Transcript Unit 32-Death and Dying

Unit 32- Death & Dying
Adonis K. Lomibao, R.N.
Objectives
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Spell & Define terms
Discuss differences in how people handle the
process of death & dying
List nursing assistant measures designed to
promote a peaceful death experience
List nursing assistant measures designed to
comfort family & friends of people who are
dying
Objectives Cont.
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List the stages of death & dying
Differentiate between spirituality &
religiousness
List the signs of impending death
Identify beliefs regarding death & dying in
various cultures
Introduction
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POSTMORTEM-the after-death
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Death is the natural result of the life process
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Death & Dying is handled differently by
different people
TERMINAL-life-ending
Intro Cont.
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Different reactions to terminal illness:
-Some have prepared for death & accept it
-Some look forward to relief
-some fearful or angry-denial/depression
-Others reach out, verbalize thoughts & feelings
-despair/anxiety---hostility to searching/groping
questions
Intro Cont.
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Reaction states are not predictable
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Accept pt's behavior with understanding
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Interpret pt's need for family support
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Support family in meeting their needs
5 stages of Grief
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Dr. Kubler-Ross
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The Five Stages:
-Denial
-Anger
-Bargaining
-Depression
-Acceptance
Denial
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Begins wn person is made aware that he is
going to die
May deny information
Most must go through denial before reaching
acceptance
Do not try to convince pt. Of diagnosis or
argue
Professional counseling may be needed
Anger
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Comes when pt. Is no longer able to deny the
fact that she is going to die
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May blame those around her for illness
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Added stresses are likely to upset pt.
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Remember pt. Is angry at diagnosis, not you.
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Remain calm & avoid making pt. Angrier
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Remedy problem that angers pt.
Bargaining
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The patient attempts to bargain for more time
to live
May be allowed to go home to finish a task
before death
pt. makes “deals” with a higher power
Frequently involves an important event the
patient has been looking forward to
Depression
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pt. realizes he will die soon\
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Sad that he won't see family friends
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May have no accomplished goals
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Regrets of not going somewhere/doing
something
Acceptance
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pt. understands & accepts he will die
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May complete unfinished business
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May help those around him deal with death
5 Stages of Grief
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Not all patients go trough stages in order
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Patients go back & forth between stages
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Staff must be able to identify pt's current
reactions
When all 5 are passed, pt. Is better able to
accept the termination of life
Family & staff also move through stagesdifficult when pt. Is at different stage
Post-funeral meals!
Preparation for Death
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Diagnosis of terminal illness difficult to conceal
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Staff may reveal information accidentally by:
-exhibiting false cheerfulness
-being evasive
-making fewer visits
-spending less time
Preparing for Death
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Each pt. Reacts to understanding of death in a
unique way
What feelings to share and with whom are
personal decisions
Be available to listen, but don't force issue
Common Fears
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Common fears with dying:
-Dying alone
-Fear of severe, unrelieved pain
-Fear of inability to finish personal business or
manage affairs
Reactions of Others
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In LTC Facility, other residents will be upset about
death or terminal diagnosis
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Loss reminds residents of end of life
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They will cope with their own pain & grief
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Other residents will:
-be sad & grieve loss of friend
-reminisce about person who died
-want to know about person who died
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Encourage others to express feelings. Be honest
without breaking confidentiality
The Patient Self-Determination Act
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Requires healthcare providers to provide
written info about state laws regarding
advance directives
ADVANCE DIRECTIVE-a document that is put
into effect if the patient later becomes unable
to make decisions
Informed of right to execute advanced
directive by at admission
Act passed so pt.'s wishes are followed
Patient Self-Determination Act
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SUPPORTIVE CARE- patient's life will not be
artificially prolonged but that the patient will be
kept comfortable physically, mentally, &
emotionally.
Includes:
-O2 if needed
-food & fluids by mouth
-meds for pain, nausea, anxiety, phys/emot
discomfort
Cont.
-physical care such as grooming,hygiene,
positioning, ROM
-caring & emotional support of staff
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LIFE-SUSTANING TREATMENT- giving
medications and treatments for the purpose of
maintaining life.
-ventilator
-CPR if cardiac arrest occurs
-artificial nutrition through feeding tube or
hyperalimentation device
-Blood transfusions
-Surgery
-Radiation therapy
-chemotherapy
2 Types of Advanced Directives
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LIVING WILL: a request that death not be
artificially postponed if the pt. Has an
incurable, irreversible injury, disease or illness
that the physician determines to be a terminal
condition
-must be witnessed by 2 persons that would not
benefit from person's death
2 Types of Advanced Directives
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DURABLE POWER OF ATTORNEY FOR
HEALTH CARE:assigns someone else the
responsibility for making medical decisions for
the patient if the patient becomes unable to do
so himself.
Must be signed by agent, principal, & witness.
Power of attorney can decide if life should be
prolonged, prolonged unless physician
believes pt. In irreversible coma, or wants life
prolonged regardless
DNR
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No-code order/DNR: no extraordinary means
(CPR) will be used to prevent death.
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Person dies with maximum dignity
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Pt. discusses decision with family & physician.
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Placed in chart & staff made aware
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Order can be changed
Witnessing Advance Directives
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Become familiar with facility policies & state
laws for witnessing
Many states, caregivers cannot witness or be
appointed to be the agent unless related by
blood or marriage.
Withdrawing/Modifying AD
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Pt. can withdraw or modify advanced
directives
If pt. Informs you of changes that affect AD,
notify nurse.
The Role of the Nursing Assistant
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Be a source of strength & comfort
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Instill confidence in pt. & family
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Keep in mind:
-consistent response guided by pt. Attitude & careplan
-be open & receptive,pt. attitudes change
-report incidents related to pt. Moods & needs
-don't force your own ideas
-Resolve your own conflicts with accepting death
PCT Roles Cont.
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Give best & most careful nursing care, esp.
mouth care & fluid intake
Be quietly empathetic...carry out duties in
calm, efficient way
CRITICAL LIST-pt. Condition is critical &
family/chaplain notified.
Providing for Spiritual Needs
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Spiritual faith comforts during difficult times
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Some religions have rituals when pt. Is ill or dying
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Allow for privacy for prayer, but be accessible
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Others have no formal religion, but need spiritual
needs from chaplain
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Others don't believe in higher beeing
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Respect beliefs & religious items
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Catholic-Sacrament of the Sick (Confession)
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Bible or spiritual reading may be requested
Remember Family
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Allow privacy with loved one
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Allow to assist with care if desired
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Inform where food can be obtained
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Privacy for calls
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Offer comfort if staying the night
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Avoid being judgemental
Hospice Care
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Terminally ill with less than 6 mos to live
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Direct physical care when needed
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Supports family & pt.
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Provided in facilities & home
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Largely carried out by home health assistant
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Follow-up bereavement counseling
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Volunteers visit
Goals of Hospice Care
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Control pain so pt. Can remain active in life
Coordinate psychological, spiritual, social
support services for pt. & family
Make legal & financial counseling available
Keep in mind...
-report pain
-encourage self-care
-listen & spend time
-get to know & support family
-give same care as if no terminal diagnosis
-always follow careplan
-carry out activities with dignity & respect
Physical Changes as Death
Approaches
-less responsiveness
-body functions slow
-loses general voluntary & involuntary muscle control
-may involuntarily void & defecate
-the jaw tends to drop
-irregular/shallow breathing
-circulation slows-rapid/weak pulse
-skin pales
-eyes stare & do not respond to light
-hearing last sense to be lost
As Death Approaches...
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Period before death, pt. Receives same care
as if he was to survive.
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Pay attention to physical/emotional needs
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If death is near, call nurse
Signs of Death
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MORIBUND changes: changes that continue to take
place in the body after death
-pupils become permanently dilated
-no pulse/respiration
-heat gradually lost from body
-patient may urinate/defecate/pass gas
-blood pools in low areas (purple)
-2-4 hours, rigor mortis (body rigidity)
-protein breakdown unless embalmed in 24hrs
-raise head of bed to 30 to prevent pooling
Postmortem Care
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POSTMOTEM CARE-care of the body after
death
-Standard precautions
-Dignity
-some leave alone till mortuary staff arrives
-check hospital procedure
Morgue Kit
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Shroud
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Clean gown
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ID Tags
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Gauze squares
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Safety pins
Organ Donations
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Organ donor card
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Specifies specific organs or whole body
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HARVESTED