1. Slide 1 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Textbook For Nursing Assistants Chapter 22 - Caring For People Who Are Dying

2. Slide 2 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Introduction to Caring For People Who Are Dying

3. Slide 3 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Biological death occurs when all vital body functions stop A person is declared brain dead when no brain activity is shown for a period of time specified by the law (usually 24 hours or more) Declaring a Person Dead

4. Slide 4 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Circulation fails Respiratory pattern changes Digestive system slows down Urine output decreases Nervous system changes Consciousness may be altered Physical Signs of Impending Death

5. Slide 5 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Blood pressure drops Pulse becomes rapid and weak Skin feels cool and clammy, despite rise in body temperature The person may perspire heavily Skin may appear mottled (blotchy), very pale, cyanotic (blue-tinged), or grayish The person needs only light bed coverings Circulatory System Changes

6. Slide 6 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Cheyne-Stokes respiration Irregular, shallow breaths Alternating fast-slow pattern Fluid or mucus may collect in the air passages, causing the noisy, rattling breathing called “death rattle” Respiratory System Changes

7. Slide 7 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. The person may experience: Nausea Vomiting Abdominal swelling Fecal impaction, or bowel incontinence The person may not want food or water Offer ice chips Provide frequent oral hygiene Digestive System Changes

8. Slide 8 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. The kidneys respond to the lack of blood flow The person may become incontinent of urine Urinary System Changes

9. Slide 9 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Decreased muscle tone and sensation Muscles relax and the person may be too weak to reposition himself Ability to speak may be lost Sensation in the arms or legs may be lost, and pain may diminish Blurred vision Hearing usually remains normal until the moment of death Nervous System Changes

10. Slide 10 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Some dying people lose consciousness and become comatose as death approaches As consciousness diminishes, so does pain Not uncommon for a person to drift in and out of a semi-comatose state and then become alert and oriented right before he or she dies Physical Signs of Impending Death: Altered Consciousness

11. Slide 11 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Caring For A Dying Person

12. Slide 12 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Dying people, like everyone else, have physical and emotional needs These needs may vary: As the time of death approaches Depending on the person Holistic Approach To Care

13. Slide 13 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. The nursing assistant’s role: Honor each person’s right to die peacefully and with dignity Be careful not to compromise the care given to a dying patient or resident Be aware of your own feelings about death  Your relationship with your patient or resident can make providing end-of-life care emotionally difficult  However, it is this relationship allows you to provide much needed holistic care to the dying person Holistic Approach To Care

14. Slide 14 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Care of the skin Frequent skin care and linen changes Regular checks for urine and fecal incontinence Care of the mucous membranes Frequent mouth care helps keep the mouth moist Warm, wet washcloth to remove mucus crust from eyes Application of ointment, moist eye pads, lubricants Positioning Helps to prevent pressure ulcers and promote comfort Notify the nurse of your observations of pain Meeting the Dying Person’s Physical Needs

15. Slide 15 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Other comfort measures  Providing back massage  Playing soft music  Giving enemas to assist with bowel elimination  Providing suctioning and oxygen therapy to make breathing easier  Keeping the room well lit and ventilated  Removing soiled linens, bedpans, or emesis basins  Using air freshener to help eliminate unpleasant odors Meeting the Dying Person’s Physical Needs

16. Slide 16 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. People may have many fears regarding death, including: A fear of the unknown A fear of losing dignity and self-control A fear that death will be painful A fear about the effects of their death on the people left behind People may have concerns about: Unfinished business Facing death alone While some people are able to speak of their fears, others remain silent, afraid to speak of what frightens them the most Meeting the Dying Person’s Emotional Needs

17. Slide 17 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. A nursing assistant can help meet a dying person’s emotional needs by: Being a good listener Checking on the person frequently and regularly and reminding her that you are close by if she needs anything Gently holding the person’s hand or touching her shoulder when you are speaking to her Gently smoothing the person’s hair after you have finished straightening the bed linens or repositioning the pillow Comforting the person with a back massage Meeting the Dying Person’s Emotional Needs

18. Slide 18 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Cultural and religious beliefs influence how a person feels about death and prepares for it Respect the beliefs of other people, even if you do not share these beliefs Meeting the Dying Person’s Emotional Needs

19. Slide 19 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Care of the Family

20. Slide 20 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. A nursing assistant can help meet the family’s needs by: Ensuring good communication between the family members and the health care team Allowing family members to stay with the dying person, and to participate in the person’s care if they want to Ensuring that the family members’ basic needs are met Being available to provide needed care to the patient or resident Care of the Family

21. Slide 21 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Postmortem Care

22. Slide 22 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Postmortem care is the care of a person’s body after the person’s death Cultural and religious beliefs often dictate how the body is to be cared for after death, and by whom It is necessary to keep the body in proper alignment and to prevent skin damage and discoloration Postmortem Care: What Is It?

23. Slide 23 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Rigor mortis The stiffening of the muscles that usually develops within 2 to 4 hours of death Once rigor mortis occurs, it is difficult to reposition the body Autopsy Examination of the person’s organs and tissues after the person has died In most cases, the doctor is responsible for obtaining a family member’s permission to perform an autopsy Postmortem Care: What Is It?

24. Slide 24 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. If you are present when one of your patients or residents dies: Notify the nurse that the person has died, and note the time You may need to document the absence of vital signs After the doctor has pronounced the person dead, you may be required to assist the nurse in giving postmortem care Postmortem Care: Your Duties

25. Slide 25 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Many facilities use pre-assembled postmortem kits, which usually contain: A shroud (“body bag”) Safety pins or tape for securing the shroud Ties for holding the person’s hands together Identification tags A chin strap for securing the person’s jaw A plastic bag or envelope for the person’s belongings 12” x 12” gauze pads to absorb drainage Postmortem Care: The Kit

26. Slide 26 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Postmortem Care: The Kit

27. Slide 27 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. End of Presentation