1. Bell Work 11/5 and 11/6
Why is being willing to learn important in late adulthood?
Show fewer signs of decreased mental ability
Which life stage is frequently the most productive life stage?
Early adulthood – marriage, childbearing, family, career,

2. Emotional and Physiologic Elements of Death and Dying

3. ELISABETH KUBLER-ROSS
Landmark work entitled On Death and Dying
Identified five emotional stages experienced by dying individuals

4. FIVE EMOTIONAL STAGES Denial - or “no not me” Anger - or “why me?”
Bargaining - or “Yes, but. . .”
Depression - or “It’s me!” (realize death will come soon)
Acceptance - or “It’s part of life. I have to get my life in order.”

5. Results of Kubler-Ross’ Research
Most medical personnel now believe patient should be informed of approaching death
Patient should be left with some hope and know they will not be left alone
Staff need to know extent of information known by patient

6. DEATH CAN INVOLVE FEARS THAT ARE PHYSICAL, SOCIAL, AND EMOTIONAL
PHYSICAL - Helplessness, dependence, loss of physical faculties, mutilation, pain
SOCIAL - Separation from family, leaving behind unfinished business
EMOTIONAL - Being unprepared for death and what happens after death

7. INTERVENTIONS FOR FEARS
Talk as needed
Avoid superficial answers, i.e. “It’s God’s will
Provide religious support as appropriate
Stay with the patient as needed
Work with families to strengthen and support

8. PHYSIOLOGY OF DYING Somatic death or death of the body
Causes of death varies

9. BASIC CHANGES RESULTING IN THE DEATH OF VITAL BODY SYSTEMS
PULMONARY:
Unable to oxygenate the body
Assess for poor oxygenation-skin pale, cyanotic, mottled, cool
in dark skinned - assess mucous membranes, palms of hands, soles of feet (capillary refill time)

10. CARDIOVASCULAR Large load on heart when lungs fail
Heart not getting needed oxygen
Heart may not be strong enough to circulate blood
Blood backs up causing failure
Leads to pulmonary and liver congestion

11. Cont… Decreased, as heart less able to pump
May have a “drenching sweat” as death approaches
Pulse becomes weak and irregular
If pulse relatively strong, death is hours away
If pulse is weak and irregular, death may be imminent

12. COMBINATION OF THESE EVENTS LEADS TO CELL & SYSTEM DEATH
As pulmonary and cardiovascular systems fail, other body systems begin to fail, also

13. FAILING METABOLISM Metabolic rate decreases, almost stopping
Feces might be retained or incontinence might be present

14. FAILING URINARY SYSTEM
Urinary output decreases
Blood pressure too low for kidney filtration
Further load on cardiovascular system due to increase circulating volume

15. FAILING NERVOUS SYSTEM
Decrease oxygen to the brain, means decreasing brain function
Sensation and power lost in legs, first, then arms
May remain conscious, semi-conscious, or comatose

16. SPECIFIC SENSORY DECLINE
Dying person turns toward light - sees only what is near, may have slow or weakly responsive pupils
Can only hear what is distinctly spoken
Touch is diminished - response to pressure last to leave
Dying person might turn toward or speak to someone not visible to anyone else
Eyes may remain open even if unconscious
Person might rally just before dying

17. FURTHER NEUROLOGIC DECLINE AT DEATH
Pain might be significant
Assess for pain if person is unable to talk, restless, tight muscles, facial expressions, frowns
Provide pain medication as needed

18. Caring for the Dying Patient
Very challenging, but rewarding work
Supportive care
Health care worker must have self-awareness
Common to want to avoid feelings by avoiding dying patient

19. Hospice Care Palliative care only Often in patient’s home
Philosophy: allow patient to die with dignity and comfort
Personal care
Volunteers
After death contact and services

20. Right to Die Health care workers must understand this issue
Ethical issues must be addressed
Allowing patients to die can cause conflict
Specific actions to end life cannot be taken
Laws allowing “right to die”

21. Summary Death is a part of life
Health care workers will deal with death and dying patients
Must understand death and dying process and think about needs of dying patients
Then health care workers will be able to provide the special care these individuals need

22. Bell work Nov 2, 3
What stage in the process of death and dying does the person understand and accept the fact they are going to die?
Acceptance
What stage in the process of death and dying does the dying person try to make deals with a higher power?
Bargaining