Case Study #3
From Videbeck Chapter 10: Grief and Loss
The following scenario has questions interspersed throughout the material for ease of reading and review.
Maria Thomas lost her 36-year-old son to death two years ago. This is her experience of going through the grieving process.
Maria’s son David was recently married for his first time and was very happy. This was a great source of comfort to Maria. She also gained a grandson from the union. David became ill with bronchitis which quickly progressed to pneumonia. Although he received medical care, he kept getting weaker over the next few days after finishing antibiotic treatment. He went to the emergency department because he was having trouble breathing. The ED physician diagnosed him with COVID-19 and admitted him to the intensive care unit. The nursing staff and doctor provided excellent, kind care to David. At times Maria believed David was improving. Since Maria had been inoculated for COVID, the staff allowed her to put on personal protective equipment (PPE) and stay at David’s bedside. His wife was outside the room but could see him. She had not had her COVID shots. After 10 days of intense treatment David passed away with his mother at his side. Maria was devastated. Over the next couple of days she told her family, “I can’t believe that he’s gone, it seems so unreal to me.”
- Which stage of Elisabeth Kübler-Ross’ stage of grieving is Maria experiencing?
- Define this stage of grief.
Maria became inconsolable, crying all throughout the day. She had been prone to depression and anxiety before her son’s death, but it seemed worse now. She didn’t understand why she couldn’t just “get over it” and feel better.
- Which stage of Elisabeth Kübler-Ross’ stage of grieving is Maria experiencing?
- Define this stage of grief.
Maria still had David’s voice on her cell phone messages. She also had photos and a movie of him laughing. She played these over and over so that she could hear his voice again. Sometimes she thought she saw him or evidence that he was still near. She thought he would rustle a curtain or a piece of paper showing that his spirit lingered, giving her more time with him. She was glad to know that he wasn’t really gone. She believed he was helping her get through the loss.
- Which stage of Elisabeth Kübler-Ross’ stage of grieving is Maria experiencing?
- Define this stage of grief.
A few days after David died, Maria’s other son confessed what David had confided in him. David had received the COVID immunization about a month prior to his death. Maria was livid. “Why did he do that? I think that’s what caused his death!” Maria said that David’s doctor kept telling him to get it because he was severely overweight and felt that getting COVID itself would be bad for David. “I wish David wouldn’t have done it! He knows the side effects of those shots! Why didn’t he ask me first – I would have warned him! And why didn’t you tell me sooner?”
- Which stage of Elisabeth Kübler-Ross’ stage of grieving is Maria experiencing?
- Define this stage of grief.
David’s funeral seemed to provide some closure for his wife and son, although they missed him terribly. Maria went to visit them often to provide comfort. But often they ended up trying to comfort her instead. Maria continued to cry most of each day. She said, “I don’t understand why this happened, he was so young and had just begun his life with his wife and son.” She would often call family members and cry. She would say, “I still can’t believe it’s real. He’s not really gone. I can’t accept it.” This went on for months after David’s death.
- Which important stage of Elisabeth Kübler-Ross’ stage of grieving has Maria not yet experienced?
- Define this stage of grief.
In an effort to ease her depression, Maria’s medical health provider changed her medication. He prescribed fluoxetine.
- Which medication class is fluoxetine and what are the effects and nursing interventions and education for this medication?
After taking fluoxetine for two weeks, Maria’s suicidality increased. She had a history of suicide ideation but felt worse than ever.
- Why do you think this occurred?
- How long does fluoxetine take to become fully therapeutic?
Maria’s doctor advised her to keep taking the medication to see if she would feel more relief later when it reached its full therapeutic level.
After taking fluoxetine for two months, Maria felt increased depression, sadness, and despondency. She had difficulty functioning. She had difficulty sleeping until after midnight and then would sleep 14 hours at a time. She said, “I’m just so tired.”
Maria’s provider tried other medications over the next several months, duloxetine for two months and then bupropion.
- Which drug classes are each of these medications in?
- Describe their use, side effects, and nursing interventions/education (for each).
Maria felt little difference in her mood with either of these medications, except for a slight increase in energy. She continued to have severe depression 18 months after David passed away.
- What is Maria most likely experiencing?
- What should her provider recommend next?
- What are risk factors for the above type of grieving?
After some grief therapy and continuing her medications two years after David’s death, Maria admits that she is beginning to finally feel some relief. She finds comfort in the fact that David’s wife has remarried and expecting another child. Her new husband also has a daughter nearly the same age as David’s son. Maria has chosen to feel hopeful as she watches this new family grow. She is supportive and loving as their grandmother.
