Grieving - Nursing Case Study

Pathophysiology

• Primary mechanism: Grieving involves the activation of the limbic system, particularly the amygdala, which processes emotions and triggers stress responses. This can lead to physical symptoms like changes in appetite and sleep disturbances.

• Secondary mechanism: The hypothalamic-pituitary-adrenal (HPA) axis is often activated during grieving, resulting in increased cortisol production. Elevated cortisol levels can affect mood, immune function, and overall health.

• Key complication: Prolonged activation of these systems may lead to minor complications such as anxiety, depression, and weakened immune response, highlighting the importance of supportive care in managing emotional and physical health during the grieving process.

Patient Profile

Demographics:

45-year-old female, school teacher

History:

• Key past medical history: Mild hypertension

• Current medications: Lisinopril 10 mg daily

• Allergies: None

Current Presentation:

• Chief complaint: Feeling of sadness and loss

• Key symptoms: Tearfulness, occasional insomnia, lack of appetite

• Vital signs: Blood pressure 125/80 mmHg, heart rate 72 bpm, respiratory rate 16 breaths per minute, temperature 98.6°F

Section 1

Initial Assessment Findings:

During the initial assessment, the nurse observes that the patient is oriented to time, place, and person but appears visibly tearful and speaks in a soft, subdued tone. She reports feeling overwhelmed by the recent loss of her father, who passed away unexpectedly three weeks ago. The patient describes her father as her biggest supporter, and his absence has left her feeling a significant void. While she maintains her responsibilities as a school teacher, she expresses difficulty concentrating on tasks that once brought her joy.

The nurse conducts a physical examination and gathers additional information about the patient's daily routine and coping mechanisms. The patient reveals that she has been neglecting her usual morning walks, which she used to find soothing, and has been skipping meals due to a lack of appetite. Despite these changes, her vital signs remain stable, with a blood pressure reading of 125/80 mmHg, heart rate at 72 bpm, respiratory rate at 16 breaths per minute, and temperature at 98.6°F. The patient denies any suicidal ideation or thoughts of self-harm, though she admits to feeling persistently sad.

The nurse initiates a discussion on supportive measures, highlighting the importance of self-care practices and social support. The patient is encouraged to gradually reintroduce activities she finds comforting, such as short walks and regular meals, to help stabilize her mood and energy levels. The nurse also suggests considering a support group for individuals who have experienced similar losses, offering a space to share feelings and gain new coping strategies. This approach aims to address the emotional and physical aspects of grieving, promoting a holistic path to recovery.

Section 2

Response to Interventions:

Two weeks following the initial assessment, the patient returns for a follow-up appointment with the nurse. Upon entering the clinic, she appears more composed, though still carries a somber demeanor. During the consultation, the patient shares that she has made a concerted effort to reintroduce her morning walks, finding them to be a gentle but effective way to start her day. She reports a slight improvement in her appetite and has been attempting to eat small, regular meals. The patient acknowledges that while her grief remains present, these small steps have brought her moments of peace and clarity.

The nurse notes that these positive changes have resulted in a slight improvement in the patient's overall mood and energy levels. Her vital signs remain stable: blood pressure is 122/78 mmHg, heart rate is 70 bpm, respiratory rate is 16 breaths per minute, and temperature is 98.5°F. The patient has started attending a local support group for individuals grieving the loss of loved ones, and she describes the experience as a comforting reminder that she is not alone in her journey. She mentions having found solace in sharing stories and listening to others who are in similar situations, which has provided her with new perspectives and coping strategies.

The nurse acknowledges the patient's progress and reinforces the importance of maintaining these self-care practices, along with continued participation in the support group. The nurse also suggests setting small, attainable goals to help the patient feel a sense of accomplishment and gradually rebuild her routine. Encouraged by the positive feedback, the patient expresses a cautious optimism about her ability to navigate this challenging time. As the session concludes, the nurse and patient agree on a plan for another follow-up visit in a month to assess ongoing improvements and address any new concerns.

Section 3

One month later, the patient returns for her scheduled follow-up visit with the nurse. She appears more at ease and shares that she has maintained her morning walks and has even extended them by a few minutes each week. Her focus on small, regular meals has become a consistent routine, and she reports an improved appetite and more stable energy levels throughout the day. The patient continues to attend the support group regularly and has developed a few friendships with other members, which she finds to be a source of strength and encouragement.

During the assessment, the nurse observes that the patient’s affect is brighter, and she engages more readily in conversation. Her vital signs indicate stability and slight improvement: blood pressure is 118/76 mmHg, heart rate is 68 bpm, respiratory rate is 16 breaths per minute, and temperature remains at 98.4°F. The patient mentions that she has started journaling as a way to process her feelings and reflect on her journey, which has provided her with a sense of release and insight. She has also begun setting small, daily goals, such as completing a household chore or calling a friend, which have given her a sense of purpose and accomplishment.

The nurse reinforces the importance of these positive habits and suggests incorporating a relaxation technique, such as deep breathing exercises or meditation, to further support her emotional well-being. The patient agrees to try this and expresses gratitude for the support and guidance she has received. As they conclude the session, the nurse and patient agree to another follow-up in six weeks to continue monitoring her progress and address any new challenges she may encounter. This plan aims to ensure that the patient’s journey through grief continues to be supported with a focus on gradual, sustainable improvements in her overall well-being.

Section 4

Six weeks later, the patient returns for her follow-up appointment, and the nurse immediately notices the patient's continued positive demeanor. During the initial assessment, the patient reports that she has successfully incorporated deep breathing exercises into her daily routine, finding them particularly helpful in moments of stress or when feeling overwhelmed. She shares that she has experienced a few days of feeling more down than usual, but these have been less frequent and less intense than before. Her routine of morning walks, consistent meals, and support group attendance remains strong, and she has found particular joy in her growing friendships.

The nurse conducts a thorough assessment, noting that the patient's vital signs remain stable: blood pressure is 116/74 mmHg, heart rate is 66 bpm, respiratory rate is 15 breaths per minute, and temperature is 98.2°F. The patient mentions experiencing mild headaches over the past two weeks, which tend to occur in the late afternoon. She has managed them with over-the-counter analgesics, but the nurse decides to explore this further. Upon questioning, the patient reveals that she has been working on a personal project that sometimes extends into the evening, potentially leading to eye strain and inadequate hydration.

The nurse advises the patient to take regular breaks during her projects and ensure she is drinking enough water throughout the day. They discuss setting a timer to remind her to rest her eyes and hydrate regularly. The nurse also suggests scheduling an eye exam to rule out any vision-related issues. The patient agrees to these interventions and expresses confidence in her ability to manage the headaches with these adjustments. The nurse and patient plan another follow-up in two months to continue monitoring the patient's progress and address any new developments, aiming to maintain the positive trajectory in her journey through grief.

Section 5

Two months later, the patient returns for her scheduled follow-up appointment. The nurse notes that the patient continues to display a positive and motivated attitude, though she mentions experiencing a few additional stressors related to work. During the assessment, the patient's vital signs remain within normal limits: blood pressure is 118/76 mmHg, heart rate is 68 bpm, respiratory rate is 16 breaths per minute, and temperature is 98.1°F. The patient reports that the mild headaches have decreased significantly since she began taking regular breaks during her projects and increasing her water intake. However, she mentions a new concern: occasional difficulty falling asleep despite feeling tired.

The nurse conducts a further assessment and learns that the patient has been drinking caffeinated beverages later in the afternoon to maintain her energy levels. The nurse educates the patient about the potential impact of caffeine on sleep patterns and suggests she try reducing her caffeine intake after lunchtime. The nurse also advises exploring relaxation techniques before bedtime, such as reading or listening to calming music, to help signal her body that it's time to wind down.

In addition, the nurse inquires about the patient's recent eye exam, which revealed mild vision changes requiring corrective lenses. The patient shares that she has started wearing glasses while working on her projects, which has further alleviated the eye strain. The nurse praises the patient's proactive approach and self-care strategies, reinforcing the importance of these habits in managing her overall well-being. They agree to another follow-up in three months to assess her sleep quality and continue supporting her progress through her grieving process.