PATIENT CARE STUDY
1.Objective data are underlined; subjective data are in
boldface.
LeRoy is a 40-year-old architectwhose life partner,
Michael, is dying of AIDS. Although both LeRoy
and Michael “did the bathhouse scene” in the early
1980s and had multiple unprotected sexual encoun-
ters, they have been in a monogamous relationship
for the past 14 years. Michael has been in and out
of the hospital during the past 3 years and is now
dying of end-stage AIDS at home. He is enrolled in
a hospice program. LeRoy has been very supportive
of Michael throughout the different phases of his ill-
ness but at present seems to be “losing it.”Michael
noticed that LeRoy is sleeping at odd times and
seems to be losing weight. He suspects that LeRoy
may be drinking more than usual and using
recreational drugs.He also says that he is “acting
strangely;” he seems emotionally withdrawn and
unusually uncommunicative. “I don’t think he’s
able to deal with the fact that I am dying,”
Michael tells you. “He won’t let me talk about it at
all.” The hospice nurse notes that LeRoy is now
rarely home when he comes to visit. When the hos-
pice nurse calls to arrange a meeting with LeRoy,
LeRoy informs him that he is “managing quite
well, thank you,”and that he has no concerns or
problems to discuss.
2.Nursing Process Worksheet
Health Problem: Anticipatory grieving
Etiology: Inability to allow himself to think about
what his life will be like without his life partner;
history of using denial as a coping mechanism
Signs and Symptoms: Partner reports that LeRoy is
sleeping at odd times and seems to be losing
weight. He suspects that LeRoy is drinking more
than usual and using recreational drugs. He also
says that he is “acting strangely” and that he seems
emotionally withdrawn and unusually uncommu-
nicative. LeRoy is now rarely home when the
hospice nurse visits. When the nurse called to
arrange a meeting with him, LeRoy informed him
that he was “managing quite well, thank you” and
that he had no concerns or problems to discuss.
Expected Outcome: LeRoy will openly express his
grief over Michael’s impending death and
participate in decision making for the future.
Nursing Interventions:
a.Determine what is making this anticipated loss
so “unthinkable.”
b.Encourage patient to share concerns. Normalize
the experience of grieving by sharing experiences
of other gay partners who have successfully
grieved over the death of their friends and loved
ones. Respect patient’s use of denial to make
time to work things through. Let him know you
are available to help at a later date, if necessary.c. Help the patient explore his usual strategies for
adjusting to loss (i.e., denial) and determine how
they are serving him now. If he feels they are
inadequate, help him develop new strategies.
d.Promote grief work through each phase of the
grieving process: denial, isolation, depression,
anger, guilt, fear, rejection. Help Michael under-
stand LeRoy’s grief and need to move in and out
of each stage at his own pace.
e.Refer patient to community-based support groups.
Evaluative Statement: 5/1/11: Goal not met. LeRoy is
still denying that he is experiencing any difficulty
dealing with Michael’s impending death; appears
fearful of even discussing this subject. Revision:
Reiterated stages of grieving and importance of grief
work; offered a listening ear should he decide he
wishes to talk about this later.—C. Taylor, RN
3.Patient strengths: LeRoy’s longstanding relationship
with Michael and desire to be present and support-
ive is a powerful motivator for getting him to
address his inability to consciously work through
his grief. LeRoy is intelligent and trusts healthcare
professionals, with whom he has had good experi-
ences in the past.
Personal strengths: Knowledge about stages of grief
and grief work; strong interpersonal skills; teaching
and counseling skills
4.5/13/11: LeRoy, the patient’s life partner and signifi-
cant other, called today to arrange a time to meet.
He noted that he finally had a long talk with
Michael and can see that he hasn’t been able to
deal with his dying in a conscious manner at all: “I
guess I just kept hoping that if I didn’t think about
it, it wouldn’t happen.” He says he realizes that if
he continues in this manner, he won’t be able to
provide Michael the support he needs. He also
admits feeling “totally overwhelmed.” Brief discus-
sion of stages of grieving and grief work, and
appointment made for follow-up.—C. Taylor, RNCHAPTER 44
PRACTICING FOR NCLEX
MULTIPLE CHOICE QUESTIONS
1.c 2.d 3.b 4.a 5.b
6.d 7.b
ALTERNATE-FORMAT QUESTIONS
Multiple Response Questions
1.b, c, e, f
2.c, d, e
3.a, c, e
4.d, e, f
5.a, d, f
6.b, d, f
7.c, e, fCopyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins. Study Guide for Fundamentals of Nursing:416 ANSWER KEY
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