DEALING WITH DEATH

GRIEF AND DYING Final stage of life is death  Ends unexpectedly  Must come to grips with terminal illness

THE NURSE AND DYING

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

DHSR APPROVED CURRICULUM- UNIT SIGNS OF APPROACHING DEATH Changes in sensory functions and ability to speak  Vision  increased secretions in corner of eyes  blurred vision  failing vision  no eye movement/staring

DHSR APPROVED CURRICULUM- UNIT SIGNS OF APPROACHING DEATH Changes in sensory functions and ability to speak (continued)  Speech  becomes difficult  hard to understand  may be unable to speak  Hearing - last function to be lost

DHSR APPROVED CURRICULUM- UNIT SIGNS OF APPROACHING DEATH Changes in circulation and muscle tone  Circulation  fails  heat gradually lost from body

SKIN CHANGES  hands and feet cold to touch and mottled  face becomes pale or gray and mottled  perspiration may increase (diaphoresis)

DHSR APPROVED CURRICULUM- UNIT SIGNS OF APPROACHING DEATH Changes in circulation and muscle tone (continued)  Muscle tone  body limp  jaw may drop  mouth may stay partly open

DHSR APPROVED CURRICULUM- UNIT SIGNS OF APPROACHING DEATH Changes in Vital Signs  Respirations  slower  shallow  labored  may experience dyspnea, apnea, Cheyne-Stokes  mucous collects in the throat and bronchial tubes (death rattle)

CHEYNE STOKES RESPIRATIONS

DHSR APPROVED CURRICULUM- UNIT SIGNS OF APPROACHING DEATH Changes in Vital Signs (continued)  Pulse  rapid  weak and irregular  Blood pressure drops  Temperature  elevated  subnormal

DHSR APPROVED CURRICULUM- UNIT 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 dilated  No pulse or respiration  Heat lost  Urinate, defecate or release flatus  Lowest parts of body turn purple  Rigor mortis  Odor

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