45.15: Chapter 36

Unfolding Case Study

1. 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.

2. 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.

3. 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.

4. 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.

5. 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.

6. 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.