Grief and Death Awareness Quiz

Grief, Loss, and Dying

• Signs of Imminent Death: Decreased circulation (mottled skin, cold extremities, low blood pressure and heart rate), dry mucous membranes and airway congestion, periods of apnea, decreased consciousness and possible hallucinations, muscle weakness/relaxation and incontinence, decreased urinary output. Hearing is the last sense lost.

• Grief Stages: Denial (refusal to accept the situation), anger, bargaining (attempting to make a deal), depression (common and needs to be addressed), acceptance.

• Depression Signs: Disheveled appearance, crying, statements of despair ("what's the point?"). Suicidal ideation is NOT normal and requires immediate attention.

• Expected Grief Symptoms: Sleep disturbances (insomnia), nausea, headaches, poor concentration.

• Ethical Considerations: All patients have the right to dignified end-of-life care.

• Hospice Care: Goal is patient comfort (pain management is priority). Interventions include ensuring adequate pain medication, frequent turning and repositioning to prevent skin breakdown, and addressing spiritual needs (with assessment and support for preferences, including chaplain referral).

• Palliative Care: Improves quality of life at ANY stage of life, for chronic debilitating conditions. Focuses on pain management, coordinating care, and addressing physical, psychological, and spiritual needs to reduce family burden.

• Family Support: Allow family involvement in postmortem care if desired. Express condolences and permit private time with the body.

Postmortem Care

• Cleanse the body.
• Remove tubes and drains (unless autopsy).
• Keep dentures in place.
• Place pads on wrists and ankles, tied with gauze.
• Apply ID tag and bag the body.
• Transport supine in a gown to the morgue.
• Personal belongings given directly to the family.

Delegation

• Nurse Practice Act (NPA): Guides appropriate delegation for Registered Nurses (RNs) and Licensed Practical Nurses (LPNs).

• Delegatable Tasks (UAP): Vital signs, blood glucose checks, repositioning, basic comfort measures (not requiring assessment).

• Non-Delegatable Tasks (UAP): Medication administration, any task requiring patient assessment (including documentation). Pain interventions beyond turning and repositioning.

Health and Illness

• Cultural Competence: Respect and incorporate cultural values into care, even if not initially familiar. Family-oriented cultures, foods, and practices should be accommodated. Respect for sensitivities regarding cultural values is crucial.

Infection

• Transmission Precautions: Always wear gloves upon entry and remove before exit. Use surgical masks (not N95s) for droplet/airborne transport, contact precautions (gown & gloves, dedicated equipment), droplet precaution (mask & gloves), and airborne precautions (N95 mask, negative pressure room, gloves, and appropriate PPE).

• Localized vs. Systemic Infection: Localized inflammation (mild erythema, tenderness, swelling) is a normal immune response. Systemic infection (fever, tachycardia, lymph node swelling, high white blood cell count) indicates a broader problem needing evaluation.

Hygiene

• Oral Care: Necessary for all patients. Raise the head of the bed fully while providing oral care to prevent aspiration. For unconscious patients, turn to their side and lower the head of the bed. Do not force patient's mouth open.

• Foot and Nail Care: Important for patients with diabetes and peripheral vascular disease, due to decreased sensation and circulation.

Comfort

• Nonpharmacological Methods: Encourage cold/warm therapy (with barrier), distraction, humor, massage, and relaxation techniques, and consult sources that provide information related to specific non-pharmacological comfort strategies.

• Pain Assessment: Use OLDCARTS (onset, location, duration, characteristic, aggravating factors, relieving factors, severity, and time) or PQRST (provocative/palliative, quality, region/radiation, severity, and time).

Sensory

• Sensory Impairment: Assess for deficits (especially in elderly). Use simple language and a compassionate approach. Skin breakdown may be an indication of circulation problem or sensory impairment.

Mobility

• General Considerations: Promote safe mobility to prevent immobility complications. Use non-skid footwear, gait/transfer belts, proper positioning for assistance, and allow dangling before standing. Avoid having patients hold onto IV poles for support.

• Fall Risk Assessment: Confusion is a major fall risk factor and should be thoroughly assessed. Monitor patients who need the bathroom frequently for possible needs for assistance.

• Logrolling: Ensure the patient's spine is in a straight line during movement (requires assistance of at least 3 people).

• Canes and Walkers: Proper use and adjustments are vital for safety.

Nutrition

• Constipation: Address through increased water, fiber-rich foods, and exercise.

• Nasogastric Tubes: Flush with 30-45 mL water, maintain proper temperature for formulas, and promptly address abnormal findings (e.g., coffee-ground output).

• Modified Diets: Understand implications for constipation or other dietary restrictions based on the mechanical soft (soft, chopped) diet providing limited fiber.

Oxygenation

• Hypoxia: Symptoms include cyanosis, rapid breathing, low blood oxygen saturation, fast heart rate. Assess mucous membranes (especially for dark-skinned individuals).

• Oxygen Delivery: Nasal cannula (preferred initial choice), non-rebreather mask for severe hypoxia/respiratory distress.

• Pneumonia: Discharge criteria (stabilized SpO2, clear lung sounds, ability to cough & breathe deeply).

• Tuberculin Skin Test: Interpretation of results to determine tuberculosis.

Medication Administration

• Side Effects: Unintentional effects, usually predictable, can occur from any medication dose and may cause harm. Differentiated from adverse effects, which are more severe, unpredictable, and can lead to drug discontinuation. Ensure safety when patients take multiple medications (OTC and prescriptions).

Rest and Sleep

• REM Sleep: Mental and emotional restoration occurs.

• Sleep Deprivation: Daytime drowsiness and poor concentration are signs.

• Sleep Hygiene: Avoid caffeine before bed, exercise earlier in the day, proper use of the bed, avoid daytime naps, promoting calming activities and environmental controls before bedtime.

Stress and Coping

• Stress Reduction: Guided imagery, relaxation techniques.

• Coping Strategies: Balanced diet, exercise, meditation (versus maladaptive coping like substance use).

• General Adaptation Syndrome (GAS) Stages: Exhaustion phase (decreased blood pressure, increased pulse, and rapid breathing) from ineffective coping mechanisms.

• Chronic Stress Manifestations: Headaches, memory problems, constipation, fatigue, illness (e.g., high blood pressure and stroke), and weakened immune response.

Elimination

• Urinary Tract Infection (UTI): Symptoms (dysuria, frequency, urgency) are distinct from symptoms that may indicate sexually transmitted infections, such as genital discharge.

Sensory, Mobility & Nutrition are connected

Explore the key symptoms and stages associated with the process of dying and the grieving experience. This quiz covers various aspects, such as negotiation in grief, sensory experiences near death, and behavioral signs of grief. Test your knowledge on these important topics relating to grief and end-of-life awareness.