The document provides information on coping with loss, death, and grieving. It defines key terms like loss, grief, death, and coping. It discusses the various types of loss and grief, as well as the stages of grief. It also covers death and dying, including definitions of terms like advance directives and palliative care. Palliative care aims to relieve suffering and improve quality of life, while hospice care supports those in the last six months of life. The document provides nursing implications for supporting those coping with loss, death, and grieving.
Nursing Education is designed to guide students into high-level nursing education careers. Graduates of this type of program are nurse scholars who go on to find employment in academic institutions, research environments, and other education-based roles.
Nursing Education is designed to guide students into high-level nursing education careers. Graduates of this type of program are nurse scholars who go on to find employment in academic institutions, research environments, and other education-based roles.
CODE OF ETHICS: The guiding principle in nursing
code are the direction of conduct , understanding of what is right and wrong while providing care in the hospital and community settings.The ICN code of ethics are the milestone to establish nursing as a profession.
History of development of Nursing ProfessionsAnamika Ramawat
History of development of Nursing Professions, Characteristics, Criteria of the Nursing Profession, Perspective of Nursing Profession- National and Global Level
CODE OF ETHICS: The guiding principle in nursing
code are the direction of conduct , understanding of what is right and wrong while providing care in the hospital and community settings.The ICN code of ethics are the milestone to establish nursing as a profession.
History of development of Nursing ProfessionsAnamika Ramawat
History of development of Nursing Professions, Characteristics, Criteria of the Nursing Profession, Perspective of Nursing Profession- National and Global Level
The five stages, denial, anger, bargaining, depression and acceptance are a part of the framework that makes up our learning to live with the one we lost. They are tools to help us frame and identify what we may be feeling. But they are not stops on some linear timeline in grief.
Care of terminally ill patient full chapter fundamental of nursing pinkijat
Care of terminally ill patient,include concept of loss,grief , grieving,types of losses,type of grief,factors influencing loss and grief ,stage of grief and losses(DABDA) ,sign of clinical death,care of dying patient , palliative and hospice care, advance directive,legal documents related to advance directive,and after death care in fundamental of nursing full chapter.
Tips to reduce alcohol intake:
- Gradually reduce the number of drinks
- Use smaller glasses
- Substitute a glass of water in between alcoholic drinks
- Change triggering environment
- Change from your preferred alcoholic drink to one you do not like
- Don't stock up on alcohol
- Be realistic
- Find healthy coping mechanism
Digital Addiction | Psycho Education | Juhin JJuhin J
Digital Addiction:
---Signs & Symptoms---
- Unable to leave your house without phone
- Compelled to check the phone constantly for no particular reason
- Eating with your phone on the table
- Feeling anxious or depressed after using social media
- Obsessed over sending or recieving a text or posting a comment
- Feeling afraid of missing out
---Management---
- Start the day without mobile phone
- Turn off devices 30 minutes before bed
- Delete time setealing apps from your phone
- Turn off notifications
- Only respond to emails and texts at specific times of the day
Stress Management:
- Get enough sleep (6-8 hours)
- Be active
- Engage in meditation and yoga
- Eat well
- Take a break
- Talk to someone
- Practice deep breathing
Tips to improve Sleep Quality:
- Establish a regular bedtime and waking time
- Do regular exercise
- Use comfortable bed
- Make sure your bedroom is quiet, dark with good ventilation
- Switch off your electronic devices 30-60 minutes before bed
- Avoid taking heavy foods before sleep
- Reduce intake of water before bed
- Avoid coffee, alcohol & nicotine intake
Warning Signs of Mental Illness:
- Excessive sadness & anxiety lasting more than 2 weeks
- Sleeping or eating more/less than usual
- Inability to perform daily tasks
- Harming self
- Increased use of alcohol or other substances
- Unusual mood changes
- Decreased performance
- Believing things that aren't real
Rights of Special Groups | Constitution of Indian | Juhin JJuhin J
Rights are rules of interaction between people. These are legal, social, or ethical principles of freedom or entitlement and are the fundamental normative rules about what is allowed to people according to some legal system, social convention, or ethical theory.
Special groups are those who need special attention such as children, women, HIV, handicapped, aged and mentally ill. To protect these groups, these rights have been formulated by the constitution.
Continuing Nursing Education(CNE) is the process directed towards the personal and professional growth of nurses and other personnel while they are employed by a health care agency. It is essential for the upliftment of personal as well as administrative field. CNE helps in updating the knowledge and practice of professional. It is applicable not only to nursing field but also to all the professional fields.
Socioeconomic Status Scale | Nursing Education | Juhin JJuhin J
Socioeconomic status(SES) is a combination of both social and economic variables. It is one of the most important social determinants of health and disease. It influences the accessibility, affordability, acceptability and actual utilization of available health facilities.
Alternative Systems of Medicine in Mental Health | AYUSH | CAM | Juhin JJuhin J
Alternative Systems of Medicine in Mental Health | AYUSH | Complementary Alternative Medicine CAM | Juhin J
Medical products and practices that are not part of standard care is called alternative medicine. Standard care is what medical doctors and allied health professionals, such as nurses and physical therapists, practice. Alternative medicine is used in the place of standard medical care.
HERBAL: The use of plants to heal is probably as old as human kind. Virtually every culture in the world has relied on herbs & plants to treat illness. Many people are seeking a return to herbal remedies because they perceive these remedies as being less potent than prescription drugs and as being free of adverse side effects.
UNANI: According to the principles of unani medicine, disease is a natural process. Its symptoms are the reactions of the body to the disease.
SIDDHA: Siddha System of Medicine in an ancient Science, which belongs to Dravidian culture. It is very useful in maintenance and restoration of good health. Siddha system accounted for total 4448 disease symptoms and its cure. Thousands of herbs and mineral were Included in Siddha system providing good and easy management of chronic to degenerative, viral to cardiac disease.
HOMEOPATHY: Homeopathic remedies are typically derived from plants, herbs, minerals, or animal products. After being crushed and dissolved in alcohol or water, the selected substance undergoes a long process of dilution and succession (a process that involves vigorous shaking of the solution). The solution is then stored.
ACCUPUNCTURE: Acupuncture technique means penetrating the acupoints with hair thin, sterile, disposable, stainless needles to dissolve the obstructions along the meridians.
ACCUPRESSURE: Acupressure is similar in practice to acupuncture, but no needles are involved.
Disorders of Thought and Perception | Mental Health & Psychiatric Nursing | J...Juhin J
The ideas or arrangement of ideas that result from thinking is called thought. Thinking represent the most common form of mental activity. All human achievements and progress are the products of thought. Thought disorder is a disorganized way of thinking that leads to abnormal ways of expressing language when speaking and writing. It is one of the most difficult disorders to diagnose.
Impulse Control Disorder | Psychiatric Nursing | Juhin JJuhin J
Impulse control disorder happens when a person often unable to resist the sudden, forceful urge to do something that may violate the rights of others or conflict with societal norms. These impulsive behaviors may occur repeatedly, quickly and without consideration of the consequences of the actions.
Personality means enduring qualities of a person in many circumstances. It includes perceptions, attitudes and emotions. These behaviors and characteristics are consistent across a broad range of situations and do not change easily. A person usually is not consciously aware of his/ her personality. Many factors influence personality; some stem from biologic and genetic makeup, whereas some are acquired as a person develops and interacts with the environment and other people. These qualities develop into personality traits(Characters).
PERSONALITY TRAITS:
The most widely used system of personality trait is called Five- Factor Model. This includes, Openness, Conscientiousness, Extraversion, Agreeableness and Neuroticism. Each trait is further divided into several trait facets to analyse one’s personality clearly. Several theorists still argue that there are more traits which have not been captured by this five-factor model.
Openness people loves adventure, appreciate art, imagination and learn new things throughout their life time. Meanwhile low openness people avoid new experiences, stick to their habits and not adventure lovers.
Conscientiousness people are dependable, disciplined and achievement focused. Meanwhile low conscientiousness people are more spontaneous and careless, when extreme.
Extraversion people/ Extroverts are cheerful, sociable and draw energy from crowds. Meanwhile introverts love to be alone. Commonly people think introversion and shyness are same. They both are different. Shyness people has fear of social interaction meanwhile introverts are cheerful but they prefer solo or small group activities.
Agreeableness people are warmth, kind, helpful, compassionate and trust worthy. Meanwhile disagreeable people are cold and suspicious of others.
High Neuroticism people experience lot of negative emotion. Meanwhile low neuroticism people will be emotionally stable.
Personality disorder is defined as, “characteristic and enduring pattern of inner experience (or) behavior as a whole marked deviation for a level of exception and acceptable range of individuals’ culture”. – ICD 10
Persons with histrionic personality disorder are excitable and emotional and behave in a colorful, dramatic, extroverted fashion. Inability to maintain sincere, long-lasting attachments. They are unaware of their true feelings and cannot explain their motivations. With age, the symptoms of histrionic personality disorder will come down. But patients will feel hard to handle it because they lack the energy they had earlier.
Individuals with narcissistic personality disorder have a heightened sense of self-importance, lack of empathy and grandiose feelings of uniqueness. Underneath, however, their self-esteem is fragile and vulnerable to even minor criticism. Narcissistic symptoms diminish after 40 years of age.
Persons with avoidant personality disorder show extreme sensitivity to rejection and may lead socially withdrawn lives. Although shy, they are not asocial and show a great desire for companionship, but they need unusually strong guarantees of uncritical acceptance. We often describe this group as having an inferiority complex. Some marry, have children, and live their lives surrounded only by family members. If their support system fails, however, they are subject to depression, anxiety, and anger.
Primary sleep disorders:
Primary sleep disorders are those disorders not attributable to another cause, which includes dyssomnias and parasomnias.
Dyssomnias: are primary disorders of initiating or maintaining sleep/ excessive sleepiness, characterized by abnormalities in the amount, quality, or timing of sleep.
Insomnia:
Difficulty initiating or maintaining sleep or nonrestorative sleep that lasts for 1 month and causes significant distress or impairment in social, occupational, or other important areas of functioning.
Hypersomnia:
Excessive sleepiness for atleast 1 month that involves either prolonged sleep episodes or daily daytime sleeping that causes significant distress or impairment in social, occupational or other functioning.
Narcolepsy:
A rare sleep disorder in which a person, usually under the age of 20, has recurrent sudden episodes of irresistible sleep attacks of short duration 10 - 15 minutes (directly enters into REM sleep).
Breathing related sleep disorder:
Sleep disruption leading to excessive sleepiness or, less commonly, insomnia, caused by abnormalities in ventilation during sleep. These disorders include obstructive sleep apnea (repeated episodes of upper airway obstruction), central sleep apnea (episodic cessation of sventilation without airway obstruction), and central alveolar hypoventilation (hypoventilation resulting in low arterial oxygen levels).
Circadian Rhythm Sleep Disorder:
Persistent or recurring sleep disruption resulting from altered functioning of circadian rhythm or a mismatch between circadian rhythm and external demands. Subtypes include; delayed sleep phase, jet lag, shift work and unspecified.
Delayed sleep phase: A persistent pattern of late sleep onset and late awakening times, with an inability to fall asleep and awaken at a desired earlier time.
Jet lag: Sleepiness and alertness that occur at an inappropriate time of day relative to local time, occurring after repeated travel across more than one time zone.
Shift work: Insomnia during the major sleep period or excessive sleepiness during the major awake period associated with night shift work or frequently changing shift work.
Parasomnias: are disorders characterized by abnormal behavioral or psychological events associated with sleep, specific sleep stages, or sleep–wake transition. These disorders involve activation of physiological systems, such as the autonomic nervous system, motor system, or cognitive processes, at inappropriate times during sleep.
Nightmare disorder:
Repeated occurrence of frightening dreams that lead to waking from sleep.
Sleep terror disorder:
Repeated occurrence of abrupt awakenings from sleep associated with a panicky scream or cry.
Sleepwalking disorder (Somnambulism):
Repeated episodes of complex motor behavior initiated during sleep, including getting out of bed and walking around.
Personality means enduring qualities of a person in many circumstances. It includes perceptions, attitudes and emotions. These behaviors and characteristics are consistent across a broad range of situations and do not change easily. A person usually is not consciously aware of his/ her personality. Many factors influence personality; some stem from biologic and genetic makeup, whereas some are acquired as a person develops and interacts with the environment and other people. These qualities develop into personality traits(Characters).
PERSONALITY TRAITS:
The most widely used system of personality trait is called Five- Factor Model. This includes, Openness, Conscientiousness, Extraversion, Agreeableness and Neuroticism. Each trait is further divided into several trait facets to analyse one’s personality clearly. Several theorists still argue that there are more traits which have not been captured by this five-factor model.
Openness people loves adventure, appreciate art, imagination and learn new things throughout their life time. Meanwhile low openness people avoid new experiences, stick to their habits and not adventure lovers.
Conscientiousness people are dependable, disciplined and achievement focused. Meanwhile low conscientiousness people are more spontaneous and careless, when extreme.
Extraversion people/ Extroverts are cheerful, sociable and draw energy from crowds. Meanwhile introverts love to be alone. Commonly people think introversion and shyness are same. They both are different. Shyness people has fear of social interaction meanwhile introverts are cheerful but they prefer solo or small group activities.
Agreeableness people are warmth, kind, helpful, compassionate and trust worthy. Meanwhile disagreeable people are cold and suspicious of others.
High Neuroticism people experience lot of negative emotion. Meanwhile low neuroticism people will be emotionally stable.
Personality disorder is defined as, “characteristic and enduring pattern of inner experience (or) behavior as a whole marked deviation for a level of exception and acceptable range of individuals’ culture”. – ICD 10
Obsessive-compulsive disorder (OCD) is a chronic and relapsing anxiety disorder that is characterized by persistent obsessive thoughts and/or repetitive compulsive actions that impair daily functioning. The repetitive actions can be mental or physical acts, either of which is perceived by the individual as reducing anxiety. Individuals with OCD might recognize the irrationality of their anxiety-driven patterns, they feel helpless to resist the compulsive urges that serve as dysfunctional coping mechanisms to reduce anxiety. Many patients prefer to keep ritualistic compulsions such as repetitive checking of locks or repeated hand washing a secret because they are ashamed of their illogical behavior.
Definition:
Obsession: Repetitive thoughts, images and doubts which make a person absolutely senseless and irrational. Individual tries to resist but finds unable to do so because that restriction might increase the level of anxiety.
Compulsion: Repetitive actions are performed followed by obsession in order to avoid the marked distress even though the client knows that behavior is unrealistic, senseless and irrational.
Etiology/ Predisposing factors:
I. Biological Theories:
a) Neurotransmitters:
Studies have suggested that changes in brain serotonin(5-HT) function may contribute to anxiety symptoms and anxiety type behaviors. Among anxiety disorders, the most compelling evidence implicating 5-HT exists for OCD.
OCD patients were found to have higher plasma free 3-methoxy-4-hydroxy-phenylglycol and plasma norepinephrine levels. The maximum number of binding sites (Bmax) for tritiated clonidine was significantly greater in OCD patients than in normal people. There was a blunted growth hormone, cortisol and ACTH response to clonidine in OCD.
b) Genetics:
Family studies: 35% of first-degree relatives of OCD clients might suffer from this disorder.
Twin studies: Monozygotic twins are more prone to it as compared to dizygotic twins.
c) Electrophysiological Studies:
Electroencephalography: Many of the earlier reports suggested EEG abnormalities in OCD. Temporal lobe spikes and increased theta waves have been reported in sleep EEG or OCD subjects.
Evoked Potentials: Higher N60 amplitudes were found in somatosensory evoked patients in OCD. Obsessional patients are characterized by reduced amplitudes and decreased latencies of late EP component.
d) Brain Imaging:
Cranial CT and MRI scans: An increase in ventricular-brain ratio was found in cranial CT in OCD. Subsequent studies have shown similar results in caudate nuclei. Earlier reports found non-specific abnormalities on Magnetic Resonance Imaging of the brains in OCD.
Management:
IV. Psychosurgery:
There are various procedures that have been used in treatment of OCD. They are as follows;
• Prefrontal leucotomy
• Transorbital leucotomy
• Biomedical leucotomy
• Orbital leucotomy
• Rostral leucotomy
• Limbic leucotomy
• Subcaudate tractotomy
Hallucinogenic substances are capable of distorting an individual’s perception of reality. They have the ability to alter sensory perception and induce hallucinations. Substance induced hallucinations are usually visual.
The term opioid refers to a group of compounds that includes opium, opium derivatives, and synthetic substitutes. Opioids exert both a sedative and an analgesic effect, and used to relieve pain, cough and treatment of diarrhea. They induce a pleasurable effect on the CNS that promotes abuse. These drugs are capable of inducing tolerance and physiological and psychological addiction.
Inhalant disorders are induced by inhaling the aliphatic and aromatic hydrocarbons found in substances such as fuels, solvents, adhesives, aerosol propellants, and paint thinners. When inhaled, they cause euphoria, sedation, emotional lability, and impaired judgment.
Delirium is an organic cerebral syndrome characterized by concurrent disturbances of consciousness and attention, perception, thinking, memory, psychomotor behavior, emotion and sleep wake schedule.
Delirium Tremens is a psychotic condition caused by complications from alcohol withdrawal. It involves tremors, hallucination, anxiety and disorientation.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
3. OBJECTIVES
At the end of this session, you will be able to get clear understanding about;
• Loss– Introduction.
• List down the types of loss
• Grief – Introduction
• Enumerate the symptoms of grief
• Classify the types of grief
• List down the factors influencing loss and grief
• Explain the stages of grief
• Death and dying – Introduction
• Explain in detail about trajectory model
• Explain end of life care in detail
• Enumerate amyotrophic lateral sclerosis
• Describe the process of coping with loss, death and grief
• Enumerate care of care giver
4. INTRODUCTION
▪ Death is inevitable, loss of a close
friend or family member always
shower us with a range of emotions.
▪ Grieving for loved one helps us cope
and heal.
▪ Without a doubt, grieving is painful,
but it is also necessary.
▪ Going forward doesn’t meant
forgetting about the loved one who
died.
▪ It simply means that your grief has
run its course.
5. DEFINITIONS
A situation in which a valued
object or person is no longer
perceived as valuable
Loss
Normal, appropriate emotional
response to an external and
consciously recognized loss.
Grief
Cessation of all vital functions
of the body including heart,
brain activity and breathing.
Death
Adaptive or successful method of dealing
with individual or environmental
situations that involve psychological or
physiological stree or threat.
Coping
6. LOSS
● Loss is a part of life cycle.
● Everyone experience loss in
the form of change, growth
and transition.
● The experience of loss is
painful, frightening and lonely.
● It triggers a set of emotional
responses.
7. TYPES OF LOSSES
Necessary Loss
• Natural & Integral part
of each person’s life.
• Eg: Growing up process
Actual Loss
• Any loss of a person or
object
• Eg: Loss of child
Perceived Loss
• Any loss that is uniquely
defined, may be less obvious
to others, easily
misunderstood.
• Eg: Loss of confidence
Maturational Loss
• Any change in developmental
process that is normally
expected during a life time.
• Eg : Normal life transition.
8. TYPES OF LOSSES
Situational Loss
• Any sudden, un predictable external event.
• This loss includes multiple loss rather than a single loss.
• Eg: Automobile accident that leaves a driver paralyzed, unable to
return to work and grieving over the loss of passenger in accident.
Loss of external
objects
• Grieving depends on
object’s value,
sentiment attached to
it and its usefullness.
Loss of known
environment
• Loss occurs through maturational
or situational event.
• Loneliness or new unfamiliar
setting threatens self esteem and
makes grieving difficult.
• Eg: Moving from a neighbourhood
Cont.
9. TYPES OF LOSSES
Loss of an aspect of Life
• Illness, injury or developmental changes result in
loss of aspect of self.
• Eg: Loss of body part
Loss of Life
• Creates grief for those left behind.
• Person facing death often fears pain, loss of
control & dependency on others.
• Eg: Death of friend
Own death
Cont.
10. GRIEF
● Grief is an emotional response
to a loss.
● People grieve in different ways
and there is no time limit for
completing the grieving
process.
● Mourning – Psychological
process, an individual passes
on to successful adaptation to
the loss of a valued object.
● Bereavement – the inner
feeling and outward reactions
of survivor.
12. SYMPTOMS OF GRIEF
Anger
Even if the loss was
nobody’s fault, we may
feel irritated
Fear
May feel anxious, helpless
or insecure
Physical Symptoms
Fatigue, nausea, lowered
immunity, weight loss/
gain, pain, insomnia
Shock & disbelief
Have trouble in believing that
the loss really happened or
even deny the truth
Sadness
Have feelings of
emptiness, yearning or
deep loneliness
Guilt
may feel guilt about things
we did or didn’t say or do.
13. TYPES OF GRIEF
Normal grief
Consists of normal
feelings, behaviours and
reaction to a loss.
Anticipatory grief
Process of disengaging or
“letting go” before an actual
death.
Complicated grief
Bereavement appears to go
wrong and loss never
resolves
Disenfranchised grief
Experiences grief for a loss which
cannot be shared publicly.
14. FACTORS INFLUENCING LOSS & GRIEF
● Human development
● Psychological perspectives of loss and grief
● Socio- economic status
● Personal relationships
● Nature of loss
● Culture and ethnicity
● Spiritual beliefs
16. Shock
● May provide an emotional buffer and can protect an individual from
being overwhelmed all at once.
Denial
● May feel like the world around is meaningless and the life may make
no sense.
● It is a natural way of dealing with only what can be handled.
Anger
● May be directed at things or person that was lost, doctors, friends,
family, God, etc.
● It is a necessary stage of healing process.
17. Bargaining
● This is the step where one may think, “If this ____, then this ____”.
● It may come in a form of “what if” statements.
Depression
● Empty feelings come forward and one’s grief moves in a deep level
than before.
● This type of depression is not a sign of mental illness, although
reaching out for help maybe the right step.
18. Testing
● This is the process of rebuilding the life in the new setting.
● Individual may require further resources during this stage as they
are trying out what works for their new way of life.
Acceptance
● Accepting that, this is their new reality and it is permanent.
● Without acceptance life cannot go on.
19. NURSING IMPLICATIONS
Nurses should help the patient in
● Acceptance of the loss
● Acknowledgement of the
intensity of pain
● Adaptation of life after loss
● Cultivation of new relationships
and activities.
20. CARE OF BEREAVED
● Have contact physically and emotionally with the person.
● Assess when the person is in grieving process.
● Allow the person to grieve and normalize the grieving process.
● Encourage the person to talk about the relationship he/she had with the
deceased person.
● Tell the person to expect mood swings, pain and various life changes.
● Allow the person to take a break and focus on self care.
● Encourage sources of comfort such as religion or nature.
● Encourage medical or psychiatric care as needed.
21. DEATH & DYING
● Death means end of life.
● It means cessation of all vital
functions of the body
including heart, brain activity
and breathing.
22. DEFINITIONS
Legal order that tells a
health care team that patient
does not want to be intubated in
life threatening situations
DNI - Do Not Intubate
Removal of tubings to provide a
peaceful death. Eg: Ventilator
De- Escalation
DNR – Do Not Resuscitate
Legal order that tells a
health care team that patient
does not want CPR in life
threatening situations
23. DEFINITIONS
When the patient discharges himself from the
hospital, but the discharge has not been authorized by the
treating doctor
DAMA – Discharge Against Medical Advice
When the patient leaves the hospital
against the advice of Doctor, without informing or
may walk out of the ward
LAMA – Left Against Medical Advice
24. TRAJECTORY MODEL
● Nursing model, applicable in
situations on people with chronic
diseases.
● Developed by Anselm L Straus and
Juliet Corbin.
● This model is used to find the
actions taken by patient, families
and health care workers to manage
the course of disease.
25. STAGES OF COURSE OF DISEASE
● Initial or Pre trajectory phase
● Trajectory onset phase
● Crisis phase
● Actual phase
● Stable phase
● Unstable phase
● Downward phase
● Dying phase ●McCorcle & Pasacreta
●2001
26. NURSING PROCESS IN
TRAJECTORY MODEL
● Identify the trajectory phase
● Identify problems and establish goals
● Identify factors that facilitate attainment of goals
● Implement interventions
● Evaluate the effectiveness of interventions
(Corbin and Straus)
27. END OF LIFE CARE
Nursing care given to patient
and their family members during the
final weeks of life when death is
imminent.
28. GOALS OF END OF LIFE CARE
● Prevent or relieve suffering
● Provide comfort and support
● Maintain human dignity
● Respect patient wishes and desires
● Improve quality of life
● Provide emotional support
29. ASPECTS OF END OF LIFE CARE
Advance Directives Palliative Care
Hospice Care Preparation at the
end of life care
30. 1. ADVANCE DIRECTIVES
● Living Will
● Durable health care power of attorney
Patient Self Determination Act (PSDA) in 1990
31. 2. PALLIATIVE CARE
• Palliative care is active total care of the clients whose disease is
not responsive to curative treatment.
• The goal is not to give cure to the disease condition, but to
reduce pain and side effects and to improve the quality of life.
32. 2.1 PRINCIPLES OF PALLIATIVE CARE
• Respect likes & dislikes, goals and choices of dying person.
• Offer a support system to help patients live as actively as possible
until death.
• Concerned with healing rather than curing.
• Provide relief from pain and other distressing symptoms
• Accepting death but also life enhancing.
• Offer support system to help the family to cope during the patient’s
illness and in their own bereavement.
33. 2.2 PALLIATIVE CARE TEAM
• Doctor
• Nurses
• Dietician
• Spiritual advisor
• Physiotherapist
• Social worker
• Grief and bereavement coordinator
35. 3. HOSPICE CARE
● Criteria for hospice care
Hospice care refers to a
program that supports the client and
family through the dying process and
family members through the process of
bereavement, traditionally limited to
last six months of life.
36. 4. PREPARATION AT THE END OF
LIFE CARE
• Grieving loss
• Getting affairs in order
• Religion & Spirituality
37. AMYOTROPHIC LATERAL
SCLEROSIS (ALS)
● Signs and symptoms
● Causes
● Risk factors
● Diagnostic methods
● Management of ALS
● Complications
● Recent researches
Rare neurological
disease, affects nerve cells in
brain & spinal cord, responsible
for controlling voluntary muscle
movement, causing loss of
muscle control in chewing,
waling, talking, breathing, etc.
38. CLINICAL MANIFESTATION AT THE END
OF LIFE
• Sensory system
• Integumentary system
• Respiratory system
• Urinary system
• Gastrointestinal system
• Musculoskeletal system
• Cardiovascular system
• Psychosocial manifestations
39. NURSING IMPLICATIONS
Nurses should help the patient in
● Providing comfort
● Maintaining safety
● Addressing physical and
emotional needs
● Reducing pain
● Preventing dehydration
● Preventing skin breakdown
● Care of anorexia, nausea &
vomiting
40. COPING WITH LOSS, DEATH & GRIEF
• Seek out caring people
• Express your feelings
• Take care of your health
• Accept that life is for living
• Postpone major life changes
• Be patient
• Draw comfort from your faith
• Seek outside help when
necessary
41. CARE OF CARE GIVER
● Allow them to share the sorrow
● Don’t offer false comfort
● Offer practical help
● Be patient
● Encourage professional help when necessary
45. REFERENCES
Book:
Shebeer. P. Basheer , S. Yaseen Khan.(2013).A Concise Text Book of Advanced Nursing Practice . P.638-643
Journals:
The Journals of Gerontology, Series B, Vol 57, Issue 1, 2002, P. S33- S42
Internet:
https://www.ncbi.nlm.nih.gov/books/NBK518989/
https://www.medicinenet.com/script/main/art.asp?articlekey=83860
https://www.apa.org/topics/grief
https://www.nursingpath.in/2013/04/trajectory-model.html
https://medical-dictionary.thefreedictionary.com/de-escalate
https://slideplayer.com/slide/10731022/
https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Amyotrophic-Lateral-
Sclerosis-ALS-Fact-Sheet