DEALING W

ITH

DEATH

GRIEF AND DYING

Final stage of life is death

Ends unexpectedly

Must come to grips with terminal illness

THE NURSE AND DYING

https://www.youtube.com/watch?v=4o7w3iOV_WM

GRIEF AND DYING

Stages of grief

Denial

Anger

Bargaining

Depression

Acceptance

GRIEF AND DYING

Denial

Reject the idea

GRIEF AND DYING

Anger

Hostility directed at anyone they come in contact with

GRIEF AND DYING

Bargaining

Setting goals

Making promises to reach goals

GRIEF AND DYING

Depression

Quiet withdrawal

Spoken regrets

Great sadness

GRIEF AND DYING

Acceptance

Slowly separate from the world

Rest in peace and dignity

GRIEF AND DYING

Role of health care workers

GRIEF AND DYING

Special needs of terminal patients

Physical

Emotional and social

Spiritual

GRIEF AND DYING

Physical needs

Kept comfortable

Oral care, fluid intake and skin care

Report changes

GRIEF AND DYING

Emotional and social needs

Provide privacy

With family as much as desired

Listen if needed

Be genuine

GRIEF AND DYING

Spiritual needs

Cooperate with patient’s clergy

Assist in finding a clergy or chaplain

Remember it is their right to believe whatever feels right to them

GRIEF AND DYING

Hospice care philosophy

Death is a natural process

Control pain

Provide for psychological, spiritual, and social needs of the patient and family

Provide legal and financial counseling

GRIEF AND DYING

Hospice care services

Care for patients with 6 months or less to live

Nursing care under supervision of physicians and nurses

Care in hospice facility, long-term care facility or at home

Support patient and family

Provide counseling to family after death

DEATH AND POSTMORTEM CARE

Signs of approaching death

Less responsive Body functions slow down Lose of voluntary and

involuntary muscle control Involuntarily void or defecate Jaw may drop Breathing becomes irregular,

shallow and laborious Circulation slows, extremities

become cold and mottled Pulse becomes rapid then

weaker Skin becomes pale Eyes stare and do not respond

to light

D H S R A P P R O V E D C U R R I C U LU M -U N I T 1 2 18

SIGNS OF APPROACHING DEATHChanges in sensory functions

and ability to speakVisionincreased secretions in corner of eyesblurred visionfailing visionno eye movement/staring

D H S R A P P R O V E D C U R R I C U LU M -U N I T 1 2 19

SIGNS OF APPROACHING DEATHChanges in sensory functions

and ability to speak (continued)

Speechbecomes difficulthard to understandmay be unable to speak

Hearing - last function to be lost

D H S R A P P R O V E D C U R R I C U LU M -U N I T 1 2 20

SIGNS OF APPROACHING DEATH

Changes in circulation and muscle tone

Circulationfailsheat gradually lost from body

SKIN CHANGES

hands and feet cold to touch and mottledface becomes pale or gray and mottledperspiration may increase (diaphoresis)

D H S R A P P R O V E D C U R R I C U LU M -U N I T 1 2 22

SIGNS OF APPROACHING DEATHChanges in circulation and

muscle tone (continued)

Muscle tonebody limpjaw may dropmouth may stay partly open

D H S R A P P R O V E D C U R R I C U LU M -U N I T 1 2 23

SIGNS OF APPROACHING DEATHChanges in Vital SignsRespirationsslowershallowlaboredmay experience dyspnea, apnea, Cheyne-Stokesmucous collects in the throat and bronchial tubes (death rattle)

CHEYNE STOKES RESPIRATIONS

https://www.youtube.com/watch?v=CrKfmfuP9l4&safe=active

D H S R A P P R O V E D C U R R I C U LU M -U N I T 1 2 25

SIGNS OF APPROACHING DEATHChanges in Vital Signs (continued)

Pulserapidweak and irregular

Blood pressure dropsTemperatureelevatedsubnormal

D H S R A P P R O V E D C U R R I C U LU M -U N I T 1 2 26

SIGNS OF APPROACHING DEATH

Urinary and anal incontinence

Decreased peristalsis, abdominal distention

Release of flatus

Decreased pain

Loss of consciousness

DEATH AND POSTMORTEM CARE

During death

Notify head nurse

Remain respectful

Use soft, kind words

DEATH AND POSTMORTEM CARE

Moribund changes

Pupils dilatedNo pulse or respirationHeat lostUrinate, defecate or release flatus

Lowest parts of body turn purple

Rigor mortisOdor

DEATH AND POSTMORTEM CARE

Religion and death

Ask family and clergy what is acceptable

LESSON 2 – DEATH AND POSTMORTEM CARE

Postmortem care

Treat body with respect and dignity at all times

Use standard precautions