BSC 1 ST YEAR NURSING

1. CONCEPT OF
LOSS, GRIEF,
GRIEVING
PROCESS.

3. LOSS
 An experienced felt by a person as he gets separated from his
loved one, close one.
 Loss may include death of loved one, loss of body image,
separation or divorce, financial losses, break up of romantic affair,
retirement, separation from friend etc.
 Nurses play an important role in educating the client about the loss
process and in helping the client mournless.

4. WAYS OF EXPRESSING LOSS
1. GRIEF.
2. MOURNING.
3. BEREAVEMENT.

5. GRIEF
 Grief is the painful psychological and
physiologic responses to loss.
 These response often includes helplessness,
loneliness, hopelessness, sadness, guilt,
anger.
 It effects physical, cognitive, behaviour,
emotional, social and spiritual aspects of the
individual.

6. Contd…..
 If you block yourself off and don’t let yourself walk the
journey, this can cause problems further down the
track – we deal with a number of people using
hypnotherapy who have bottled up grief from an old
loss and have never fully released it.

7. BEREAVEMENT
 Bereavement is the period after a loss
during which grief is experienced
and mourning occurs.
 When you grieve, it's part of the
normal process of reacting to a loss.

8. MOURNING
 Mourning is the process by which people adapt to
a loss.
 It is the period of acceptance of loss and grief
during which the person learns to deal with loss.
 Mourning refers to culturally define patterns of
expressions of grief.
 Mourning patterns includes funerals, memorials,
black dress/white dress etc….
 Those most affected by the loss of a loved one
often observe a period of grieving, marked by
withdrawal from social events and quiet, respectful
behavior.
 People may follow religious traditions for such
occasions.

9. Loss can be in different types
1. ACTUAL LOSS: Actual loss of a person or object that can no longer be felt, heard, or
experienced by the individual.
EXAMPLE- Loss of arm, child, relationship etc.
2. PERCIEVED LOSS: Any loss that is tangible and uniquely defined by the grieving
client.
EXAMPLE : loss of confidence prestige.
3. MATURATIONAL LOSS: It includes any changes in the developmental process that
is normally expected during a lifetime.
EXAMPLE: Mothers feeling of loss as a child goes to school for the first time.

10. Contd……
4. SITUATIONAL LOSS: It includes any sudden, unexpected external event that is not
predictable. Often this types of loss includes multiple losses rather than a single loss.
EXAMPLE: Accident that haves a driver paralysed, unable to return to work and
grieving over the loss of passenger in the accident.
5. ANTICIPATORY LOSS: In which a person displays loss and grief behaviour for a loss
has yet to be takes place.

11. SYMPTOMS OF GRIEF
 PHYSICAL: Weakness, anorexia, feeling of choking, shortness of breath, tightness
of chest, dry mouth, gastro-intestinal disturbances, insomnia etc.
 COGNITIVE: Difficulty in concentration, hallucinations.
 BEHABIOURAL: Inability to perform even basic activities of daily living,
restlessness, disorganized behaviour.
 AFFECTIVE SYMPTOMS: Sadness, guilt, anger, major depression.

12. STAGES OF GRIEF PROCESS BY
KUBLER ROSS(1969)
Denial
Anger
Bargaining
Depression
Acceptance

14. A. DENIAL OR ISOLATION
In this stage, the client denies that he or she will die,
may repress that is discussed and may isolate self from
reality.
This person may think “ They made mistakes in the
diagnosis.” They may not come to the hospital.

15. B. ANGER
The client expresses range and hospitality in the anger
stage and adopts a “Why me”? Attitude.

16. C. BARGAINING
The client tries to barter for more time.
“ If I can live up to my grandson’s marriage, I will be
satisfied. Just let me live until then”.

17. D. DEPRESSION
In this stage, the client goes through a period of grief
before death.
This is a time of quiet desperation and disengagement
from all associations with the lost entity.

18. E. ACCEPTANCE
The final stage brings a feeling of peace regarding
the loss that has occurred.
Focus is on the reality of the loss and its meaning
for the individuals affected by it.

19. Contd…..
 All in individuals do not experience each of these stages in
response to a loss, nor do they necessarily experience them in
this order.
 Some individuals grieving behaviour may fluctuate, and even
overlap between stages.

20. NURSING INTERVENTION
 Provide an open accepting environment.
 Encourage ventilation of feelings and listen actively.
 Provide various diversional activities.
 Provide teaching about common symptoms of grief.
 Bring together similar aggrieved persons, to encourage
communication, shares experiences of loss and offer companionship,
social and emotional support.

21. DEATH
 Death is the cessation or permanent termination of all the
biological functions that sustain a living organism.

22. CAUSE OF DEATH
 Cerebrovascular disease.
 COPD.
 Lower respiratory tract infection.
 Lung cancer
 Accidents.
 Cancer.
 HTN, Heart diseases.
 Suicide.
 Childhood diseases e.g- diarrhea..
 And many more……………………………….

23. SIGNS & SYMPTOMS
FACIAL APPEARANCE
1. Facial muscle relax.
2. Flaccid cheeks.
3. Loss of muscle tone.
5. Pale skin.
6. Sunken eyes.
SIGHT, SPEECH & HEARING.
1. Gradual sight fails.
2. Pupil fail to react to
light
3. Sunken eyes
4. Difficult speech-
confused
5. Hearing gradually
becomes low.

24. SIGNS & SYMPTOMS
 Respiratory system
1. Irregular.
2. respiration(rapid & slow).
3. Stertorous (noisy
breathing) due to secretion.
Circulatory system
1. Alteration in vital signs.
2. Rapid pulse gradually
fails.

25. SIGNS & SYMPTOMS
 Gastrointestinal system
1. Hiccoughs.
2. Nausea & vomiting.
3. Abdominal distension
4. Inability to swallow.
Genito-urinary system
1. Retention of urine.
2. Distended bladder.
3. Incontinence of urine & stool
 Skin & musculoskeletal system
1. Pale skin.
2. Cold sweats.
3. Ears & nose are cold at touch
4. Stiff muscles.

26. SIGNS & SYMPTOMS
 Central nervous system
1. Loss of reflexes & pain.
2. Restless due to lack of oxygen.
3. Raised body temperature.

27. SIGNS OF CLINICAL DEATH
1. Absence of pulse, heart beat & respiration.
2. Fixed pupils & non reactive to light.
3. Absence of reflexes.
4. Rigor mortis(a stiffening of body after death due to muscle
fixation)
5. Cyanosis.

28. MANAGEMENT OF DYING PATIENT
1. Oxygen inhalation.
2. Suctioning.
3. Positioning.
4. Well- ventilation.
5. Medication as prescribed.
6. IV fluids, oral fluids, or sips of water.
7. Perineal care, skin care, mouth care, eye care & clean clothing's.
8. Rest & sleep.

29. 9. Psychological support
 Relief from loneliness, fear & depression.
Maintenance of security, self-confidence & dignity.
Maintenance of hope & spiritual comfort.
Maintenance of a comfortable & peaceful environment.
Use therapeutic communication.
Protect against Isolation.
Assist with end- of- life decision making.

30. 10. Palliative care
 Palliative care is the prevention, relief, reduction
or soothing of symptoms of disease or disorders
throughout the entire course of an illness,
including care of dying and bereavement follow-
up for the family. - Ferrell & Coyle.
 But palliative care can begin at diagnosis, and at
the same time as treatment.

31. 11. Hospice care.
 Both palliative care and hospice
care provide comfort.
 Hospice care begins after treatment of the
disease is stopped and when it is clear that
the person is not going to survive the
illness.
 Care of dying and bereavement follow-up
for the family

32. CARE OF BODY AFTER DEATH
 Death declaration/ Death certificate by physician.
 Autopsy(written permission)
 Customs & principles are kept in mind.
 Positioning- body straitened & arms laid at the side.
 Eyes are closed as in sleep.
 Dentures are removed & prop chin in position with bandaging.
 Remove all appliances used for patient care( e.g - catheter
tubing's etc..)

33. CARE OF BODY AFTER DEATH
 Remove ornaments and list them to relatives.
 All orifices are to be plugged with cotton to prevent escape of
body discharges.
 Prevention of spread of diseases (i.e sealing body)
 Send body clean and neatly dressed.
 An identification tag for body.

34. CARE OF BODY AFTER DEATH
 If relatives are present then body is handed over them with
proper written legal authority permission.
 Maintain record of death and inform to authority for register of
deaths.
 Care of unit.

35. MEDICO LEGAL ISSUES

36. DNR
 A do-not-resuscitate order, or DNR order, is
a medical order written by a doctor.
 It instructs health care providers not to do
cardiopulmonary resuscitation (CPR) if a
patient's breathing stops or if the patient's
heart stops beating.
 Is DNR legal in India?

37. PRONOUNCEMENT OF DEATH
 The govt. has formed laws to protect the public when dealing
with issues of death.
 The various definitions of death are as follows:
1. The absence of awareness of external stimuli.
2. Lack of movement & spontaneous breathing.
3. A flat brain wave or ECG.

38. ORGAN DONATION

39. EUTHANASIA.
 It is mercy-killing.
 This means easy or painless death.
 Legal or illegal in India ??
A. Active euthanasia : It is to take deliberate action to end the
patient’s life. A physician who
administers a lethal dose commits active
Euthanasia.
B. Passive euthanasia: it is stopping from
treatment that would prolong a person’s
life such as chemotherapy, surgery.

40. CARE OF DECEASED
 When a client dies, the nurse is responsible to treat the deceased
with respect and dignity.
 The nurse should prepare the body for removal to the mortuary
according to agency policies, the nurse is responsible for properly
identifying the body could result in severe distress for the family as
well as legal ramifications for both hospital and the nurse.

41. Autopsy
 The surgical dissection of a body after death to determine the
exact cause and circumstances of death or discover the pathway
of disease.
1. FORENSIC-
 Done for medical legal purpose.
 No family permission is required.
 Carried out when the cause of
death may be a criminal.

42. Contd….
2. CLINICAL/ACADEMIC-
 Perform in the hospitals for research and study purposes.
 Death certificate must be completed and present.
 Permission from the deceased family is required.

43. Contd….
3. CORONER’S –
 Autopsy involves cases where no medical cause of death is readily available.
 Cause, manner and mechanism of death are in question.
 Permission from the deceased family is required.

44. EMBALMING

45. EMBALMING
Embalming is the art
and science of
preserving human
remains by treating
them to forestall
decomposition.

46. CONTD…….
It is a process of sanitizing and preserving human
remains to render them as safe as possible for handling
while retaining of tissue for funeral viewing purposes.

47. EMBALMING CHEMICALS
 A mixture of these chemicals is known
as embalming fluid, and is used to preserve
deceased individuals, sometimes only until
the funeral, other times indefinitely.
 Typical embalming fluid contains a mixture
of formaldehyde, glutaraldehyde, methanol
, ethanol and other solvents.

48. TYPES/STEPS OF EMBALMING
Arterial embalming.
Cavity embalming.
Hypodermic embalming.
Surface embalming.

49. REFERANCES
 Textbook of nursing foundation, by I Clement, jaypee publisher, First edition
2011, page no. 593-600.
 A text book of nursing foundation by lakhwinder kaur, maninder kaur, PV books,
2016 edition, page no. 752-773.
 What is palliative care? Available at
https://medlineplus.gov/ency/patientinstructions/000536.htm#:~:text=The%20Difference
%20Between%20Palliative%20Care%20and%20Hospice&text=Both%20palliative%20care
%20and%20hospice,going%20to%20survive%20the%20illness.

50. UNIT TEST
Q1. what is Grief. Explain the stages of grief process.
5marks.
Q2. Explain the care of dead body after dead? 3
marks
Q3. What is embalming? 1m
Q3. What is Euthanasia? 1m
Q5. what is Autopsy? 1 m