N109: Foundations in Nursing Practice

N109: Foundations in Nursing Practice Study Guide The cause of the death of a loved one will often impact the grief response as well. If the cause of death is expected or honorable it is sometimes easier to accept. Examples of this include the death of an elderly adult or a firefighter in the line of duty. However, if the cause of death is preventable or has a stigma associated with it, it may exacerbate grieving. Examples of this are deaths caused from drunk driving, drug overdose, suicide, or AIDS. 4.5 Death and Dying Dying refers to the process of the body’s preparation for death. This process may be very short in the case of accidental death, or can last weeks or months in some patients, such as those with a chronic illness. Just as birth is the beginning, death is the end of the life continuum. A permanent cessation of all vital functions occurs with death. Indications of death for physicians include: • Unresponsive to external stimuli • No respiratory effort • No reflexes • No brain waves as measured on the encephalogram Other signs may be scant concentrated urine, progressive skin coolness and clamminess that starts in the extremities, and paleness or mottling of the skin. Sometimes, in spite of treatment, a condition or illness will cause death, particularly in aging individuals. In all cases, patients can decide what they do and do not want done. They can decide whether they want aggressive treatment that might prolong life, or whether they prefer to stop treatment, which could mean dying sooner but more comfortably. They may want to plan their own funeral. Advance directives can help make the patient’s wishes clear to families and healthcare providers. Care at the end of life focuses on making patients comfortable. They may still receive medicines and treatments to control pain and other symptoms. Some patients choose to die at home while others enter a hospital or a hospice setting. Dying Trajectories Individuals who are dying move toward death at different rates and ways. Different causes of death are associated with different patterns of dying, referred to as dying trajectories. These patterns indicate the path of an individual’s experience of dying. Dying can be sudden and unexpected, a steady decline with a short terminal phase, or a slow decline. The attitudes and behaviors of people caring for the patient are strongly influenced by their perceptions of the patient’s dying trajectory. Trajectories will also affect the types of emotional responses and coping mechanisms displayed by patients and their families, as well as the interventions that will be initiated. For these reasons, the purpose of understanding an individual’s dying trajectory is to anticipate and implement appropriate interventions.

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