1. Loss, Grief, Death
Birth, loss, and death are universal experiences.

2. Loss-loss is experienced with the absence of an object, person, body part or function, or emotion that was formerly present.

3. Sources of Loss
Loss of an aspect of oneself-a body part, a physiologic function or a psychological attribute.
Loss of an object external to oneself.
Separation from an accustomed environment.
Loss of a loved or valued person.
Developmental-losses that occur in the process of normal development.

4. Kubler-Ross has described the stages of grief and observable behaviors that have occurred with each stage.

5. Stages of Grieving
Denial

6. Anger

7. Bargaining

8. Depression

9. Acceptance

10. Parkes’s Model Numbness-brief, uses denial as a coping mechanism
Yearning-usually several months. Thoughts focus on deceased.
Disorganization-Social withdrawal at times. Accident prone, depression.
Reorganization- Gradual renewal in interest in others, job, activities.

11. Demi’s Grief Cycle Shock- Disorganized thinking, wish to join the deceased Protest-Anger, fatigue, weight loss, seeks help and advice of others Disorganization-Difficulty making decisions, perception of life as meaningless, loss of interest in people and activities Reorganization- realistic memory of deceased

12. Life span concepts and death
The infant/toddler
If loss of person who cares for them interferes with
sense of trust—child will develop inability to achieve warm relationships—this will last his lifetime

13. The preschooler
learns about the concept of death when a pet dies or they see a dead mouse.
Envision death:
Temporary
Little adult fear of death

14. Schoolager
Additional experience with death.
At about 9 years of age: Death is:
not reversible
permanent
inevitable

15. The Adolescent/Young Adult
Immune to death

16. Middle Age
Concrete plans for death.

17. Older adult
Life review
Ego Integrity Vs Despair

18. Physiological Changes as One Nears Death
Cardiovascular
Decreased stroke volume, the power to circulate blood decreases. Poor circulation.

19. Respiratory system
Slowed respiration increased secretions

20. Neuromuscular
Severe weakness and fatigue.
General loss of ability to swallow, loss of gag reflex
Tone of body sphincters lost
Decreased LOC

21. Neuromuscular continued:
DTR’s decrease or are not perceptible
Vision blurs
Touch remains intact
Hearing last sense to
leave

22. GI system
Digestion slows
Total body metabolism slows
Constipation due to decreased peristalsis
(abdomen becomes distended)

23. Modifications of Care Don’t turn suddenly Position on side Mouth care
Keep skin dry
Artificial tears
Analgesics
Include patient in
decision making

24. Other special needs of the dying
Promotion of comfort
Maintenance of independence
Conservation of energy
Prevention of loneliness and isolation
Promotion of spiritual comfort
Support the grieving family

25. Legal issues surrounding death
When does death occur
Documentation of death
Euthanasia
Dignity of the body
Required request
No code orders

26. Care of the Body after Death
Rigor mortis –occurs 2-4 hours after death
Position of body
Cleaning body
Family support
Proper identification
Rigor mortis leaves after about 96 hours
Body temperature after death

27. Role of Funerals Helps family accept the reality of death
Family accepts support of others
Cements memories