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Chapter 25,33, & 40


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[Front]


Loss
[Back]


person suffers when any aspect of self is no longer available to a person

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Chapter 25,33, & 40 - Details

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Loss
Person suffers when any aspect of self is no longer available to a person
Death
Cessation of life
Grief
Is a pattern of physical & emotional responses to bereavement, separation or loss
Grief work
The process of adapting to & mourning a loss is called grief work
Mortality
The condition of being subject to death
Grief therapy
Mental health treatment aimed at helping a patient deal with the pain of loss; a program that assists the bereaved to cope with a loss
Maturational loss
A loss that results from normal life transitions
Situational loss
Is defined as a loss that occurs suddenly in response to a specific external event, such as the sudden death of a loved one
Bereavement
Is defined as a common depressed reaction to the death of a loved one
Mourning
Reaction activated by a person to assist in overcoming a great personal loss; refers to culturally defined patterns for the expression of grief
Morbidity
An illness or an abnormal condition
Anticipatory grief
To expect, await, or prepare for the loss of a family member or significant other
Bereavement overload
Before an initial loss is resolved, it is compounded by an additional loss
Thanatology
The study of dying & death
Unresolved grief
Signifies some disturbance of the normal progression toward resolution
Complicated grieving
Unresolved grief or complicated mourning
Dysfunctional grieving
Is a delayed or exaggerated response to a perceived, actual, or potential loss
Euthanasia
Greek for "easy death"; a deliberate action taken with the purpose of shortening life to end suffering or to carry out the wishes of a terminally ill patient
Do not resuscitate (DNR)
Decision made by the patient, the family, & the health care providers is best
Allow natural death
Is more acceptable to parents; acknowledges that one is going to die & forgoes aggressive treatment
Living wills
Advance directive; legal document drawn up by a person who is not yet near death detailing how much medical care he or she wants to receive if terminally ill
Durable power of attorney
Advance directives signed & notarized document that appoints another person to make decisions in the event of the patient's incompetence; usually completed by the patient while still able to function
Advance directives
Signed & witnessed documents that provide specific instructions for health care treatment if a person is unable to make these decisions personally at the time they are needed
Palliative care
The prevention, relief, reduction, or soothing of symptoms of disease or disorders without affecting a cure
Inquest
Is a legal inquiry into the cause or the manner of a death
Autopay
Examination performed after a person's death to confirm or determine the cause of death
Postmortem care
Care for the patient's body after death
Mortician
Person trained in the care of the dead
Chronologic age
Age of an individual expressed as time elapsed since birth
Baby Boomers
More than 70 million people born between 1946 & 1964
Ageism
A term that describes prejudice against older adults
Sandwich generation
One group of caregivers; individuals who are faced with caring for their parents while also caring for their own children
Respite care
Refers to the provision of care by non family members with a goal of allowing the primary caregivers the opportunity for relief from the stressors & strains imposed by caring for an ill or debilitated family members
Pruritus
Dryness & itching of the skin
Shearing forces
Forces that can injure small blood vessels by sliding on a rough surface
Dysphagia
Difficulty swallowing; may arise from many possible causes, including a stroke or other neurologic dysfunction, local trauma, & obstruction with a tumor
Nocturne
Urination at night
Orthostatic hypotension
A drop in blood pressure when moving from a lying to sitting position
Claudication
Cramping pain in the calves
Kyphosis
An abnormal curve in the upper spine sometimes called "dowager's hump"
Presbyopia
Farsightedness resulting in loss of elasticity of the lens of the eye
Presbycusis
Is a sensorineural hearing loss & the most common form of loss in older adults
Dementia
As a progressive impairment of intellectual (cognitive) function
Akinesia
An abnormal state of motor & psychic hypoactivity
Ataxia
Impaired ability to coordinate movement
Hemiplegia
Paralysis of one side of the body
Dysarthria
Difficult, poorly articulated speech, resulting from interference in the control over the muscles of speech
Aphasia
An abnormal neurologic condition in which language function is a defective or absent because of an injury to certain areas of the cerebral cortex
Terminal illness
A disease in an advanced stage with no known cure & poor prognosis
Hospices
Vary in structure & organization
Curative treatment
Is aggressive care in which the goal & intent are curing the disease & prolonging life at all cost
Primary caregiver
A person who assumes ongoing responsibility for health maintenance & therapy for the illness
Holistic
Pertaining to the total patient care in which the physical, emotional, social, economic, & spiritual needs of the patient are considered
Interdisciplinary team
A multi professional health team whose members work together in caring for a terminally ill patient
Psychosocial
A combination of psychological & social factors
Pain assessment
Evaluation of the factors that alleviate or exacerbate a patient's pain
Adjuvant
Additional drug or treatment that is added to assist in the action of the primary pain treatment
Titrated
Slowly increased to the level at which the drug is therapeutic
Cachexia
Malnutrition marked by weakness & emaciation
Life is
A series of losses & gains
Coping mechanisms determine?
A person's ability to face & accept loss
All losses have the possibility of?
Triggering the grief process
Another way to look at loss
Is to classify it as maturational, situational, or both
Loss of a job can lead to?
A loss of self esteem
Early experiences with loss
Can prepare the individual to deal with loss throughout the life cycle
Grief is
The subjective response to actual or anticipated loss; it is natural, normal, & universal part of human experience
Mourning patterns include
Funerals, wakes, memorials, black dress, & defined time of social withdrawal
What does grief involve?
Thoughts, feelings, & behaviors
What can the grieving process lead to?
Resolution of the hurt & the reestablishment of one's life
Grief is not an episode
It is a process that sometimes one that goes on forever
Unresolved grief
Can result if the tasks are not completed & can lead to incomplete relationships & health problems
Out-of-sequence death
The sudden death of someone who is not "supposed to die"; most difficult grief to bear
Sense of presence
Nonthreatening, comforting perception that the decease is present; vary from general feelings of the deceased's presence to actual sensory experiences
When is sense of presence known to occur?
During the grief process & beyond
Grief attack
The involuntary & unexpected reappearance of emotions & behaviors associated with grief
Kubler-Ross's Stages of Dying
Denial, Anger, Bargaining, Depression, & Acceptance
Kubler-Ross's anger stage
Individual resist the loss & may strike out at everyone & everything
Kubler-Ross's bargaining stage
Individual postpones awareness of reality o the loss & may try to deal in a subtle or overt way as though the loss can be prevented
Worden's Task of Mourning
Accept reality of loss, work through pain & grief, adjust to environment in which deceased is missing, & emotionally relocate the deceased & moved on with life
Adjust to environment in which the deceased is missing:
Individual does not realize full impact of loss for at least 3 months. At this point, friends stop calling & person feels that loneliness; individual must take on roles that were filled by the deceased
What is the nurses's role during stages of grief & dying?
To assess grieving behaviors, recognize the influence of grief on behavior, & provide empathic support
Why is it important that grief work is not overstated?
Bereavement is a state of great risk physically, emotionally, & socially
Infant to 5 yr; concept of death
Does not understand, sense of separation forms basis for later understanding of loss & death, believes death is reversible, temporary departure & sleep
5 to 9; conception of death
Understand death is final, believes death can be avoided, associated death with aggression or violence, believes wishes or unrelated actions can be responsible for death
9 to 12; conception of death
Understands death as the inevitable end of life, begins to understand own mortality, expressed as interest in afterlife or as fear of death
12 to 18; conception of death
Fears a lingering death; may fantasize that death can be defied, acting out defiance through reckless behaviors
18 to 45: conception of death
Has attitude toward death influenced by religious & cultural beliefs
45 to 65; conception of death
Accepts own mortality, encounters death of parents & some peers, experiences peaks of death anxiety, which diminishes with emotional well being
65+; conception of death
Fears prolonged illness, encounters death of family & peers, sees death as having multiple meanings (ex: freedom from pain, reunion with already deceased family members)
What are the 4 types of complicated grief?
Chronic, Delayed, Exaggerated, & Masked
Chronic grief
Active acute mourning characterized by normal grief reactions that do not decrease but persist over long periods; people verbalize an inability to "get past" the grief
Delayed grief
Characterized by normal grief reactions that are suppressed or postponed; avoids pain of loss; active grieving is held back only to resurface later only to response to a trivial loss or upset
Exaggerated grief
People become overwhelmed with grief & cannot function; can cause alcoholism, substance abuse or suicide
Masked grief
Not aware that behaviors that interfere with normal functioning are a result of their loss
What does the thanatologic philosophy dictate?
That family members are free to choose if & when they wish to be with the patient who is dying, Do not raise a barrier because of "visitation hours"
When hope is relinquished
Death follows rapidly