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Difficulty: MediumGrief and Loss

An older adult client visits a community health clinic for a routine wellness check. The client's spouse passed away 18 months ago. During the intake assessment, which of the following statements by the client indicate to the licensed practical nurse (LPN) that the client is experiencing manifestations of complicated grief and requires reporting to the registered nurse (RN)? Select all that apply.

  1. "I continue to set a place at the dinner table for my spouse every evening."Answer
  2. B
    "I still experience waves of deep sadness on our wedding anniversary."
  3. "I have avoided seeing any of my friends or family since the funeral."Answer
  4. D
    "I recently started attending a community support group for widows."
  5. "I feel like my life is completely empty and meaningless without them."Answer

Answer

The statements indicating complicated grief are continuing to set a place at the dinner table, avoiding friends and family since the funeral, and feeling that life is completely empty and meaningless.
Complicated grief (or prolonged grief disorder) is characterized by an intense, persistent yearning for the deceased, profound denial of the loss, and severe impairment in daily functioning that lasts far beyond the expected mourning period (typically greater than 12 months in adults). Continuing to set a place at the table indicates persistent denial. Avoiding all friends and family indicates severe social impairment. Feeling that life is entirely empty and meaningless is a core feature of prolonged grief. The LPN must recognize these deviations from normal grieving and report them to the RN for comprehensive assessment and potential psychiatric referral.

Step-by-Step Solution

1
Analyze the client's timeline and the nature of the loss.
The client is an older adult whose spouse died 18 months ago.
Understanding the timeline helps differentiate between acute normal grief and prolonged complicated grief, which is typically diagnosed after 12 months in adults.
2
Evaluate each client statement to determine if it represents an adaptive coping mechanism, a normal grief reaction, or a maladaptive, complicated grief response.
Setting a place at the table, severe social isolation, and persistent feelings of meaninglessness represent severe impairment and denial.
Complicated grief is characterized by prolonged, severe functional impairment, intense emotional pain, and inability to accept the loss well beyond the typical mourning period.
3
Identify the LPN scope of practice regarding abnormal findings.
The LPN should recognize these abnormal psychological findings and report them to the RN for further assessment and intervention.
The LPN plays a critical role in data collection and must escalate significant deviations from normal coping to ensure the client receives appropriate psychiatric or counseling referrals.

Key Concept

Differentiating manifestations of complicated grief from normal grief reactions in older adults.
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Topics

Grief and Loss

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