Suggested Answers to Case Studies, Chapter 43, Loss, Grief, and Dying
1a. Factors that contribute to a patient experiencing a “good death” include:

Control of symptoms

Preparation for death

Opportunity to sense a completion of one’s life

Good relationships with health care professionals
1b. Care that would be deemed “excellent” for dying patients include:
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Care that is guided by the values and preferences of the individual patient,
maintaining patient independence and dignity

Care that attends to the needs of both patient and family

Care that focuses on symptom relief, not limited to pain, using both
pharmacologic and nonpharmacologic methods

Care from all health professionals that have received insightful, culturally
sensitive, in-depth training in optimal care for dying patients

Provision of adequate funding to research continual improvement in end-oflife care
1c. The best way to meet the needs of a patient who is dying and wants to discuss
difficult family conversations is to:

Be willing to discuss patient fears and doubts openly

Serve as a nonjudgmental listener
1d. Strategies to promote personal communications with patients include:

Keep lines of communication open with your patient

Provide counseling and death education when patient asks for/needs
information

Do not provide false reassurance

Be willing to engage in personally uncomfortable (yet appropriate)
discussions that meet your patient’s needs---your needs are not the priority

Be vulnerable to cry, as appropriate

Utilize nonverbal communication
1e. Physical signs and symptoms that can signal impending death include:

Difficulty talking or swallowing
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Nausea, flatus, abdominal distention

Urinary and/or bowel incontinence or constipation

Loss of movement, sensation, and reflexes

Decreasing body temperature with cold or clammy skin

Weak, slow, or irregular pulse

Decreasing blood pressure

Noisy, irregular, or Cheyne--Stokes respirations

Restlessness and/or agitation

Cooling, mottling, and cyanosis of the extremities and dependent areas
2a. The nurse’s role in active euthanasia is one of refusal. It violates the American
Nurse Association Code for Nurses to participate in active euthanasia.
2b. Palliative care is holistic care provided across the health--illness continuum. It
involves symptom management for patients with chronic conditions. This patient
and family might benefit from shifting away from curative care, which includes
hospitalization and treatment. The patient’s code status involves aggressive
measures to sustain life. Palliative care enables the patient to stay home and
have symptoms addressed to ensure comfort. An advanced directive for this
patient would be a do-not-resuscitate code status, lifting ethical and legal
requirements for life-sustaining measures.
2c. An appropriate reaction of a nurse to the death of a patient for which the nurse
has offered care for a significant amount of time includes grieving stages:

Denial and isolation

Anger

Bargaining

Depression

Acceptance