| 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 |
| One protective impulse when dealing with sudden death | is to blame someone |
| 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 |
| The universality of the loss experience often leads nurses who work with the terminally ill & the bereaved | to develop a heightened empathy for their patients |
| 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" |
| What is difficult to maintain during the dying process? | hope |
| When hope is relinquished | death follows rapidly |
| What is the 10th leading cause of death for all ages? | suicide |
| passive euthanasia | is permitting the death of a patient by withholding treatment that may extend life, such as medication, life-support systems, or feeding tubes |
| active euthanasia | is assisting in such a death |
| What are the 3 most crucial needs for a dying patient? | love & affection, control of pain, & preservation of dignity & self-worth |
| What are signs of decreased oxygenation? | restlessness & pick or pull at the bed linens |
| Change in vitals when a patient is dying? | slow, weak, thready pulse, lowered blood pressure & rapid, shallow irregular or abnormally slow respirations, cool & clammy skin |
| Cheyne-Stokes respirations | the pulse becomes increasingly weaker & more rapid |
| death rattle | mucous collects in the throat & noisy respirations are heard |
| When a death is the result of an accident? | an inquest is held into the circumstances of the accident to determine any blame |
| coroner | a public official, not necessarily a health care provider appointed or elected to inquire into cause of death |
| medical examiner | a trained health care provider & usually has advanced education in pathology or forensic medicine |
| agency policy | dictated who is responsible for reporting deaths t the coroner or medical examiner |
| jews; care of the body after death | dying person may want tp have a deathbed confession or desire prayers; usually oppose autopsy but consider organ donation; body must not be left unattended until burial; a family member may remain present |
| buddhists; care of the body after death | ordained monk or nun should care for the dying person; after death body should be covered by cotton sheet; body should not be touched; eyes & mouth should not be closed; no noise talking or crying allowed; organ donation is an individual choice |
| What primarily nursing interventions are required to use for physically caring of dying patients? | providing adequate nutrition, elimination, hygiene, safety, & comfort is a nursing priority |
| Baby boomers recognize | the importance of nutrition, exercise, & a healthy environment |
| Biologic common theories of aging | programmed aging, genetic factors, immunologic, free radical, and wear&tear |
| Psychosocial common theories of aging | Erikson's developmental stages, disengagement theory, exchange theory, activity theory, & continuity theory |
| programmed aging | cells in the body can reproduce only 40 to 60 times; aging takes place when more & more cells no longer have the capacity to regenerate themselves |
| genetic factors | people inherit a genetic program that determines their specific life expectancy |
| wear and tear | cells of the body wear out from internal & external stress, including chemical damage, trauma, or dysfunction of body systems, & buildup of waste products |
| Nursing interventions to decrease nocturia are? | limiting fluids in the evening, giving diuretic medications in the morning, & preventing fall hazards when an individual has to get up to urinate |
| What does a history of nocturia or an increase # of episodes necessitates? | medical evaluation, because it may indicate an infection & the need for medical treatment |
| In an older adult what is the first sign of infection? | confusion |
| Another related problem for many older adults is? | incontinence |
| Cardiovascular changes with aging involve? | loss of structural elasticity; chambers are less elastic, the heart takes longer to contract & the chambers longer to fill |
| With aging, the resting heart rate tends to? | Decrease |
| Arteriosclerosis | develops as the blood vessels become less elastic & are lined with deposits, resulting in increased blood pressure |
| The leading cause death in United States? | is heart disease |
| The history of the patient with a fracture usually includes | trauma followed by immediate local pain |
| Significant percentage of patients with hip fractures | die within 1 year after injury |
| osteoporosis | a systemic skeletal disease; one of the most common conditions in older woman |
| Age related changes in vision include? | presbyopia, or narrowing of the peripheral field of vision, decreased ability to focus on near objects or react to light |
| Most common cause of dementia | alzheimer's disease |
| early stage of alzheimer's | memory loss & difficulty focusing attention |
| middle stage of alzheimer's | difficulty with language, object recognition & judgement |
| final stage of alzheimer's | urinary & fecal incontinence, inability to ambulate or provide self-care, & inability to communicate |
| Leading cause of accidental death in individuals older than 65 | falls |
