MEDICAL COLLEGES OF NORTHERN PHILIPPINES

Alimannao Hills, Peñablanca, Cagayan

COLLEGE OF NURSING

FUNDAMENTALS OF NURSING OUTLINE

FINALS

Coping with Loss, Grieving and Death

Loss- an actual or potential situation in which a valued object, person or the like is inaccessible
or changed so that it is no longer perceived as valuable

Bereavement- subjective response to a loss through the death of a person with who there has
been a significant relationship

Grief- Total response to the emotional experience of the loss and is manifested in thoughts,
feelings and behaviors

Mourning- the behavioral process through which grief if eventually resolved or altered; it is
often influenced by culture and custom.

Development of the Concept of Death

1. Infancy to 5 years old

 No understanding of the concept of death
 Believes that death is REVERSIBLE, TEMPORARY or SLEEP
2. 5-9 years old
 Understands that death is final
 Believes that own death can be avoided
 Associate death with aggression or violence
3. 9-12 years old
 Understands death as the inevitable end of life
 Begins to understand own mortality
4. 12-18 years old
 Fears of lingering death
 May fantasize that death can be defied, acting out defiance through reckless
behavior
 Views death in religious and philosophic terms
5. 18-45 years old
 Attitude towards death is influenced by religious and cultural beliefs
6. 45-65 years old
 Accepts own mortality
 Encounters death of parents and some peers
 Experience peak of death anxiety
7. 65 years and above
 Fears prolonged illness
 Sees death as having multiple meanings
Stages of Grieving (Kubler-Ross) DABDA
1. Denial
 Refuses to believe that loss is happening
 Unready to deal with practical problems
 May assume artificial cheerfulness
2. Anger
 Client or family may direct anger at a nurse or hospital about matters normally
would not bother them
3. Bargaining
 Seeks to bargain to avoid loss
 May express feelings of guilt or fear of punishment for past sins, real or imagined
4. Depression
 Grieves over what has happened and what cannot be
 May talk freely or may withraw
5. Acceptance
 Comes to term with loss
 May have decreased interest in surroundings and support persons
 May wish to begin making plans

Symptoms of Grief
1. Repeated somatic distress
2. Tightness in the chest
3. Choking or shortness of breath
4. Sighing
5. Empty feeling in the abdomen
6. Loss of muscular power
7. Intense subjective distress

Assisting clients with their grief

1. Provide opportunity for the person to “tell their story”
2. Recognize and accept the varied emotions that people express in relation to a significant
loss
3. Provide support for the expression of difficult feelings such as anger and sadness
4. Include children in their grieving process
5. Encourage the bereaved to maintain established relationships
6. Acknowledge the usefulness of mutual-help group
7. Encourage self-care by family members particularly the primary caregivers
8. Acknowledge the usefulness of counseling for especially difficult problems

Signs of Impending Clinical Death

1. Loss of muscle tone
 Relaxation of the facial muscles m(the jaw may sag)
 Difficulty in speaking
 Difficulty in swallowing and gradual loss of the gag reflex
 Decreased activity of the gastrointestinal tract
 Possible urinary and rectal incontinence
 Diminished body movement
2. Slowing of circulation
 Diminished sensation
 Mottling and cyanosis of the extremities
  Cold skin, first in the feet and later in the hands, ears and nose
3. Changes in vital signs
 Decelerated and weaker pulse
 Decreased blood pressure
 Rapid shallow, irregular or abnormally slow respirations; cheyne-strokes
respirations; noisy breathing (death rattle); mouth breathing
4. Sensory impairment
 Blurred vision
 Impaired sense of taste and smell

Indication of Death
1. Total lack of response to stimuli
2. No muscular movement
3. No reflexes
4. Flat encephalogram (ECG). This is the most accurate indication of death

Nursing Interventions for the Dying Clients

1. Assist the client achieve a dignified and peaceful death
 Provide relief from loneliness, fear and depression
 Maintain the client’s sense of security, self confidence, dignity, and self worth
 Maintain hope
 Help the client accept his or her losses
 Provide physical comfort
2. Maintain physiologic and psychologic comfort
 Personal hygiene measures
 Pain control
 Relief of respiration difficulties
 Assistance with movement, nutrition, hydration and elimination
3. Provide spiritual support
 Search for meaning
 Sense of forgiveness
 Need for love
 Need for hope

Hospices are healthcare facilities designed to care for terminally ill clients and other families
by providing supportive and palliative services

Care of the body after death

Body Changes
1. Rigor Mortis
 Stiffening of the body that occurs about 2-4 hours after death
 Results from lack of ATP, which is not synthesized due to lack of oxygen in the
body
 Nursing intervention: position the body, place dentures in the mouth, close the
eyes and mouth before rigor mortis sets in
2. Algor mortis
 Gradual decrease in body temperature
  Results from termination of the blood circulation and when the hypothalamus
stops to function, body temperature falls about 1°C (1.8°F) per hour until it
reaches room temp.
3. Livor Mortis
 Discoloration of the skin after death when circulation ceased.
 Red Blood cells break down, releasing hemoglobin which discolors the
surrounding tissues

Nursing Interventions for the Body after Death

 Make the environment as clean and as pleasant as possible
 Make the body appear natural and comfortable
 Remove all equipment and supplies from the bedside
 Place the body in supine position, the arms at the sides, palms down
 Place one pillow under the head and shoulders to prevent blood from discoloring the
face
 Close the eyelids, insert the dentures and close the mouth
 Wash soiled areas of the body
 Place absorbent pads under the buttocks to take up any feces and urine released
because of relaxation of the sphincter muscles
 Provide clean gown, brush/ comb the hair
 Remove all jewelries. All the client’s valuables are listed and placed in a safe storage
area for the family to take away
 Allow the family to view the patient’s body
 Apply identification tags, one to the ankle and one to the wrist
 Wrap the body in shroud. Apply another identification tag to the outside of the shroud
 Bring the body to the morgue for cooling.

Prepared by:

Fundamentals of Nursing Team