INTRODUCTION: • BREATHING PATTERNS - refer to the rate,

volume, rhythm and relative ease or effort of res-

OXYGEN - a clear, odorless gas that constitutes piration.
approximately 21% of the air we breath, is • Eupnea - normal respiration; quiet, rhythmic,
necessary for proper functioning of all and effortless
living cells. • Tachypnea - rapid respiration
• Bradypnea - abnormally slow respiratory rate
RESPIRATORY SYSTEM - provides the essen- • Apnea - is the absence of any breathing
tial first process in the integrated system, move-
ment and transfer of gases between the atmosphere HYPOVENTILATION - inadequate alveolar
and the blood ventilation, may caused either slow or
shallow breathing, or both. It may lead to
RESPIRATION - is the process of gas exchange increased levels of carbon dioxide
between the individual and the environment and in- (hypercarbia or hypercapnia) or low levels of
volves four components: oxygen ( hypoxemla)

1.Ventilation or breathing - the movement of air in HYPERVENTILATION - is the increased move-

and out Of the lungs as we inhale and exhale ment of air into and out of the lungs; the rate and
depth of respiration increase, and more CO2 is
2. Alveolar-capillary gas exchange - which in- eliminated than Is produced.
volves the diffusion of oxygen and carbon dioxide
between the alveoli and the pulmonary lungs KUSSMAUL'S BREATHING - accompanies
metabolic acidosis by blowing off acid in the form
(KULANG NO.3) of CO2.

4. Movement of Oxygen and carbon dioxide ABNORMAL RESPIRATORY PATTERNS

between the systemic capillaries and the ARE:
tissues
a. CHEYNE - STOKES RESPIRATION- marked
rhythmic waxing and waning of respirations from
Condition Affecting the Airways: very deep to very shallow with short periods of ap-
• Partial obstruction of the upper airway passages nea commonly caused by chronic diseases, in-
is indicated by low-pitched snoring sound during creased cranial pressure, or drug overdose.
inhalation.
b. BIOT'S RESPIRATIONS - shallow breaths
• Complete obstruction is indicated by extreme in- interrupted by apnea. (CNS disorders)
spiratory effort that produces no chest movement
and inability to cough or speak. c. ORTHOPNEA - is the inability to breathe
except in an upright or standing position.
(Assessment)
• Lower airway obstruction is not alwavs as easy to d. DYSPNEA - difficulty breathing or the feeling
observe - STRIDOR, a harsh, high-pitched sound, of being short of breath (SOB).
may be heard during inspiration.
Objective signs: flaring of nostrils, labored-
The client may have altered arterial blood gas appearing breathing, increased rate,
levels, restlessness, dyspnea, and adventitious cyanosis, and diaphoresis.
breath sounds (abnormal breath sounds)

Condition Affecting Movement of Air. (Assess- Condition Affecting Diffuslor. (Assessment)

ment)
HYPOXEMIA - reduced oxygen levels in the Inability to clear secretions or obstruction from the
blood, may be caused by conditions that impair dif- respiratory tract to maintain a clear airway.
fusion at the alveolar-capillary
level such as pulmonary edema or atelectasis (col- 2. Ineffective breathing pattern:
lapsed alveoli) or by low hemoglobin levels. Inspiration and/or expiration that does not provide
adequate ventilation.
HYPOXIA - insufficient oxygen anywhere in the
blood results, potentially causing cellular injury or 3. Impaired gas exchange:
death. Excess or deficit in oxygenation and/ or
carbon dioxide elimination at the alveolar
Signs are. capillary membrane.
• Rapid pulse
• Rapid, Shallow respirations and dyspnea 4. Activity intolerance:
• Increased restlessness or light-headedness Insufficient physiological or psychological
• Flaring of the nares energy to endure or complete required or
• Substernal or intercostal retractions desired daily activities
• Cyanosis
5. Anxiety related to ineffective airway clearance
NURSING MANAGEMENT ASSESSING and feeling of suffocation
ONURSING HISTORY
O data about current and past respiratory problems 6. Fatique related to ineffective breathing
O lifestyles paftern
O presence of cough (sputum)
pain 7. Fear related to chronic disabling respiratory
OMedications of breathing illness
O Presence of risk factors
8. Powerlessness related to inability to maintain
ASSESSING independence in self-activities because of Inef-
PHYSICAL EXAMINATION fective breathing pattern

Inspection - observe the rate, depth, rhythm 9. Insomnia related to activity intolerance and
and quality of respirations, noting the inability to travel to usual social activities
position the client assumes for breathing.

•Inspect the shape of the thorax: client with OVERALL OUTCOMES/GOALS for a
emphysema develops a BARREL CHEST client with oxygenation problems.
Palpation - for bulges, tenderness, or 1. Maintaln a patent alrway.
abnormal movement. To detect vocal (tactile) 2. Improve comfort and ease of breathing.
fremitus. 3. Maintain or improve pulmonary ventilation
Percussion - for diaphragmatic excursion and oxygenation.
Auscultation - for chest to assess if the client’s 4. Improve the ability to participate in physical
breath sounds are normal or abnormal. activities
5. Prevent risks associated with oxygenation
ASSESSING DAIGNOSTIC EXAM problems such as skin and tissue breakdown.
• Sputum specimens syncope, acid-base imbalances, and feelings of
• Throat cultures hopelessness and social isolation
• Visualization procedures
• Venous and arterial blood specimens CLIENT TEACHING PROMOTING
• Pulmonary function tests = measure lung volume HEALTHY BREATHING
and capacity. • Sit straight and stand erect to permit full
expansion.
NANDA diagnostic labels for clients with • Exercise reqularly.
oxygenation problems. • Breath through the nose.
1. Ineffective airway clearance: • Breath in to expand the chest fully.
• Do not smoke cigarettes, cigars, or pipes.
• Eliminate or reduce the use of household of postural drainage by assessing the Vital
pesticides and irritating chemical sub- signs.
stances • is the drainage by gravity of secretions from vari-
• Do not incinerate garbage in the house. ous lung seqments
• Avoid exposure to secondhand smoke.
• Use building materials that do not emit va- MEDICATION:
Bronchodilators - reduce bronchospasm, opening
pors.
fight and congested airways and facilitating ventila-
• Make sure furnaces, ovens, and wood tion.
stoves are correctly ventilated.
• Support a pollution-free environment. Anti-inflammatory- decrease the edema and
inflammation in the airways and allowing a better
Nursing interventions to maintain nor- air exchange.
mal respiration.
Expectorant - help breaks up mucous, making it
more liquid and easier to expectorate.
1. Positioning the client to allow for maximum
chest expansion.
ICENTIVE SPIROMETRY
2. Encouraging or providing frequent changes
position
• Referred to as sustalned maximal Inspiration de-
3. Encouraging ambulation
vice (SMI)
4. Implementing measures that promote com-
• Measure the flow of alr Inhaled through the
fort, such as giving pain medications.
mouthplece and are used to:
Nursing interventions to facilitate pul- - Improve pulmonary ventilation
monary ventilation - Counteract the effects of anesthesia or hypoven-
tilation
1. Ensuring a patent airway - Loosen respiratory secretions
2. Positioning - Facilitate respiratory gaseous exchange
3. Emergency deep breathing and co - Expand collapse alveoli
(abdominal and pursed-lip breathi
4. Ensuring adequate hydration OXYGEN THERAPY-OXYGEN DE-
5. Suctioning LIVERY SYSTEM
6. Lung inflation techniques
7. Administration of analgesics before
A. CANNULA
deep breathing and coughing.
nasal cannula (nasal prongs) is the most common
8. Percussion, vibration and postural
and inexpensive device used to administer oxygen.
drainage
• Delivers low concentration of O2 (24% - 45%) at
9. Medications
flow rates of 2 - 6 LPM.
10. Oxygen therapy
B. FACE MASK
PERCUSSION (clapping)- is forceful striking of
• Simple face mask - delivers 40% - 60% at liter
the skin with cupped hands, can mechanically dis-
flows of 5 - 8 liters per minute.
lodge tenacious secretions from the bronchial walls.
VIBRATION - a series of vigorous quivering pro-
duced
by hands that are placed flat against the client's
chest wall, to increase the turbulence of the exhaled
PARTIAL REBREATHER MASK
air and thus loosen thick secretions.
Delivers oxygen concentrations of 60% - 90% at
liter flows of 6 to 10 L per minute.
POSTURAL DRAINAGE - is the drainage by
• The oxygen reservoir bag that is
gravity of secretions from various lung
attached allows the client to rebreathe about the
segments.
first third of the exhaled air in conjunction with
• It is done 2-3 times daily
oxygen.
• Avoid hours shortly after meals, it can induce
vomiting
THE NON BREATHER MASK
• Nurse need to evaluate the client's tolerance
• Delivers the highest O2 concentration - 95% - 2. To facilitate ventilation
100% at liter flows of 10 to 15L per minute. 3. To obtain secretions for diagnostic purposes.
4. To prevent infection that may result from
VENTILATION MASK accumulated secretions
• Delivers O2 concentrations varying from 24% to
40% or 50% at liter flows of 4 to 10L per minute CHEST TUBES AND DRAINAGE SYS-
and has wide-bore tubing and color-coded jet TEMS
adapters that correspond to a PNEUMOTHORAX - when air collects in the
precise O2 concentration and liter flow. pleural space
HEMOTHORAX - Is the accumulation of blood
FACE TENT in the pleural space
• Delivers 30% to 50% concentration of O2 at 4 to PLEURAL EFFUSION - exist when there is ex-
8L per minute cessive fluld in the pleural space

ARTIFICIAL AIRWAYS The air, blood, or fluid in the pleural space

places pressure on lung tissue and interferes
OROPHARYNGEAL with lung expansion
ANDNASOPHARYNGEAL
- used to keep the upper air passages open CHEST TUBES may be inserted into the
when the become obsfructed with pleural cavity to restore negative pressure
secretions or the tonque. and drains collected fluid or blood.

OROPHARYNGEAL AIRWAYS-STIMU- Nursing responsibilities regarding drainage

LATES GAG REFLEX AND ARE ONLY USED systems:
FOR CLIENT WITH ALTERED LEVEL OF • Monitor and maintain the patency and integrity of
CONSIOUSNESS the drainage system.
• Assess the client's vital signs, oxygen saturation,
Nasopharyngeal airways - tolerated better by alert cardiovascular status, and respiratory status.
clients for they are inserted through • Check the breath sounds bilaterally and check
the nares, terminating in the oropharynx for symmetry of breath sounds.
• Observe the dressing sites at least every 4 hours.
2. ENDOTRACHEAL TUBES Inspect the dressing for excessive abnormal
• commonly inserted in clients who have had drainage.
general anesthesia or for those in emergency • Determine level of discomfort with and without
situation when mechanical ventilation is activity.
required. inserted through the mouth or the nose • Encourage deep breathing exercises and cough-
and into the trachea with the quide of a laryngo- ing every 2 hours with client in upright position.
scope. • Reposition the client every 2 hours.
• Assist client with ROM exercises of the affected
3. TRACHEOSTOMY shoulder 3x per day to maintain joint mobility
. used to client who need airway support • Ensure that connections are securely taped, and
due to a temporary or permanent that
condition. • the chest tube is secured to the client's chest wall.
• an opening into the trachea through the • Keep the collection device below the client's
neck. chest level.
• Frequently check the water-seal and suction con-
4.SUCTIONING trol chambers. The water-seal level should fluctu-
used for clients who have difficulty handling secre- ate witH respiratory effort.
tion or an artificial airways is in place, to clear air • Assess the drainage in the tubing and collection
passage. chamber.
-Is the aspiration of secretions through a • Avoid aggressive chest tube manipulation.
catheter connected to a suction machine or wall • Avoid clamping chest tube because this Increase
suction the risk of a tension pneumothorax.
• If the tube becomes disconnected from the col-
PURPOSES for Oropharyngeal, lecting system, submerge the end in 2.5 cm of
nasopharyngeal and nasotracheal suctioning: sterile saline or water to maintain the seal.
1. To remove secretions that obstruct airways
CARE OF CLIENTS TO PROMOTE • Nurses can often teach clients how to prevent
COMFORT AND HYGIENE foot problems.

• Oral hygiene should include daily dental flossing

HYGIENE
and mechanical brushing of the teeth.
- Is the science of health and its maintenance.
* PERSONAL HYGIENE
• Regular dental check ups and fluoride supple-
- Is the self-care by which people attend to such
ments are recommended to maintain teeth.
function as bathing . toiletinq, general body hy-
giene and groominG
• Nurses provide special oral care to clients who
are unconscious or debilitated.
COMMON SKIN PROBLEMS
• Changing bed linens is a part of maintaining
1. Abrasion - superficial layers of the skin are
hygiene It is important to keep beds clean and
scraped or rubbed away.
for patients. comfortable
2. Excessive dryness - skin can appear flaky and
rough.
3. Ammonia dermatitis (Diaper rash) - caused Nursing diagnoses:
by skin bacteria reacting with • Self-Care deficit: Bathing/hygiene
urea in the urine • Self-Care deficit: Dressing/Grooming
4. Acne - Inflammatory condition with • Self-Care deficit: Toileting
papules and pustules. • Self-Care deficit: Feeding
5. Erythema - redness associaled with a • Impaired skin integrity
variety of conditions, such as rashes, • Risk for infection
exposure to sun elevated body temperature. • Knowledge deficit
6. Hirsutism - excessive hair on a person's body • Disturbed body image
and face particularly in women
6. Hirsutism - excessive hair on a person's body
and face particularly in women

TWO CATEGORIES OF BATH

1. Cleaning bath CARE OF CLIENTS WITH MOBIL-
a. Complete bed bath - entire body is washed. ITY/
b. Self-help bed bath IMMOBILITY
c. Partial bath
d. Towel bath
e. Tub bath
Terms:
Activity tolerance - type and amount of exercise or
f. Shower
ADL an individual is able to perform without expe-
2. Therapeutic baths - given for physical effects,
riencing adverse effects.
to sooth irritated skin or to treat an area.
Base of support - foundation on which the body
rests. The distance between two feet when a person
SKIN CARE
is standing.
The major functions of the skin are to:
Center of gravity - the center of body mass.
• Protect underlying tissues
(midway between umbilical area and symphysis
• To help regulate body temperature
pubis)
• To secrete sebum
Line of gravity - imaginary vertical line at the cen-
• To transmit sensations through nerve
ter of gravity.
• receptors for sensory perceptions
Mobility- ability to move freely, easily, rhythmi-
• To produce and absorb Vit D in conjunction
cally and purposefully.
with.,
Phvsical activity - body movement produced by
• ultraviolet rays from the sun.
skeletal muscle contraction that increases energy
expenditures.
Special consideration:
Proprioception - awareness of posture,
When planning client's care, the nurse must take
movement and changes in equilibrium and the
the client's preferences into considerations.
knowledge of position, weight and resistance of ob-
jects in relation to the body.
• Nurses provide perineal-genital care for clients
Range of motion (ROM) - maximum movement
who are unable to do so for themselves
that is possible for joint.
Exercises - planned, structured and repetitive body -The lower center of gravity to the ground the
movements done to improve or maintain fitness. greater stability.
-Level of working area at waist decreases the
TYPES OF EXERCISE workload and energy consumption.
1.Isotonic - or dynamic exercise. -The wider the base of support, the greater the sta-
Example: running, walking, swimming. bility.
2.Isometric - static or sitting.
Example: gluteal, abdominal and quadriceps Lifting Reminders:
muscle contraction, Keel's exercise. 1. Bend with your knees.
3. Isokinetic - or resistive 2. Keep objects close to the body
Example: weightlifting 3. Never lift heavy objects (> 51 Ibs)
4. Aerobics - often done by a group of people 4. Avoid twisting while lifting a heavy object
while music is playing
Example aerobic dancing ACTIVITY INTOLERANCE - insufficient phys-
iological or psychological energy to endure or com-
Benefits of exercise plete required or desired daily activities
Cardiovascular SIGNS:
• efficient heart work and abundant blood supply • Breathing - Dyspnea, chest pain and shortness of
• Increases heart rate and strength of the heart mus- breath
cles contraction • Complaint - weakness or dizziness
Endocrine • HR /R significantly exceeds the normal baseline.
• elevation of metabolic rate • Pulse - weakening pulse
• Skin - sudden facial pallor
Gastrointestinal
• Improves appetite, facilitating peristalsis and Note: if patient's V/S return back to normal after 5
increases gastrointestinal tract tone. minutes, the activity is considered safe.
Muscular
muscle hypertrophy and good muscle tone.
• Increases joint flexibility and ROM
Psychological IMMOBILITY:
• Improve well being Effects of immobility
Respiratory 1. Cardiovascular
• Increased ventilation - clot formation due to impaired venous return.
• Prevent pooling of secretion of secretions in the -Dependent edema due to vein stasis, venous pres-
bronchi and bronchioles sure increases.
• Decreases breathing effort -Diminished cardiac reserve immobility results to
• Improve diaphragmatic excursion ANS predominance, increased HR may reduce the
preload
Skeletal -Orthostatic Hypotension = due to decreased
• maintenance of bone density, ROM, joint vasoconstriction ability of blood vessels in lower
flexibility. half of the body.
Urinary Cardiovascular creates:
excretion of more wastes, increased blood flow. • Venous stasis - blood stays in vein due to de-
Stasis(stagnation) crease muscular contraction which milks blood
• urine in the bladder is prevented. back to heart
• Venous vasodilatation - due to venous stasis
BODY MECHANICS - efficient, coordinated Thrombus formation
and safe use of the body to move objects and carry 2. Gastrointestinal - constipation due to
out activities of daily living. decreased peristalsis and colon mobility
Alternate - work-rest-work to prevent muscle 3. Integumentary - reduced skin turgor due
strain. to skin atrophy and fluid shifts, skin
Avoid - reaching, stretching and twisting breakdown due to poor skin circulation.
objects carried should be close to body 4. Metabolic System
• Contract muscles before use • • Anorexia due to decreased catabolism, de-
• Always face the direction of movement. creased metabolism.
-Bend with your knees and not with your waist
• Decreased metabolic rate: diminished chemical 1. Bed board
and physical processes. 2. Hand roll
• Negative calcium balance - more calcium is lost 3. side rails
compared to what is taken in. 4. Trapeze
• Negative nitrogen balance- more nitrogen is lost 5. Trochanter
• NNB represents protein depletion due to muscu- 6. Wedge pillow or abductor pillow - triangular-
lar regeneration or atrophy. shaped pillow made of heavy foam to maintain
5. Musculoskeletal the legs in abduction following total hip replace-
• Contractures- permanent shortening of the mus- ment.
cle, limiting mobility.
• Disuse atrophy- unused muscles decrease in size Musculo-Skeletal disorders
and strength.
• Disuse osteoporosis - bones demineralize without
exercise or weight bearing activities resulting 1. Carpal- tunnel syndrome - compression of the
into loss of calcium. median nerve at wrist level.
• Joint pain and stiffness - permanent immobility Phalen's sign - wrist pain upon wrist flexion
(ankylosis) of joints. Tinel's sign - wrist pain upon wrist
6. Respiratory systems percussion.
• Atelectasis - pooled secretions may block bron- 2. Compartment - increased pressure
chioles, causing collapse of lobes or within a muscle compartment reduces
• Decrease ventilation due to limited chest move- circulation to the area.
ment. of lungs. 3. DVT/Deep Vein Thrombosis - Blood clot that
• Pooling of secretions - Inability to move allows forms along the lining of a large vein. It is the most
secretions to pool by gravity results in resulting common complication of the lower leg surgery.
with normal diffusion of O2 and CO2 4. Dupuytren's contracture - flexion
7. Urinary system contracture of the 4th and 5th fingers of the hand
• Renal calculi - excess calcium in urine, alkaline due to slow and progressive thickening
urine of the palmar fascia.
• Urinary retention and stasis - altered role of grav- 5. Fat embolism syndrome - long bone fracture
ity in emptying the bladder. complication in which fat globules are released
Urinary retention, bladder distention, and from the yellow bone marrow into the blood stream
urinary incontinence (involuntary within 12
urination) - 48 hours after an injury
6. Osteomalacia - softening of the bone due to Vit.
Urinary infection - static urine provides an D deficiency.
excellent medium for bacterial growth. 7. Osteomyelitis - bone infection

MANAGING POSTURAL Hypotension 8. Osteoporosis - reduction of bone density

• Position - semi fowler's position (or 8 - 12 due to:
inches • Causative drugs.
• head elevation) • Anticonvulsants
• Steps: • Corticosteroids
• Sit up in bed for 1 minute • Heparin
• Sit on side of bed, dangle feet for 1 minute • Ethanol (alcohol)
• Stand, hold on bed's permanent edge for 1 • Sex hormone blockers
minute
Risk factors for osteoporosis
Reminders: • Family history
• Don't stand quickly after stooping down • Low ca intake
• Shave and comb hair at least one hour after • Estrogen deficiency
rising from bed. • Smoking history
• Rocking chair improves leg circulation. • High alcohol intake
• Attack time : Common hypotensive moments
-30 minutes to one hour after heavy meal 9. Paget's disease - slow, progressive bone
-1-2 hours after taking antihypertensive drug. destruction and bone remodeling resulting to
bone malformation due to an unknown cause.
10. Scoliosis - S-shaped malformation of the
Alignment devises
spine, most commonly in the right lateral those affected.
thoracic area. Females are more affected
with onset at adolescent years. LOSS
11. Sprain - excessive stretching of a ligament. LOSS - is an actual or potential situation in
12. Strain - excessive stretching of muscle which something that is valued is
or a tendon changed or no longer available.
People can experience the loss of:
Common Arthritis • body image
Rheumatoid arthritis - chronic, progressive, • a significant others
systemic inflammatory auto immune disease • a sense of well-being
primarily affecting synovial joints. • a job
Osteoarthritis - progressive deterioration and loss • personal positions or beliefs
of cartilage in joints.
Gouty arthritis - systemic disease in which urate TYPES of LOSS
crystals deposit in the joints causing inflammation 1. ACTUAL LOSS - can be recognized by others
2. PERCEIVED LOSS - is experienced by one
Nurses responsibilities person but cannot verified by others.
• To prevent the complication of immobility and Ex: A woman who leaves his employment to loss
reduce the severity of any problem resulting form of care for her children at home may perceive a in-
immobility dependence and freedom.
• To design exercise programs for clients thatpro- 3. ANTICIPATORY LOSS - experienced before
mote wellness the loss actually occurs.
death.
Ex: a woman whose husband is dying may experi-
Descriptors for functional level ence actual loss in anticipation of his death
0 - completely independent
(+1) - Requires use of equipment or device 4. SITUATIONAL LOSS
(+2)- Semi-dependent: requires help from another • losing one's job
person for assistance, supervision or teaching. • the death of a child
(+3) - Moderately dependent: requires help from • Losing functional ability because of acute illness
another person and equipment for device or injury
(+4) - Totally dependent: dependent, does not par- 5. DEVELOPMENTAL LOSS
ticipate in activity • departure of grown child from home
• Retirement from a career
• Death of aged parents
Nursing diagnoses:
• Activity intolerance
SOURCES of LOSS
• Impaired physical mobility
a. Loss of an aspect to oneself - a body part, a phys-
• Self-Care deficit
iological function, or a psychological attribute
• Risk for injury
b. loss of an object external to oneself
• Fear
c. Separation from accustomed environment
• Ineffective coping
d. loss of a loved or valued person
• Risk for infection
GRIEF - is the total response to the emotional
CARE OF THE DYING experience related to loss.
PERSON (End of Life Care) BEREAVEMENT - is the subjective response
experienced by the surviving loved ones
MOURNING - is the behavioral process through
End of Life which grief is eventually resolved or altered; it is
In clinical setting, the nurse encounters clients who
often
may experience grief related to declining health,
influenced by culture, spiritual beliefs, and custom
loss of the body part, terminal illness, or the im-
pending death of self or a significant others.
ENGEL'S STAGES OF GRIEVING
Nurses must recognize the influences on the 1. Shock and disbelief
dying process and be prepared to provide Refuses to accept loss
sensitive, skilled, and supportive care to all Has stunned feeling
Accept the situation intellectually but denies • Resolving emotional problem
it emotionally. • Mourner accepted about the loss

Ex: Nursing diagnoses to grieving clients

"I can't believe my mother died of breast cancer. Anticipatory grieving: Intellectual and emotional
She responses and behaviors
was never seriously ill in her life” Dysfunctional grieving: Extended, unsuccessful
use of intellectual and emotional responses and be-
2. Developing awareness haviors
Begin to acknowledge the loss, there maybe Interrupted family processes: if loss has such im-
crying, feeling of helplessness, frustration pact on the individual and family
despair and anger that can be directed to self or oth- Impaired adjustment: if the client has great diffi-
ers, including God and the diseased person. culty placing the loss in appropriate perspective to
Ex: his or her other life activities.
"Every time I think of my mother, I can't help but Risk for loneliness: related to loss of relationships
cry” with others

3. Restitution -Encourage the client to express and share grief

Participation in the ritual associated with death like with support people.
funeral wake, family gathering or religious cere- -Teach family members to encourage the client's
mony that help the individual accept the reality of expression of grief.
the loss and begin the recovery process -Encourage the client to resume normal activities
on a schedule to promote physical and psychologi-
Ex: cal health.
"I've been attending mass every morning to pray for
my mother's soul to help me get over her death' PROVIDING EMOTIONAL SUPPORT:
-Use silence and emotional presence with tech-
4. Resolving the loss niques of therapeutic communication.
The individual is preoccupied with the loss -Acknowledge the grief of the client's family and
the mourner may imitate the lost significant others.
person, the preoccupation decrease, -Offer choices that promote client autonomy.
usually in a year or more Provide information regarding how to access
-Attempt to deal with painful loss community resources: clergy, support groups and
-Still unable to accept new love object to counseling services.
replace lost person or object.
-May accept more dependent relationship with sup-
port person

5. Idealization
-Produces image of loss object/person that is
devoid of undesirable features.
-Represses all negative and hostile feelings
lost object/person
-May feel guilty and remorseful about the past
inconsiderate or unkind acts to lost person.
-Reinvest feelings in others
-Unconsciously internalizes admired qualities of
objects/person

6. Outcome
Behavior influenced by several factor:
• Importance of lost object /person as source of
support
• Degree of dependence on relationship
• Degree of ambivalence toward lost object/ person
• Number and nature of other relationship
• Number and nature of previous grief experiences