Complicated Grieving- fails to grieve, guilt, low self esteem, negatively impacts relationships

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1 Grief Nursing Diagnoses Uncomplicated Grieving normal grief Complicated Grieving- fails to grieve, guilt, low self esteem, negatively impacts relationships Risk for Complicated Grieving traumatic loss, strained relationship at time of loss, sudden loss Disenfranchised Grief not socially supported or acknowledged Anticipatory grief before a loss occurs but is anticipated

2 Death and Dying Dr. Elisabeth Kubler Ross 5 stages of dealing with death D A B D A Denial Anger Bargain Depression Acceptance Also applies to other losses Box 17-2 pg. 353

3 Physiological Stages of Dying 1-3 months prior Sleeps Withdraws from social interactions/family Decreased appetite & difficulty eating solid foods may prefer liquids 1 2 weeks prior Decreased BP / pallor of extremities / temp fluctuates/ resp. may increase or decrease may experience dyspnea or periods of apnea

4 Stages of Dying Impending Death Days to hours prior Changes in circulation Decreased pulse / weak pulse Cool, mottled extremities Decreased urine output Changes in muscle tone Relaxation of facial muscles (jaw sags) Constipation, incontinence Difficulty swallowing / speaking Respiratory changes Rapid or slow / irregular - Cheyne Stokes respirations Death rattle congestion in back of throat Sensory changes Blurred vision/visual hallucinations

5 End - of- Life Care Hospice A way of caring not a setting Quality of life as important as length Death with dignity Face death with those you love around you Symptom management Grief services to those left behind Reimbursement from Medicare, Medicaid, some HMOs

6 End of Life care - cont Relieve loneliness Provide for physical comfort palliative care Provide psychological/spiritual support Support family

7 Pronouncing Death ANA nurse may pronounce death Only physician can certify death and sign the death certificate

8 Care of Body following death Body will Cool (algor mortis) Stiffen (rigor mortis) Discolor (livor mortis)

9 Advance Directives The Patient Self-Determination Act (1991) requires healthcare institutions to provide written information to patients about their right to refuse treatment and give advance directives Living will DNR Box 17-3 page 356 Healthcare Proxy Organ transplantation