Question

Shirley Richardson (S. R.) is a 64-year-old hospice patient being cared for at home with the support of the hospice agency staff. She has a 4-year history of colon cancer with metastasis. She underwent surgery, radiation therapy, and various chemotherapy regimens over the last 4 years, until tumor growth continued despite the treatments. Chemotherapy was discontinued 2 months ago, and the metastasis accelerated. S. R.'s pain is being controlled by morphine sublingual drops. She is weak but able to use the bedside commode with assistance of one person. She requires assistance with activities of daily living (ADLs). Her husband of 41 years helps her during most of the day, but a hospice aide comes in daily for bathing. The hospice nurse visits three times per week. The family has declined hospice spiritual care because they are active with a church. The couple's grown son lives within 30 minutes and visits at least weekly but is busy with his own family and work. Their daughter lives 6 hours away and has been in touch only a couple of times during her mother's illness. When S. R. is awake, the couple often reminisces, looks at old photos of their family, and talks about funeral plans. As S. R.'s condition begins to deteriorate rapidly, the hospice nurse assesses her and tells Mr. R. that he should let the children know that their mother will probably live only a few more days. Mr. R. agrees to call his children and is openly crying while the nurse comforts him and sits quietly with him. They begin to plan S. R.'s care for her final days.

Questions 1. Which type of grief is Mr. R. experiencing right now? What type of grief reaction would the nurse expect from Mr. R. after his wife's death?

2. What type of grief reaction would the nurse expect from the couple's two children?

3. Identify an appropriate nursing diagnosis for Mr. R., and give reasons why it is appropriate.

4. What nursing interventions are appropriate for the couple during S. R.'s last few days?

Answer 1

1, The grief is defined as the series of occurrences in the resolution of loss. In the present situation MR.R, is experiencing anticipatory grief. The grief reaction included denial, acceptance, depression, anger and bargaining.The expected grief by the nurse from  MR.R is acceptance, because he understand the situation while the hospice nurse convey him about his wife condition after the assessment.

2,The grief reaction expect from the couples two children by the nurse is guilt, because the children were not involved much in their mother detorring condition when she needs more emotional support from her children.

3,Dysfunctional grieving related to real loss, to carry out activities of daily living.

MR.R accepted the loss before its occur as he reminisces, and look for old photos and good memories of the family, and he discusss the funeral plan with his wife SHIRLEY.

As grief is the reaction you have to a loss in your life and grief reaction is the normal process of reacting to a loss. the nursing diagonosis is appropriate in this scenario.

4, >Observe the non verbal communications, when the couples shows happy in mood, but looks sad.

> use short sentence for communication.

>use silence appropriately.

> introduce the client to an another client who is possibly convalescing from depression.