1. Chapter 23: Caring for People who are Dying
Nursing Assistant III
Chapter 23: Caring for People who are Dying

2. Usually we consider a person “dead” when the heart stops beating and cannot be started again
A physician can also declare a person dead when there has been a permanent loss of brain function
To be declared “brain dead” a person must show no brain activity for a specified amount of time by law (usually 24 hours or more)
Death and dying

3. Physical signs of impending death
Many people die suddenly
With so-called “natural death” there are many physical signs as the body begins to shut down
Signs may appear over the course of a few hours or a few days, or even as fast as a few minutes
Physical signs of impending death

4. Physical signs of impending death
Circulation Fails
BP drops
Pulse becomes rapid and weak
Skin feels cool and clammy
Body temperature rises
Person may perspire heavily
Skin appears mottled, pale, and cyanotic
Person will not need to be heavily covered
Physical signs of impending death

5. Physical signs of impending death
Respiratory Pattern
Person may take rapid, irregular, shallow breaths
Cheyne-Stokes Respiration
Fluid and mucus collects in air passages
“Death Rattle”
Physical signs of impending death

6. Physical signs of impending death
Digestive System
Slows down
Nausea
Vomiting
Abdominal swelling
Fecal impaction
Bowel incontinence
May not want food or water
Oral care
Physical signs of impending death

7. Physical signs of impending death
Urinary system
Kidneys respond to lack of blood flow
Physical signs of impending death

8. Physical signs of impending death
Nervous System
Decrease muscle tone
Decreased sensation
Muscles relax
May loose ability to speak
Vision becomes blurred
People may turn towards light
Hearing remains normal until time of death
Physical signs of impending death

9. Physical signs of impending death
Consciousness
Some loose consciousness and become comatose
Some remain oriented until moment of death
Common for a person who has drifted in and out of a comatose state to become alert and oriented right before they die
Physical signs of impending death

10. Physical signs of impending death
When caring for a person who is dying, take note of any physical changes, report them to the nurse, and document appropriately
Physical signs of impending death

11. Caring for a dying person
A holistic approach is taken to care for a dying person
Have the same needs as everyone else
Needs may change dramatically as death approaches
Many nurses and nursing assistants compromise care they give to a dying person
Especially new ones
Usually not fully aware
This is not a good thing
Caring for a dying person

12. Caring for a dying person
Examples:
May not check on the person as often
Provide only the necessary care because they are afraid in engaging the patient in a conversation about death
May be overly cheerful
Other avoidance behaviors
Fear
Caring for a dying person

13. Meeting a dying person’s physical needs
Care of the Skin
More frequent skin care and linen changes needed
Care of the Mucous Membranes
Frequent oral care
Eye care
Nasal care
Meeting a dying person’s physical needs

14. Meeting a dying person’s physical needs
Positioning
Person may not be able to reposition themselves
Comfort
breathing
Meeting a dying person’s physical needs

15. Meeting a dying person’s physical needs
Other Comfort Measures
Back massage
Soft music
Being read to
Enemas
Managing airway secretions
Suction
Atropine
Keep room well ventilated
Meeting a dying person’s physical needs

16. Meeting a dying person’s physical needs
Remember as death approaches person’s vision may become blurry
Keep room well lit
Introduce yourself when entering room
Encourage family members to do the same
Let person know you are leaving room
Meeting a dying person’s physical needs

17. Meeting a dying person’s physical needs
Speaking may become difficult for the person so speak
Ask simple yes or no questions
Meeting a dying person’s physical needs

18. Meeting a dying person’s physical needs
Hearing remains quite sharp
Always talk to the person as if they are able to hear you
Explain procedures to the person, even if they are unresponsive
Remind family members that the person can still here
Meeting a dying person’s physical needs

19. Meeting a dying person’s physical needs
Family members may wish to assist in physical care
Let them help
Meeting a dying person’s physical needs