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NURS 201 Exam 2 North Idaho College
2024 - 2025 Spring Fundamentals Of
Nursing (Ch. 14, 24, 25, 26, 28, & 39)
Guaranteed Pass
Chp 14 cyanosis around mouth circumoral cyanosis patches of varying colors of pallor and cyanosis mottling assisting with patient suicide euthanasia response to loss grief
arranging care for a patient to allow caregivers time away fromstrain and worry respite occurs when children become caregivers for their parents role reversal Care that tends to overcomedisease and promote recovery
- Can be provided in a hospital orat home
- Physician and nursing care, surgery, medications and therapies Curative care Aggressively planned comfort care.
- Patient does not have to be "actively dying" (chronic condition that can't be cured)
Advanced Directives:
- Directs your family and medical staff on whether to continue, withhold, or withdraw life-sustaining systems if you are incapable of expressing this yourself due to an incurable and terminal condition or persistent vegetative state Living Will Advanced Directives:
- A legal document that allows someone to make decisions on behalf of another person, such as their medical, legal, or financial decisions. Durable Power of Attorney (DPOA) No Not Resuscitate (DNR)
- A prescription written by a ___________ in the event of cardiac or respiratory failure, includes instructions on CPR wishes of the
patient provider The Dying Process: Physical Changes Prior to _________:
- BP decreases and P increases (and later P decreases)
- Diaphoresis (sweating) and clamminess
- Circumoral cyanosis and cyanotic nail beds
- Respiratory changes: apnea or Cheyne-Stokes; "death rattle"
- Restlessness
- Pallor or mottling of the ski
- Unresponsiveness toward the end
- Incontinence Death Beneficial Effects of __________
- Decreased urine output, resulting in less incontinence and less need for toileting
Non-Pharmacological Treatments for ____________
- Cool compresses to face and forehead
- Deep breathing
- Meditation/ prayer
- Music therapy
- Relaxation techniques
- Small sips of clear liquids at patient's temperature preference Nausea Non-Pharmacological Treatments for ___________
- Fan to move the air
- Meditation/prayer
- Positioning
- Pursed-lip breathing
- Relaxation techniques Dyspnea
Post Mortem care
- Notify physician
- Document time respiration and heartbeat ceased
- Ask family if they would like to assist with bathing or care
- Bathe body and remove tubes (if autopsy not performed)
- Leave dressings intact
- Apply clean gown and linens
- Close patient's eyes and mouth
- Place hands across chest
- Elevate head of bed slightly
- Insert dentures
- Remain with the family to provide support
- Allow loved ones as much time as they need
Categories of Loss:
- Includes (1) injuries (e.g., when a limb is amputated), (2) removal of an organ (e.g., hysterectomy), and (3) loss of function (e.g., loss of mobility). physical loss Categories of Loss:
- Challenge our belief system.
- Also known as perceived losses, they are commonly seen in the areas of sexuality, control, fairness, meaning, and trust. psychological losses Categories of Loss:
- Actual losses of objects that are important to the person because of their cost or sentimental value (e.g., jewelry, a home).
- These losses can be brought about by theft, destruction, or disasters such as floods and fire.
external losses Categories of Loss:
- Another term for perceived or psychological loss. internal loss Categories of Loss:
- Include physical losses such as the loss of body organs, limbs, and body functions and/or body disfigurement.
- Psychological and perceived losses in this category include aspects of one's personality, developmental change (as in the aging process), loss of hopes and dreams, and loss of faith. loss of aspects of self Categories of Loss:
Actions associated with grief (e.g., crying, wearing black clothing). These processes are normal and natural responses to a loss. Mourning The period of mourning and adjustment after a loss. Bereavement Theories of Grief:
- Uncomplicated grief is universal, has a clear onset and a predictable course (with modifications), and does not require treatment.
- Shock & Disbelief
- Developing Awareness of the Loss
- Restitution and Recovery George Engel (1961)—Three Stages of Grief
Theories of Grief:
- This attachment theory describes the reaction to strong emotional bonds that have been developed. The individual must work through each process to avoid complicated grief. Grief is a mature way of dealing with loss of attachment.
- Shock and Numbness
- Yearning and Searching
- Disorganization and Despair
- Reorganization John Bowlby (1982)—Phases of Grief Theories of Grief:
- Identified the three Processes of Grieving described next.
- Avoidance
- Confrontation
- Accomodation
- Individuals may not experience every stage or go through the stages in a linear order. In addition, individuals may experience two or more stages simultaneously.
- Denial
- Anger Bargaining
- Depression
- Acceptance Elisabeth Kübler-Ross (1969)—Five Stages of Grieving Theories of Grief:
- Mourning is cyclical. People oscillate between two dimensions in bereavement.
- Loss-oriented response
- Restoration-oriented response Margaret Stroebe and Henk Schut (1999)—Dual-Process Model
Theories of Grief:
- Bereavement, or grief, is never fully resolved. ■ The focus should not be on individuals obtaining closure but instead on finding new ways to relate to the deceased. ■ The griever maintains a continuing bond with the deceased.
- Negotiate and renegotiate Dennis Klass, Phyllis R. Silverman, and Steven L. Nickman (1996)—Continuing Bond Model Theories of Grief:
- Grieving is a process of meaning reconstruction.
- The best predictor of a positive adaptation to loss is the ability to find meaning in the loss.
- The unsuccessful struggle to find meaning can result in complicated forms of grief. Robert Neimeyer (1999)—Meaning-Making Model of Grief/Bereavement
- Confusion anddelirium
- Constipation
- Diarrhea
- Dyspnea
- Fatigue
- Nausea and vomiting
- Pain
- Sadness/depression
- Weakness End-Stage Physiological Stages of Dying:
- The dying person begins to withdraw from the world and people.
- Sleep increases; it becomes difficult for the body to digest food, especially meat; and appetite and food intake decrease.
- Liquids are preferred.
- Anorexia and the resulting ketosis may be protective because they can diminish pain and increase the person's sense of well- being. 1 - 3 months before death Physiological Stages of Dying:
- A host of physical changes indicates the body is beginning to lose its ability to maintain itself.
- Cardiovascular deterioration brings reduced blood pressure, changes in pulse and skin color (e.g., a yellowish pallor), and extreme pallor of the extremities.
- Temperature fluctuates, and perspiration increases. Respiratory rate may increase or decrease.
- During sleep, the dying person may experience brief periods of apnea.
- Congestion may cause a rattling sound and/or a nonproductive cough. 1 - 2 weeks before death
