS loss - CORRECT ANSWER-- when someone or something of value experiences change or is no longer accessible resulting in diminishing or removing of its value - Actual, perceived, anticipatory, necessary, developmental/maturational, and situational actual loss - CORRECT ANSWER-recognizable to the person experiencing the loss, as well as, other people. Ex. Death perceived loss - CORRECT ANSWER-recognizable to the person experiencing the loss but not to others. Ex. older person with loss of independence anticipatory loss - CORRECT ANSWER-when a person experiences a reaction to a loss that has not occurred yet. Ex. terminal news (grieve a loss that hasnt happened yet) necessary loss - CORRECT ANSWER-related to changes in the life cycle that can be anticipated. developmental/maturational - CORRECT ANSWER-normal and expected, results from the normal life transitions in the developmental process of life, and results in the development of coping skills situational loss - CORRECT ANSWER-unanticipated and caused by an external event. Ex. car wreck grief - CORRECT ANSWER-- an internal emotional reaction to loss - types: normal/uncomplicated, dysfunctional/complicated, anticipatory, and disenfranchised mourning - CORRECT ANSWER-the act of grieving and expressing grief bereavement - CORRECT ANSWER-a state of grieving due to loss of a loved one normal/uncomplicated grief - CORRECT ANSWER-- may show negative emotions, such as hopelessness, withdrawal, anger, resentment, and guilt - over time, negative emotions will change to acceptance with some acceptance being evident by 6 months following the loss - may demonstrate physical complaints, such as fatigue, change in sleeping patterns, chest pain, palpitations, nausea and headaches dysfunctional/complicated grief - CORRECT ANSWER-- also called unresolved grief - difficult progression through the usual grief stages - usually prolonged grieving - may result in decreased self esteem, intense guilt, and suicidal ideation - physical complaints may continue for an extended time anticipatory grief - CORRECT ANSWER-the process of starting to "let go" of someone or something before the loss actually occurs disenfranchised grief - CORRECT ANSWER-grief for a loss that may not be considered socially acceptable or cannot be shared publicly (Ex. someone dying from overdose, do not want to share due to societal views on this) Kübler-Ross' Theory of Grief - CORRECT ANSWER-- denial: difficult accepting the reality of a diagnosis, death or loss. "I'm fine", "I cant believe they are gone" - anger: expression of rage and hostility. Ex. blaming god - bargaining: an attempt to negotiate for a cure or more time. Ex trying to bargain with god - depression: a period of grief - acceptance: the reality of the diagnosis, death, or loss is accepted, and the person feels tranquil and prepared and moves forward to prepare for the future palliative care - CORRECT ANSWER-- appropriate for anyone with a chronic disease or illness regardless of disease stage - interventions focus on the relief of physical, emotional, spiritual, and psychosocial aspects of the disease - provided by an interdisciplinary team - goal is to aggressively manage symptoms in clients with life-threatening illnesses to provide the best quality of life possible hospice - CORRECT ANSWER-- comprehensive care provided in various settings, often the home - indicated when a client's life expectancy is 6 months or less - focus of treatment is shifted from a cure to quality of life and support for the client as they approach death - indications for referral may include: comorbidities, poor performance status, poor nutrition, declining cognition, previous hospital admissions, pressure injuries, and advanced age advance care planning - CORRECT ANSWER-planning for care in the future at times when the client is unable to make his/her own decisions advance directives - CORRECT ANSWER-legal documents giving direction for situations at end of life health care proxy - CORRECT ANSWER-also called a durable power of attorney for healthcare; appoints a medical decision maker for times when the client is unable to make his/her own decisions living will - CORRECT ANSWER-gives the client's wishes for medical treatment POLST - CORRECT ANSWER-- physician's orders for life sustaining treatment - document with medical orders indicating patient wishes regarding commonly used treatments in medical crises health care surrogate - CORRECT ANSWER-- medical decision maker not chosen by the patient (MPOA or durable power of attorney for healthcare are chosen by the pt has decision making capacity) - designated by hospital social worker when a patient is unable to make his/her own decisions and a previously completed medical power of attorney document is not available - signed by a healthcare provider - form follows the law and attempts to name the person who is closest to the pt and knows the pt's wishes the best as their medical decision maker - forms vary by facility do not resuscitate (DNR) - CORRECT ANSWER-- may be called No Code, No CPR, or Allow Natural Death (AND) Comfort Measures Only - CORRECT ANSWER-- goal of treatment is allowing the patient to die in a comfortable and dignified way as there is no longer an indication for further life-sustaining treatment - these DO NOT mean "do nothing" and should not be presented to patients and families as such. It is a transition from aggressive curative treatment to aggressive sx management end of life care orders - CORRECT ANSWER-- DNR, DNI, Comfort Measures Only, terminal weaning - orders not to use certain other life-sustaining treatments may also be present based on healthcare provider discussion with the client regarding their wishes, such as ventilator support, dialysis, artificial hydration and nutrition, blood transfusions, medications- such as antibiotics and/or surgery terminal weaning - CORRECT ANSWER-mechanical ventilation is gradually withdrawn from a client with a terminal illness or condition that is not reversible and a poor prognosis