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Grief and Loss Concept Map
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Grief and Loss Concept Map
Carson Barnes
Assessment Data:
Concept Map:
Pearl Rogers
- Objective:
- 70 year old Female
- swolen knees and ankles
- limited mobility in lower extremeties
- admitted to a long term nursing care center
- dx of arthritis
- weight loss of 15 pounds in two months
- dx of adjustment mood disorder or adjustment disorder with a depressed mood (situational depression).
- Subjective
- recent loss of husband of 50 years unexpectedly
- Patient states "things haven't quite been the same since"
- patient's daughter reports she becomes "agitated and helpless at times and complains constantly of pain"
- patient's daughter also reports "she is chronically constipated, has difficulty sleeping, cries often, and has stopped engaging in activities that she loves such as crocheting, socializing with friends, and church services."
- patient states "I’m a sick woman, and no one will listen to me! “I can’t walk, I’m so weak. My head hurts and I’m always sick to my stomach. I haven’t had a bowel movement in a week, and I never sleep more than 3 hours a night.”
Priority Concept:
Concept: Grief and Loss
Problem: Situational Loss
Goals:
Priority:
Grief and Loss
1. Client will voice to RN the 5 stages of grief while admitted to encourage open communication.
2. Client will communicate with RN effective coping strategies for husbands death while admitted.
Collaborative Measures:
Collaborative measures
Some collaborative measures that would be included could be a spiritual care consult, references to local support groups for spouse loss, or therapy to discuss the grieving process. Some facilities may also offer in house bereavement counseling to aide in the process of losing a loved one.
Treatments for Grief and Loss
Pharmacological Interventions
- Treatment for grief and loss is idealy delt with non-pharmacologically first. This includes using distractions such as hobbies or talk therapy to deal with the stages of grief appropriately
- At times, non-pharmacological interventions are not enough to treat a client's depression from loss. When that is the case, some SSRIs can be prescribed. Specifically citalopram (Celexa) given 20-30mg PO daily can improve symotoms of depression in patients experiencing grief from situational loss.
Nursing Interventions:
Evaluation:
Client expressed feelings of helplessness since the sudden passing of husband.
1. Communicate therapeutically with patient and family members every shift to allow them to verbalize feelings due to situational loss.
Nursing Interventions
2. Encourage client to manage their own self-care needs for rest, sleep, nutrition, leisure activities to promote homeostasis.
Evaluation:
Client bathed with assistance and slept 4 hours through the night to promote emotional healing
Concept: Mood and Affect
Problem: Adjustment Mood Disorder
Goals:
Mood and Effect
1. Client will be able to adequately rest through the night with the help of therapy and treatment while admitted.
2. Client will display motivation to participate in previously enjoyed activities before situational loss.
Collaborative Measures:
Collaborative measures
Collaborative measures that may be used in the plan of care for a patient's mood and affect are similar to those with grief and loss. Those who may be involved include spiritual care, various support groups, communication therapy, psychiatry, and occupational therapy in collaboration with the nursing staff and HCP.
Pharmacological Interventions:
Pharmacological Interventions
Treatment of adjustment mood disorder include benzodiazepines, such as lorazepam (Ativan) and alprazolam (Xanax), or SSRIs or SNRIs, such as sertraline (Zoloft) or venlafaxine (Effexor XR). These medications in combination with traditional therapy are the best options to treat the client's newly diagnosed mood disorder.
Nursing Interventions
1. Encourage client to establish a daily routine to improve coping and promote self care.
Evaluation:
Client stated that she would "shower every morning before breakfast and pick out her outfit the night before" to set a goal for the following day
Nursing Interventions
2. Assist client in verbalizing thoughts and feelings to promote therapeutic communication and a trusting rapport.
Evaluation: Client verbalized that she was "feeling helpless," RN responded with therapeutic communication and touch to promote trust and rapport.
Concept: Mobility
Problem: Arthritis
Goals:
Mobility
1. Client will ambulate in hallway with assistance every two hours to promote mobility and GI motility.
2. Client will report 0/10 pain by end of shift through pharmacological interventions.
Collaborative Measures:
Collaborative Measures
Collaborative measures to aide in mobility would include the involvement of the nursing and nursing support staff, HCP, and physical and occupational therapy. This collaboration effort will result in the best outcome for the client.
Pharmacological Interventions
Pharmacological Interventions
Pain and inflammation are common side effects for a person diagnosed with arthritis, and it can become detrimental on a client's quality of life. To promote wellness in the client the HCP may prescribe NSAID therapy such as Ibuprofen (Advil) or a topical NSAID like diclofenac sodium (Voltaren) to decrease inflammation and pain.
Nursing Interventions
Evaluation:
Client stated pain was an "6 out of 10" in her knees, non radiating, throbbing sensation that is constant.
1. Assess pain level on a 0-10 scale noting PQRST every 4 hours to monitor for an increase in symptoms of arthritis which may cause impaired mobility.
Nursing Interventions
2. Administer Ibuprofen 400mg PO every 4 hours PRN for mild to moderate pain to manage sympotms of arthritis that are impairing mobility.
Evaluation:
Administered ibuprofen 400mg PO for pain of 6/10, reassessed pain 1 hour after administration with a rating of 2/10 indicating improvement.