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Chapter 36: Grief, Loss, Death, and Dying

Every problem in the chapter beside the book’s answer, a chapter at a time as you scroll.

Chapter 36: Grief, Loss, Death, and Dying

6 problems · 0 figures

Case Study 36.1.1 §36.1 source ↗

Mr. Morales is at the oncology clinic, accompanying his wife who is undergoing treatment for aggressive breast cancer. The oncologist has just explained that Mrs. Morales has a type of cancer that is not responding effectively to treatment and hospice care is recommended at this time. Mr. Morales is visibly upset and states, “No. No. This can’t be happening. She’s young and healthy! This isn’t fair! You’re wrong! I want a second opinion right now. Get out and get someone in here that can give us a better answer!” Mrs. Morales begins to cry and says, “No. I refuse to believe it. I’ve been doing my treatments every day like I should. There’s no way this is true.”

Recognize cues: What cues are important for the nurse to recognize in this situation?

Answer

The nurse should recognize that both Mr. and Mrs. Morales are visibly upset by the news. While Mr. Morales appears to be angry, Mrs. Morales is experiencing sadness and disbelief. The nurse should recognize that both feelings are valid and allow them to grieve how they need to in this moment.

Case Study 36.1.2 §36.1 source ↗

Mr. Morales is at the oncology clinic, accompanying his wife who is undergoing treatment for aggressive breast cancer. The oncologist has just explained that Mrs. Morales has a type of cancer that is not responding effectively to treatment and hospice care is recommended at this time. Mr. Morales is visibly upset and states, “No. No. This can’t be happening. She’s young and healthy! This isn’t fair! You’re wrong! I want a second opinion right now. Get out and get someone in here that can give us a better answer!” Mrs. Morales begins to cry and says, “No. I refuse to believe it. I’ve been doing my treatments every day like I should. There’s no way this is true.”

Analyze cues: Based on the Kübler-Ross grief cycle, which stage do Mr. and Mrs. Morales appear to be in?

Answer

Mrs. Morales appears to be in the stage of denial based on her comments of disbelief. Mr. Morales, on the other hand, appears to be experiencing anger. He is having an angry outburst about the provider, requesting that they get a second opinion. It is important for the provider to recognize that the anger being directed at them is likely not personal, but a coping mechanism being used by the patient’s husband.

Case Study 36.2.3 §36.2 source ↗

Refer back to Unfolding Case Study #5: Part 6 for a review on the patient data.

After taking some time to think about options, Mr. and Mrs. Morales make the decision to pursue hospice care. They are currently waiting for the palliative care and hospice team to come discuss more specific information about what to expect.

Hospice Nursing Notes 1400:
Completed intake assessment for Morales family. Agreed to start hospice nursing services in their home beginning tomorrow. DNR order in place. Mr. Morales expresses concern over what to expect in terms of the dying process. Discussed expectations at length with family. All questions and concerns addressed at this time.
Prioritize hypotheses: What kind of information should the nurse anticipate Mr. Morales might want to know based on his questions about what to expect during the dying process?

Answer

Based on his questions about what to expect during the dying process, the nurse should anticipate he might like to receive information about physiological changes that might occur during the dying process.

Case Study 36.2.4 §36.2 source ↗

Refer back to Unfolding Case Study #5: Part 6 for a review on the patient data.

After taking some time to think about options, Mr. and Mrs. Morales make the decision to pursue hospice care. They are currently waiting for the palliative care and hospice team to come discuss more specific information about what to expect.

Hospice Nursing Notes 1400:
Completed intake assessment for Morales family. Agreed to start hospice nursing services in their home beginning tomorrow. DNR order in place. Mr. Morales expresses concern over what to expect in terms of the dying process. Discussed expectations at length with family. All questions and concerns addressed at this time.
Generate solutions: What specific information can the hospice nurse provide to Mr. and Mrs. Morales about what to expect during the dying process?

Answer

The nurse should provide information about the specific stages of death (e.g., early, middle, late) and what symptoms and physiological changes the patient might experience during each. The nurse should also describe physical symptoms to look for, including restlessness, agitation, loss of consciousness, hallucinations, and agonal breathing.

Case Study 36.4.5 §36.4 source ↗

Refer back to Unfolding Case Study #5: Part 7 for a review on the patient data. Mrs. Morales has been receiving hospice care for two months and is beginning to experience more severe fatigue and expresses her desire to “just get it over with already.” She has requested that her extended family come to see her and say their goodbyes. One of her friends is currently visiting and notices that Mrs. Morales has stopped breathing. The friend begins to panic and yells, “HELP! She’s not breathing! Someone start CPR now!”

Take action: What action should the hospice nurse take next?

Answer

The patient has a DNR order in place, so the hospice nurse should not begin CPR. Instead, the nurse should listen to the patient’s heart and determine whether or not death has occurred. The nurse should also allow the husband and other family to be with the patient for as long as they need.

Case Study 36.4.6 §36.4 source ↗

Refer back to Unfolding Case Study #5: Part 7 for a review on the patient data. Mrs. Morales has been receiving hospice care for two months and is beginning to experience more severe fatigue and expresses her desire to “just get it over with already.” She has requested that her extended family come to see her and say their goodbyes. One of her friends is currently visiting and notices that Mrs. Morales has stopped breathing. The friend begins to panic and yells, “HELP! She’s not breathing! Someone start CPR now!”

Evaluate outcomes: After the patient’s death, the nurse provides Mr. Morales with resources related to coping and support groups for grief. What findings would indicate that Mr. Morales is coping appropriately?

Answer

Everyone grieves death differently, so this could be subjective. However, the nurse would assess for healthy coping mechanisms such as attending support group meetings, spending time with family and loves ones, and showing a gradual improvement in grief symptoms.

End of the book.

Problems and answers are adapted from Fundamentals of Nursing by Christy Bowen, Lindsay Draper and Heather Moore, OpenStax, and are used under the CC BY-NC-SA 4.0 licence. Access for free at https://openstax.org/books/fundamentals-nursing/pages/1-introduction. Illustrations: Copyright Rice University, OpenStax, under CC BY-NC-SA 4.0 license. This adaptation is released under the same licence, is non-commercial, and is neither affiliated with nor endorsed by OpenStax or Rice University.