N109: Foundations in Nursing Practice

N109: Foundations in Nursing Practice Study Guide assessment process might include: • What does the immediate family do when a family member dies? • What do friends and other relatives do when a family member dies? • What expectations do people in your culture have for the immediate family and for other relatives? • How long is bereavement expected to last? • What is different if it is a child or an adult who dies? • What meaning is attached to the death of an infant or child? • How does religious affiliation affect what family members do and what is expected of them? Planning With the patient and family, the nurse must determine expected outcomes and interventions that will promote the patient’s and family’s goals. Incorporate the patient's religious and cultural values and advance directive wishes. Consider the patient’s usual coping mechanisms. Expected outcomes for the nursing diagnoses might include: • Anxiety and fear related to impending death: The patient will express decreased anxiety. The nurse must encourage the patient to express concerns and fears. Support the patient within the context of the family. Several studies support the use of antidepressants during end of life care. • Alteration in comfort: The patient will have minimal pain. The nurse must constantly assess for discomfort, position the patient to minimize discomfort, and medicate for pain as needed. Use appropriate medications to control pain. • Compromised or ineffective coping: The patient and family will express fears and request those interventions that may help them cope more effectively. The nurse must assess the coping mechanisms of the patient and family and encourage effective coping mechanisms. • Anticipatory grieving: The patient and family will seek social support as they work through the stages of grief. The nurse must encourage the patient and family to verbalize concerns and needs, and must help the patient and family move throughthe stages of grief. • Risk for loss of dignity: The patient will maintain his dignity in the dying process. The nurse must allow the patient to do as much as possible for himself and must protect the patient's privacy as much as possible. • Risk for loneliness: The patient will continue to participate in interactions with friends, family, and social supports. The nurse must enable the patient to participate with others in social interactions and must allow the patient and family privacy for these interactions. At the same time, the nurse and healthcare team must ensure that the patient has a healthcare team support and the presence of members of the team. Implementation As interventions are implemented, the nurse must constantly reassess the individual and family to ensure that the interventions are producing the desired outcomes. Safety of the individual must be the first priority, and the nurse must ensure that the family understands modifications that must be implemented and changes that should be reported. Promote comfort by making sure the patient’s

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