Answer Key to Chapter 17 Learning Activities

Scenario A

1. What actions should the nurse take to support Mr. Lyn? The grieving process is variable for every individual. Mr. Lyn’s outward expression of grief should be supported by the nurse. The nurse can assist Mr. Lyn to cope by using supportive presence and encouraging reminiscence by sharing good memories of his life with Mrs. Lyn. It is helpful to offer the services of the agency chaplain, as well as to offer prayer and spiritual support based on Mr. Lyn’s beliefs and the nurse’s comfort level. The nurse can also encourage Mr. Lyn to contact other family members and friends for additional social support.
2. What medication is helpful to administer to treat dyspnea at end of life? Opioids such as Roxanol, a highly concentrated solution of morphine, can be administered sublingually as ordered for pain and air hunger.
3. Mr. Lyn tells the nurse, “My daughter lives six hours away and would like to be here when the time comes. How much longer does she have to live?” What is the nurse’s best response?  Although we never know exactly when death will occur, there are recognizable signs that occur as death becomes imminent, such as noisy or irregular breathing, increased lethargy, and a type of skin discoloration called “mottling.” Mrs. Lyn is demonstrating new changes in her breathing status, so death may occur in the next few days.
4. The daughter arrives and seems hesitant to talk to or touch Ms. Lyn. What tasks can the nurse coach family members to do at the end of a client’s life? Nurses can encourage family members to talk with and touch their loved one. They can encourage family members to reminisce about happy stories and say, “I love you” or say “Goodbye.”
5. Mrs. Lyn dies the following evening. What postmortem care should the nurse provide? After verifying the lack of an apical heartbeat for a full minute, the nurse should follow agency policy regarding notifications and postmortem care. The nurse should document the date and time of assessment, the physician contacted, the individuals present at the time of death, the lack of response to stimuli and absence of an apical pulse, and the arrangements for transport to the morgue or funeral home. Typically, the client is bathed, dressed, and positioned to show respect and provide dignity. Cultural practices should be honored. The nurse can offer to contact other family members to inform them of the death and support families in their ways of saying goodbye.

Scenario B

1. According to Kubler-Ross’ theory of grief/loss, what stage of grief is Terry currently experiencing? Terry is demonstrating the stage of denial according to Kubler-Ross’ theory of grief/loss, as evidenced by his statement that he “can’t believe this is happening” to him.
2. How would you explain palliative care to him? Palliative care is a way to manage your symptoms and optimize your quality of life. A team will assist you in making difficult decisions and can provide support to you and your family members
3. How would you explain advance directives to him? Advance directives are a legal way for you to establish your wishes for health care. A living will is a document that you can complete that describes your wishes if you are no longer able to speak for yourself. For example, you can decide if you would ever want a feeding tube placed if you are no longer able to eat. You can also identify a health care power of attorney who will serve as your decision maker when you can no longer speak for yourself. Would you like me to ask a social worker to visit so you can talk more about these options?
4. Identify a SMART outcome. “Terry will discuss the meaning of the cancer diagnosis to his life before discharge.”
5. List sample nursing interventions that may help Terry to cope with this new diagnosis. Use a calm, reassuring approach. Provide an atmosphere of acceptance. Seek to understand the client’s perspective. Provide Terry realistic choices about aspects of his care when possible. Encourage verbalization of feelings, perceptions, and fears. Encourage support from family and friends.

Answers to interactive elements are given within the interactive element.