Death, Grief, and Spirituality
Living will, Power of Attorney, organ donation, death certificate, DNR, Autopsy
What are the legal aspects related to death?
-A systematic and comprehensive examination of the cultural care values, beliefs, and practices of individuals, families, and communities
Some questions you could ask as a nurse include:
-Dietary preferences?
-Any expectations for treatment?
-Any practices or rituals?
-Where were you born?
What is a cultural assessment?
-The most common symptoms are sudden weight loss, polydipsia, polyuria, and polyphagia
-Fatigue
-Increase in frequency of infection
-Rapid and early onset
-Insulin-dependent
What is Type I Diabetes?
_ is to sleep disorders
_ is for problems with eating or feeding
_ is for incontinence
_ is for confusion
_ is for evidence of falls
_ is for skin breakdown
What is SPICES (elderly)?
-Presbycusis= Aged related hearing loss caused by changes in the inner ear or in the nerve pathways from the inner ear to the brain (greater loss in high pitch sounds)
-Begins at age 30
-Ossicles= don't move as well so they may become calcified
-Cerumen= could be an accumulation of dry earwax
-Tinnitus= Ringing of the ears due to aging
What are the effects of aging on the auditory system?
Difficulty talking/swallowing, GI issues, loss of muscle tone, slow circulation, Cheyne-Stokes, loss of sensation
What are the signs of impending death?
1. Beginning family (occurs at marriage)
2. Childbearing family (oldest is in infancy through two years of age)
3. Preschool-age children (oldest child is 2 and a half to 5)
4. School-age children (oldest is 6-12)
5. Teenage (oldest 13-20)
6. Launching family (oldest leaves home)
7. Middle age family (to retirement)
8. Aging family (retirement to death)
What is Duvall's Developmental States Theory?
Pancreas has insufficient insulin supply
-3Ps (polydipsia, polyuria, and polyphagia)
-History of high blood pressure
-Fatigue
-Low energy
-Recurrent infection
What is Type II Diabetes?
-Aging= normally 65 and older
-Females (2/3 of Americans)
-Family medical history of Alzheimers raises risk (more than one family member greatly increases risk)
-History of significant head trauma
-Cardiovascular health (the heart nourishes the brain)
-Ethnicity
-Lower socioeconomic status (less access to health care as well as lower or less education)
What is the risk profile for Alzheimer's?
-Its like your looking down a tunnel with no side vision
-Potentially serious form of eye disease
-From increased ocular pressure
-Can progress to blindness
-Loss in peripheral vision
-Intolerence to glares
-Decreased ability to adapt to dark
What is Glaucoma?
Actions in response to impending death, name of provider, special prep (family request), med tubes in/out, personal items, ID tag placement, time of transfer and to whom
What would you document after you've taken care of the body after death?
-Physically (caring for and providing for basic needs)
-Economically (providing financially)
-Reproductive (addition of children)
-Affective and coping (teaching each other how to cope with stress by providing support, affection, and love
-Socialization (teaching youth and bringing them into society as functioning people
what are different family functions?
Tachycardia (heart rate too high)
Irritability (normally a pleasant person)
Restlessness
Excessive hunger
Diaphoresis (sweaty)
-This could be a reaction of too much insulin
-Blood glucose less than 70
"Cold and Clammy, need some Candy"
what is hypoglycemia?
Urinary tract infection
Young: Fever, frequency, or urgency
Older: Confusion, incontinence, and falls
Pneumonia
Young: Fever, and productive cough
Older adults: Tachycardia, tachypnea, confusion, decreased appetite, and functioning
MI (heart attack)
Young: crushing, substernal chest pain, and diaphoresis (sweating)
Older: Dyspnea, anxiety, and confusion
what are the signs and symptoms of diseases comparing young and older adults?
1. bacteria, viruses, fungi
2. where the organism lives and multiples
3. point of escape for the organism
4. Direct contact, indirect contact, airborne route
5. Point at which organisms enter a new host
6. Must overcome resistance mounted by host's defenses
What is the chain of infection?
Voluntary NPO, Terminal weaning, Active euthanasia, Palliative Sedation (explain all after)
What are some ethical challenges that are faced with end of life?
-Perception of illness
-Mental health belief system
-Reactions to pain
-Gender roles (possibly male of house or grandmother makes decisions depending on your background)
-Language and communication
-Nutrition
-Family support
-Socioeconomic factors
-Spirituality
-Medication adherence/ self care
How does family influence healthcare?
LIFE THREATENING
- ketones absent or minimal in blood and urine
- enough insulin to prevent ketoacidosis
What is Hyperosmolar Hyperglycemic syndrome (HHS)?
-Diagnosis of exclusion
-MRI/ CT
-PET scan
-Lab tests to rule out other problems
-Mini-Mental State examination
-Thyroid function tests (can cause impaired memory)
-Serum glucose, BUN, and creatinine (kidney functioning)
-Serum levels of vitamins B1, B6, B12
-Liver function tests
-Complete blood count (CBC) and electrocaridogram (ECG)
-Screening for depression
-Time and Change test:
+Clock with hands
What are all the things we would need to do before diagnosing someone with Alzheimer's?
developmental consideration, stress, culture, lifestyle, medication
what are factors affecting sensory stimulation?
Helping patients maintain faithfulness to their belief system and worship practices
helping people identifying meaning and purpose in life, look beyond the present, and maintain personal relations as well as a relationship with a higher being or life force
What is the difference between religious and spiritual care?
-The way that families react to internal and external stress
-Hill's ABC- X Model
Stressor event-->family resources --> Family perception of stressor event -
What is the Family Stress Theory?
-Rebound effect in which an overdose of insulin causes hypoglycemia
-Release of counter-regulatory hormones causes rebound hyperglycemia
-Check around 2 a.m. to see if it is really low
-This will happen if their blood sugar isn't maintained
-Happens overnight while asleep
What is the Somogyi effect?
_____ prevention: No way to reduce Alzheimers disease; just try and stay healthy overall
_____ prevention: We can start to treat by giving medication to help slow down
_______ prevention: Identify patients at risk and warning signs; the earlier we can detect symptoms the earlier we can start interventions such as medication to slow down
What are primary, tertiary, and secondary preventions of Alzheimer's?
impaired or absent functioning
when a person experiences too much
decreased/meaningless sensory input
learning about the world without experiencing it
what is sensory deficits, overload, deprivation, and poverty?