N10 Unit 3 (Final) PDF

Chapter 33 20 ATI 6 Skin Wound Care PPT A wound is a disruption of normal anatomical structure and function that results form pathological processes beginning internally or externally to the involved organs Wound healing is complex Location, severity, extend of the injury and layers involved all aff...

Chapter 33 20 ATI 6 Skin Wound Care PPT A wound is a disruption of normal anatomical structure and function that results form pathological processes beginning internally or externally to the involved organs Wound healing is complex Location, severity, extend of the injury and layers involved all affect the wound healing process Goal is to promote tissue repair and regeneration to restore skin 4 phases of wound healing: Hemostasis day 1 to 3 Inflammation day 3 to 20 Proliferation or granulation week 1 to 6 Remodeling or maturation week 6 to 2 years Types of healing Primary - edges of clean incision line remain closed - granulation/ regeneration Secondary - gap between the edges - connective tissue/scar formation Tertiary - delayed primary closure..surgical wound left open 3-5 days to allow edema or infection to reduce then sutures/ stapled closed Many factors influence healing- hypovolemia, hypotension, vasoconstriction, edema, age Bariatric patients - Reduced tissue perfusion in adipose tissue - Increased tension at the suture line - Excess skin folded keeps wound moist and allows bacteria to accumulate - Associated medical conditions Complications of wound healing - Wound dehiscence - Wound evisceration - infection/ bioburden - Fistules and sinus tract/ tunneling - Undermining - Pain - Hemorrhage Bacteria burden → contamination → colonization → critical colonization → infection CDC surgical site infection is defined as infection in surgical site within 30 days if no implanted, 90 days after when a device is involved - Superficial site infection involves skin and subq tissue at incision - Deep incisional involved deep soft tissue (muscle/ fascia layers) - organ/ space involved anything deeper than fascia/ muscles and or organs Degrees of tissue destruction - Superficial - Partial thickness - Full thickness - Subq Color of wound Pressure ulcers and staging Suspected deep tissue injury Stage 1 Stage 2 Stage 3 Stage 4 Intertriginous dermatitis ITD vs Incontinent associated dermatitis IAD TD is skin breakdown that occurs in skin folds due to increased moisture and increased pocketing of bacteria. IAD is incontinence associated dermatitis related to repeated exposure of stool or urine that causes the skin to break down. Skin tears 1-3 - No skin loss - Partial flap loss - Total flap loss MARSI - MARSI is Medical Adhesive Related Skin Injury. Skin stripping could occur due to an IV dressing that is taken off and torn or stripped of the underlying skin. Tension Injury or Blister could occur when a cervical spine collar is placed too tightly on a patient and thus causes breakdown of the skin. Irritant contact dermatitis occurs due to irritation of the skin by a chemical substance like frequent handwashing that leads to dryness and dermatitis. Allergic contact dermatitis occurs when someone comes into contact with something that they are allergic to like peanut substances that results in dermatitis and other systemic allergic symptoms. Folliculitis is inflammation of the hair follicles due to something such as shaving which causes irritation to ingrown hairs. Maceration is the breakdown of skin due to prolonged exposure to moisture. A common cause of maceration occurs when a dressing becomes oversaturated with exudate and is not changed for a long time resulting in breakdown of the underlying skin Documenting wound progress Location, type of wound, type of tissue, type of wound base, size (length and width), presence of any exudate,peri wound area, pain Selecting dressing KEY If dry then moisten it If exudate then absorb it Id dead tissue (eschar/slough) then debride it Cold vs heat therapy MEASURES (measure trauma, eliminate tunnels, tracts and undermining, assess and manage exudate, support defenses, use nontoxic wound cleaners, remove infection, debris, and necrotic tissue, environment maintenance, surrounding tissue protection) CHAPTER 20 - DOCUMENTATION Documentation is written or electronic legal record of all pertinent interaction with pt including data related to assessing, diagnosing, planing, implementing, and evaluating Facilitated quality, evidence based care Serves as financial and legal record Help in clinical research and supports decision analysis Effective documentation is consistent with professional and agency standards, complete, accurate, concise, factual, organized and timely, legally prudent, confidential - Elements: content, timing, format, accountability, confidentiality Patient confidentiality Pts have the right to see and have copy of health records, update health records, get a list of disclosures, request a restriction on certain uses or disclosures, choose how to receive health information Methods of documentation include EHRs, source oriented records such is progress notes/ narrative notes, problem oriented medical records like SOAP notes, PIE charting, focus charting, charting by exception Many different formats for nursing documentation - Initial nursing assessment, care place - Progress notes, flow sheet and graphic records - Acuity records - Discharge and transfer summary CHAPTER 37 NUTRITION Specific biochemical substances used by the body for growth, development, activity, reproduction, lactation, health maintenance, recovery from illness or injury - Essential - not synthesized in the body or are made in insufficient amounts - must be provided by diet, supplements - Macro - supply energy and build tissue, carbs, fats, proteins - Micro - regulate and control body processes, vitamins and minerals Nutrients that supply energy - carbs protein, lipids Nutrients that regulate body processes - vitamins, minerals, water Energy is divided or obtained from foods consumes, measure in kilocalories - Only carbs, protein, and fat provide calories Total daily energy expenditure - all of the calorie used to perform physical activity, maintain metabolism, and digest, absorb, and metabolize food Total daily energy intake - total calories for each food item eaten Daily intake and expenditure differences determine stable weight, weight loss, weight gain BMR is energy (number of calories) required to fuel the involuntary activities of the body at rest after 12 hours, energy needed to sustain metabolic activities of cells and tissues Males have a higher BMR b. Larger muscle mass Factors the increase BMR include infection, growth, fever, emotional tension, extreme environmental temperatures, hormones Factors that decrease BMR includes aging, prolonged fasting, sleep Body mass index is the ratio of eight in kg to height in meters squared and provides an estimate of body fat - Can be used as an initial assessment for nutritional status and can provide and estimation of relative risk for disease that can occur with more body, heart disease, T2D - May be inaccurate for certain groups of people - Overweight and obesity defined differently for children and teens Location of where body fat is deposited is thought to be an important and reliable indicator of disease risk - Central abdominal obesity poses greater risk, waist circumference is a good indicator of abdominal fat - Risk increases with waist measurement of 40 inches or more for men and 35 inches or more for women - Waist to hip ratio tool used to identify central obesity Carbohydrates are sugars and starches, organic compounds composed of carbon, hydrogen, and oxygen and serves as the structural framework of plants, lactose is only animal source - Most abundant and least expensive source of calories in the world - Intake often correlated to income, as income increase, carbohydrate intake decreases - Classifies as simple or complex sugars, and primary function is to supply energy - Recommended as 45% to 60% of total calories for adults - More easily and quickly digested than protein and fat - 90% of carb intake is ingests and converted to glucose for transport though the blood - Efficient fault that certain tissues rely on almost exclusively for energy (nervous system) - Transported from the GI tract, through the portal vein, to the liver where glucose is stored and regulated entry into the body - Cells oxidize glucose to provide energy, carbon dioxide and water Protein is a vital component of every living cell, required for the formation of all body structures. More than 1,000 different proteins are made in the body by combining various of the 22 amino acids - Complete protein contains sufficient essential amino acids to support growth while incomplete protein are deficient in one or more essential amino acids - Animal protein is complete, plant proteins are incomplete except soy and quinoa - Dietary protein is broken down into amino acids by pancreatic enzymes in the small intestine which are absorbed and transported to the liver - In the liver, amino acids are recombined into new proteins or are released for use by tissues and cells - Protein tissues are in a constant state of flux. Tissues are continuously being broken down and replaced - RDA for adults is 0.8 g/kg of body weight, 10% to 35% total calorie intake Fats are insoluble in water and blood, composed of carbon, hydrogen, and oxygen containing mixtures of saturated and unsaturated fatty acids digested mostly in the small intestine - 95% of lipids in diet are triglycerides - Most animal fats are saturated - Most vegetable fats are unsaturated - Bile which is secreted by the liver and stored in the gallbladder, emulsifies fat so that pancreatic enzymes can break it down for digestion - Fats are absorbed into lymphatic circulation and transported to the liver - Most concentrated source of energy in the diet - Recommended intake, limit saturated fats to less than 10% of daily calories and intake of trans fats to as low as possible Vitamins are organic compounds needed by the body in small amounts, do not provide calories and are needed for metabolism of carbs, protein, and fat - Fresh foods are higher in vitamins than processed - Water soluble - C, B complex vitamins, not stored in body - Fat soluble - A, D, E, K - Absorbed through the intestinal wall directly into bloodstream Minerals are organisms elements found in all body fluids and tissues contained in the ash that remains after digests and functions to provide structures in the body, others help regulate body processes - Macrominerals include calcium, phosphorus (phosphates), sulfur (sulfate), sodium, chloride, potassium, and magnesium - Microminerals include iron, zinc, manganese,chromium, copper, molybdenum, selenium, fluoride,and iodine Water accounts for 50% to 60% of adults total weight, ⅔ of water is contained within the cells (ICF) and the remained of body water is ECF, and body fluids like plasma and interstitial fluid - Provides fluid medium necessary for all chemical reactions in the body - Acts as a solvent and aids digestion, absorption, circulation, and excretion Adequate diet selection tools: dietary guidelines for americans, dietary reference intakes, recommended dietary allowance, my plate, food labeling Factors affecting nutrition - Physiologic and physical factors: stage of development, state of health, medications - Social determinants of health: economic stability, health care access and quality, social and community context, education access and quality, neighborhood and built environments - Culture, religion, food ideology, and learned aversions Developmental considerations include growth, activity level, age related changes - Nutritional needs level off in adulthood - Fewer calories required in adulthood because of decrease in BMR - Other factors include sex, state of health, alcohol use disorder meds, megadoses of nutrition supplements Food choice can be influenced by social determinants of health, religion, meaning of food, culture Anorexia is lack of appetite A nutritional assessment includes history takes (dietary, medical, socioeconomic date), physical assessments, and biochemical data (protein status, body vitamin, mineral and trace element status) Nursing intervention include teaching, monitoring nutritional status, stimulating appetite, assisting with eating, providing oral nutrition, providing long term nutritional support Dysphagia is a common problem of older adults and as many as 60% of nursing home residents demonstrate clinical evidence of dysphagia - A serious problem with negative sequelae including weight loss, malnutrition, dehydration, aspiration pneumonia, even death Short term nutritional support includes using the NG or NI route - Confirming NG feeding tube placement is important - Radiographic exams, assessment of aspirate pH - Measurement of tube length and tube marking - Carbon dioxide monitoring - Confirming nasointestinal tube placement For long term nutritional support an enterostomal tube may be placed through an opening created into the stomach (gastrostomy) or into the jejunum (jejunostomy) - Gastrostomy is the preferred route to deliver enteral nutrition in the patient who is comatose - Placement of a tube into the stomach can be accomplished by a surgeon or gastroenterologist via a percutaneous endoscopic gastrostomy (PEG) or a surgically (open or laparoscopically) placed gastrostomy tube For enteral feeding, must monitor for tolerance (gastric residual volume), promote patient safety, monitor for complications, provide comfort measures, provide education Parenteral nutrition contains the 3 primary components necessary to maintain nutrition - amino acids, carbs, lipids - Highly concentrated, hypertonic nutrient solution - Given IV through a central venous access device - Monitor for and prevent complications Complication of TPN include insertion problems, infection and sepsis, metabolic alteration, fluid, electrolyte and acid base imbalances, phlebitis, hyperlipidemia, liver and gallbladder disease CHAPTER 38 URINARY ELIMINATION Know terms Anuria - 24 hours output is less than 50 ml Dysuria - painful or difficult urination Frequency - increases incidence of voiding Glycosuria - presence of glucose in the urine Nocturia - awakening at night to urinate Oliguria - 24 hours output it sles than 400 ml Polyuria - excessive output of urine (diuresis) Pyuria - pus in urine Urgency - strong desire to void Urinary incontinence - involuntary loss of urine Kidneys and ureters maintain composition and volume of body fluids as well as filter and crete blood constituents not needs and retain those are are needed Excrete waste product through urine, regulated through nephrons and empty into the kidneys Bladder is a smooth muscle sac innervated by ANS that serves as a temporary reservoir for urine composed of three layers of muscle tissue called detrusor muscle - Sphincter guards opening between urinary bladder and urethra - Urethra conveys urine from bladder to exterior of body Urethra conveys urine from the bladder to the exterior - Male functions in excretory and reproductive system - No portion of female urethra is external to body Factors affecting micturition include development consideration, food and fluid intake, psychological variables, activity and muscle tone, pathological conditions, meds - Developmental consideration - Children - toilet training 2 to 3 years old, enuresis - Effects of aging include nocturia, increased frequency, urine retention and stasis, voluntary control affects by physical problems Renal problems can be associated with UTIs, diabetes, hypertension, gout Medications - Diuretics - prevent reabsorption of water and certain electrolytes in tubules, pale yellow - Cholinergic meds- stimulate contraction of detrusor muscles, producing urination - Analgesic and tranquilizers - suppress CNS, diminish effectiveness of neural reflex - Anticoagulants - red urine - Pyridium - orange to orange red - Antidepressant amitriptyline or B complex vitamins - green or blue green urine - Levodopa - brown or black urine Affects color too Nursing history involves asking - Usual patterns of urinary elimination and any recent changes - Aids to elimination - Present of past occurrence of voiding difficulties - Presence of urinary diversion As the problem: incontinence, pattern alteration, urinary retention As the etiology: anxiety, caregiver role strain, risk for infection Physical assessment of urinary functioning - Kidneys: Palpation of the kidneys is usually performed by an advanced health care practitioner as part of a more detailed assessment - Urinary bladder: Palpate and percuss the bladder or use a bedside scanner - Urethral orifice: Inspect for signs of infection,discharge, or odor - Skin: Assess for color, texture, turgor, and excretion of wastes - Urine: Assess for color, odor, clarity, and sediment Promoting normal urination involves maintaining normal voiding habits, promoting fluid intake, strengthening muscle tone, assisting with toileting To measure urine output: - Ask the patient to void into a bedpan, urinal, or specimen container in bed or bathroom - Put on gloves. Pour urine into the appropriate measuring device - Place the calibrated container on a flat surface and read at eye level - Note amount of urine voided and record on the appropriate form - Discard urine in the toilet unless a specimen is needed. If a specimen is required, pour the urine into an appropriate specimen container Caring for patient urinary needs - Proavtively encourage patients to void every 2-4 hours !! - Do everything to get patient up to toilet or bedside commode Types of urinary incontinence: - Transient: appears suddenly and lasts 6 months or less - Mixed: urine loss with features of two or more types of incontinence - Overflow: overdistention and overflow of bladder - Functional: caused by factors outside the urinary tract - Reflex: emptying of the bladder without sensation of need to void - Total: continuous, unpredictable loss of urine - Stress: involuntary loss of urine related to an increase in intra-abdominal pressure Condom catheter, purewick Factors to consider with use of absorbent products - Functional disability of the patient - Type and severity of incontinence - Gender - Availability of caregivers - Failure with previous treatment programs - Patient preference If must use adults diapers MUST check patient every 2 hours and frequently change then to reduce skin breakdown Patients at risk for UTIs are - Sexually active people with female genitalia - People who use diaphragms for contraception - Postmenopausal people - People with indwelling urinary catheter in place - People with diabetes - Older adults Reasons for catheterization include - Relieving acute urinary retention - Obtaining a sterile urine specimen when patient is unable to void voluntarily - Accurate measurement of urinary output in critically ill patients - Assisting in healing open sacral or perineal wounds in incontinent patients - Emptying the bladder before, during, or after select surgical procedures and before certain diagnostic examinations - Providing improved comfort for end of life care - Prolonged patient immobilization Types of catheters: intermittent urethral, indwelling urethral - three way catheter for continuous bladder irrigation, suprapubic catheter ADD PICTURES CHAPTER 29 BOWEL ELIMINATION Stomach - stores food, secrete digestive fluids Small intestine - secretes enzymes that digest proteins and carbs, digestion of food and absorption into the bloodstream Large intestine - primary organs of bowel elimination and extends to the ileocecal valve to the anus, other functions include: absorption of water, formation of feces, expulsion of feces from the body Process of peristalsis - Under control of the nervous system with contractions occurring every 3 to 12 minutes - Mass peristalsis sweeps occur one to four times each 24 hours period - ⅓ to ½ of food waste is excreted in stool within 24 hours Bowel elimination can be influenced by developmental consideration, daily patterns, food and liquid, lifestyle, medications, activity and muscle tone… Constipation foods: cheese, lean meat, eggs, pasta Food with laxative effects: fruits and vegetables, bran, chocolate, alcohol, coffee Gas producing foods: onions, cabbage, beans, cauliflower Medications - Opioids can cause constipation - Antacids decrease GI motility - Antibiotics, magnesium, and metformin can cause diarrhea Nursing history involves asking about usual patterns, aids, recent changes, problems, and presence of bowel diversion Patient outcomes for normal bowel elimination - Soft formed bowel movements without discomfort - Able to explain the relationship between bowel elimination and dietary fiber, fluid intake, and exercise - Able to relate the importance of seeking medical evaluation if changes in stool color or consistency persist - Skin integrity maintained Key points: - If unable to get out of bed then ensure proper position and high fowler position - Always get patient up to bathroom or BSC when possible Individuals at high risk for constipation: - Those one bed rest or with decreased mobility - Those taking constipating medications - Those with reduced fluid or bulk in their diet - Those depressed - Those with CNS disease or local lesions that cause pain while defecating Promoting regular bowel movements include timing, positioning, privacy, hygiene, nutrition, exercise: abdominal setting and thigh strengthening Methods of emptying the colon of feces include enemas, rectal suppositories, oral intestinal lavage, digital removal of stool - Enemas include cleansing, retention: oil, carminative, medicated), hypotonic large volume, and hypertonic small volume Measures for patients with diarrhea include answer bells immediately, remove the cause when possible, if risk for impaction hold antidiarrheal medications for further evaluation, give special care to the region around the anus Managing bowel incontinence: - Note when continue is most likely to occur and assist patient to the bathroom or commode - Keep the skin clean and dry - Change bed linens and clothing as necessary - Bowel training programs - Indwelling rectal tube - External anal pouch Preventing food poisoning: - Take items requiring refrigeration him immediately - Wash hands and surfaces often - Use separate cutting boards for foods - Thoroughly wash fruits and vegetables before eating - Do not wash meat, poultry, or eggs to prevent spreading microorganisms to sink and other kitchen surfaces - Never use raw eggs in any form - Do no eat seafood raw or undercooked Use a food thermometer to ensure cooking food to safe internal temperature Keep food hot after cooking, maintain safe temperature of 140 or above Give only pasteurized fruit juices to small children Stool collective involves: medical aspect technique is imperative, hand hygiene and gloves, do not contaminate outside of container with stool, obtain still and package. Label, and transport accordion to agency policy Nasogastric tubes are inserted to decompress or drain the stomach of fluid or unwanted stomach content, also used to allow the GI tract to rest before or after abdominal surgery to promote healing, inserted to monitor GI bleeding Colostomy care: - Keep the patient as free of odors as possible, empty the appliance frequently - Inspect the patient’s stoma regularly - Keep the skin around the stoma site clean and dry - Measure intake and output - Explain each aspect of care to the patients and self care role - Encourage patient to care for and loos at ostomy - Provide support for physical, psychological, and social activities Colostomy diet include: - Low fiber food during the first 6-8 weeks - Drink at least 2.5 quarts of fluids, preferably water - Avoid food that cause blockage like nuts, corn, popcorn, coconuts, mushrooms, stingy vegetable, food with skins and casings - Avoid food that may cause gas or produce odor - Add food that may help thicken stool like bananas, cheese, pasta, rice, yogurt, applesauce, potatoes CHAPTER 6 ETHICS AND VALUES Value is a personal belief about the worth of a given idea, attitude custom, or object that sets standards that influence behavior - To resolve ethical dilemmas one needs to distinguish among values, facts, and opinions Ethics is a systematic study of principles of right and wrong conduct, virtue and vice, and good and evil as they relate to conduct and human flourishing The ability to be ethical, to make decision and to act in an ethical manner, begins in childhood and develops gradually - Morals usually refers to personal or communal standards of right and wrong Out values reflect what we believe is important, are intimately related to and direct out ethical conduct Nursing ethics is a formal study of ethical issues that arise in the practice of nursing and analysis used by nursed to make ethical judgments Utilitarian: the rightness or wrongness of an action depends on the consequences of the action Deontologic: an action is right or wrong based on a rule, independent of its consequences Basic terms of health ethics: - Autonomy - respect rights of patients to make healthcare decisions - Nonmaleficence - avoid causing harm - Beneficence - benefit the patient - Justice - give each his or her due and act fairly - Fidelity - keep promises - Veracity, accountability, privacy, confidentiality Ethical conduct is practice based on professional standards of ethical conduct as well as professional values - Nurses should cultivate the virtues of nursing, understands ethical theories that dictate and justify professional conduct - Be familiar with codes of ethics for nurses and standards for professional nursing conduct Professional nursing code of ethics: - A set of guiding principles that all member of a profession accept and helps settle question about behavior and practice Ethical dilemma - two or more clear moral principles apply but support mutually inconsistent courses of action Ethics distress - occurs when the nurse knows that right thing to fo but either personal or institutional factors make it difficult to follow the correct course of action Processing and ethical dilemma involves: - Ask if this is an ethical dilemma - Gather all relevant information - Clarify values - Verbalize the problem - Identify possible causes of action - Negotiate the outcome - Evaluate the action Four functions of ethics committees: education, policy making, case review, consultation, occasional research Resources to address moral distress include moral distress education project and nurse leader Developing moral resilience - Resilience is the capacity to recover, adapt, and even thrive in the face of threats, misfortune, or challenging times and moral resilience is the developed capacity to response well to morally distressing experiences and to emerge strong CHAPTER 7 LEGAL A law is a a standard or rule of conduct established and enforced by government designed to protect the right of the public Public law - government is directly involves and regulates relationships between individuals and governments Private law - civil law that regulates relationships among individuals Criminal law - concerns state and federal criminal statutes and defines criminal actions Nurse practice act is the most important law affecting nursing practice - Lists the violations that can result in disciplinary actions against a nurse - Defines scope and practice to prevent untrained or unlicensed people from practicing Standards are developed by ANA and are legal guidelines for defining nursing practice and identifying the minimum acceptable nursing care Professional and legal regulation of nursing practice - Credentialing - refers to ways in which professional competence is ensured and maintained - Accreditation - process by which an educational program is evaluated and recognized for meeting criteria - Licensure - process by which a state determines that a candidate meets certain minimum requirements to practice - Certification - process by which a person who has met certain criteria establishes by a non governmental association is granted recognition in a specific practice area Reasoning for suspending/ revoking license: drug and alcohol abuse, fraud, deceptive practice, criminal acts, age if affects physical or mental impairments… - Involves notice of investigation, fair and impartial hearing, proper decision based on substantial evidence - Best defense is early legal counseling, character and expert witnesses, thorough preparation for all proceedings Crime is a wrong against a person or the persons property as well as the public - Misdemeanor is punishable by fines or less than 1 year imprisonment - Felony is punishable by imprisonment for more than 1 year Tort is a wrong committed by a personal against another person or that person's property tried in civil court, can be intentional or unintentional - Intentional: assault, battery, false imprisonment, defamation of character, invasion of privacy, fraud - Unintentional: negligence, malpractice SPECIFIC LAWS Informed consent involves sign consent fro and informed consent is agreement to allow cased based on full disclosure of risk, benefits, alternatives, and consequences of refusal - Must be signs by nurse and witness that patient voluntarily gave consent, signature is authentics, and patients appears to be competent to give consent - Involves disclosure, comprehension, competence, voluntariness Patient protection and affordable care act - obama care for increased access to care, affordable health care coverage - Mental health parity act under PPACA strengthens mental health services Americans with disabilities act ADA protects rights of people with physical or mental disabilities Emergency medical treatment and active labor act EMTALA states that when a patient presents to an emergency department they must be treat, once stabilized they can be transferred to another facility Health insurance portability and accountability act HIPAA Patient self determination act PSDA required health care institution to provide written information concerning rights under state law to make decisions Advance directive Guardians and conservators DNAR/DNA - do not attempt resuscitation/ do not resuscitate No code - no CPR POLST - pink slip on refrigerated sign by physician stating patients treatment wishes Risk management and quality assurance is a system of ensuring appropriate nursing care that attempts to identify potential hazards and eliminate them before harm occurs CHAPTER 44 GRIEF AND LOSS Uniform definition of death cat: An individual who has sustained either (1) irreversible cessation of circulatory and respiratory functions or (2) irreversible cessation of all functions of the entire the brain, including the brainstem, is dead. Medical criteria used to certify a death: cessation of breathing, no response to deep painful stimuli, and lack of reflexes (such as the gag or corneal reflex) and spontaneous movement, flat encephalogram. Types of loss - Actual loss can be recognized by others - Perceived loss is felt by personal but intangible ot others - Physical loss versus psychological loss - Maturation loss is experienced as a result of natural developmental process - Situational loss is experiences as a result of an unpredictable event - Anticipatory loss is loss that has not yet taken place Grief is internal emotional reaction to loss Bereavement is the state of grieving from the loss of a loved one Mourning is the action and expression of grief including the symbols and ceremonies the make up outward expression of grief Dysfunctional grief is abnormal or distorted and may be either unresolved or inhibited Kubler ross model: denial, anger, bargaining, depression, acceptance Loss response model and cyclic loss - search for meaning, engaging emotion, adaptation Chronic sorrow nursing theory - events can trigger sorrow Advanced care planning: - Advanced directives include living wills and durable power of attorney that indicate: - Who will make decisions for the patients in case the patient is unable - The kind of medical treatment the patients wants or doesn’t want - How comfortable the patient wants to be and how wants to be treated by others - What the patients wants loved once to know Palliative care involves taking care of the whole person and views dying as natural and personal - The goal of palliative care is to give patients with life threatening illnesses the best quality of life they can by the aggressive management of symptoms - It is offered simultaneously with life prolonging or stabilizing care for those living with chronic conditions Hospice is care provided for people with limited life expectancy often in their home usually with a prognosis of 6 months of less to live Needs of dying patients: - Physiological needs - physical needs, such as hygiene, pain control, nutritional needs - Psychological need - patients needs control over fear of the unknown, pain, separation, leaving loved ones, loss of dignity - Needs for intimacy - Spiritual needs - patients needs meaning and purpose, love and relatedness, forgiveness and hope 6 C’s for promoting a good death - Care - Control - Composure - Communication - Continuity - Closure Postmortem care of the body involves: preparing the body for discharge, placing the body in anatomic position, replace dressings, removes tubes (unless need autopsy), place ID tags on body, follow local law if patient died of communicable disease