1. Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc. Chapter 41 The Dying Person

2. Slide 2 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  Your feelings about death affect the care you give. You must understand the dying process. You must understand the dying process.  Then you can approach the dying person with caring, kindness, and respect.  An illness or injury for which there is no reasonable expectation of recovery is a terminal illness. Hope and the will to live strongly influence living and dying. Hope and the will to live strongly influence living and dying.

3. Slide 3 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  ATTITUDES ABOUT DEATH  Experiences, culture, religion, and age influence attitudes about death.  Attitudes about death often change as a person grows older and with changing circumstances.

4. Slide 4 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  Culture and religion Practices and attitudes about death differ among cultures. Practices and attitudes about death differ among cultures. Attitudes about death are closely related to religion. Attitudes about death are closely related to religion. Reincarnation is the belief that the spirit or soul is reborn in another human body or in another form of life. Reincarnation is the belief that the spirit or soul is reborn in another human body or in another form of life. Many religions practice rites and rituals during the dying process and at the time of death. Many religions practice rites and rituals during the dying process and at the time of death.  Age affects a person’s attitudes and feelings about death.

5. Slide 5 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  THE STAGES OF DYING  Dr. Elisabeth Kübler-Ross described five stages of dying. Denial is the first stage. Denial is the first stage. Anger is the second stage. Anger is the second stage. Bargaining is the third stage. Bargaining is the third stage. Depression is the fourth stage. Depression is the fourth stage. Acceptance of death is the last stage. Acceptance of death is the last stage.  Dying persons do not always pass through all five stages. A person may never get beyond a certain stage. A person may never get beyond a certain stage. Some move back and forth between stages. Some move back and forth between stages.

6. Slide 6 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  PSYCHOLOGICAL, SOCIAL, AND SPIRITUAL NEEDS  Dying people have psychological, social, and spiritual needs. You need to listen and use touch. You need to listen and use touch. Some people may want to see a spiritual leader or take part in religious practices. Some people may want to see a spiritual leader or take part in religious practices.  You need to: Provide privacy during prayer and spiritual moments. Provide privacy during prayer and spiritual moments. Be courteous to the spiritual leader. Be courteous to the spiritual leader. Handle religious objects with care and respect. Handle religious objects with care and respect.

7. Slide 7 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  PHYSICAL NEEDS  Dying may take a few minutes, hours, days, or weeks.  To the extent possible, independence is allowed.  Every effort is made to promote physical and psychological comfort.  Vision, hearing, and speech Vision blurs and gradually fails. Vision blurs and gradually fails. Hearing is one of the last functions lost. Hearing is one of the last functions lost. Speech becomes difficult. Speech becomes difficult.

8. Slide 8 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  Mouth, nose, and skin Oral hygiene promotes comfort. Oral hygiene promotes comfort. Crusting and irritation of the nostrils can occur. Crusting and irritation of the nostrils can occur. Circulation fails and body temperature rises as death nears. Circulation fails and body temperature rises as death nears.  Elimination Urinary and fecal incontinence may occur. Urinary and fecal incontinence may occur.  Comfort and positioning Skin care, personal hygiene, back massages, oral hygiene, and good alignment promote comfort. Skin care, personal hygiene, back massages, oral hygiene, and good alignment promote comfort. The nurse gives pain-relief drugs ordered by the doctor. The nurse gives pain-relief drugs ordered by the doctor. Frequent position changes and supportive devices promote comfort. Frequent position changes and supportive devices promote comfort.

9. Slide 9 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  The person’s room The person’s room should be comfortable, pleasant, well lit, and well ventilated. The person’s room should be comfortable, pleasant, well lit, and well ventilated. Unnecessary equipment is removed. Unnecessary equipment is removed. Equipment upsetting to look at is kept out of the person’s sight if possible. Equipment upsetting to look at is kept out of the person’s sight if possible. The person and family arrange the room as they wish. The person and family arrange the room as they wish.

10. Slide 10 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  THE FAMILY  This is a hard time for the family.  The family usually is allowed to stay as long as they wish.  You must respect the right to privacy. You cannot neglect care because the family is present. You cannot neglect care because the family is present.  The family goes through stages like the dying person. They need support, understanding, courtesy, and respect. They need support, understanding, courtesy, and respect. A spiritual leader may provide comfort. A spiritual leader may provide comfort.

11. Slide 11 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  HOSPICE CARE  Hospice care focuses on the physical, emotional, social, and spiritual needs of dying persons and their families. The goal is to improve the dying person’s quality of life. The goal is to improve the dying person’s quality of life.

12. Slide 12 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  LEGAL ISSUES  The Patient Self-Determination Act and OBRA: Give persons the right to accept or refuse medical treatment Give persons the right to accept or refuse medical treatment Give the right to make advance directives Give the right to make advance directives  Living wills  Durable power of attorney for health care  “Do Not Resuscitate” orders

13. Slide 13 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  SIGNS OF DEATH  Signs that death is near may occur rapidly or slowly. Movement, muscle tone, and sensation are lost. Movement, muscle tone, and sensation are lost. Peristalsis and other gastrointestinal functions slow down. Peristalsis and other gastrointestinal functions slow down. Body temperature rises. Body temperature rises. Circulation fails. Circulation fails. The respiratory system fails. The respiratory system fails. Pain decreases as the person loses consciousness. Pain decreases as the person loses consciousness.  The signs of death include no pulse, no respirations, and no blood pressure.  A doctor pronounces the person dead.

14. Slide 14 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  CARE OF THE BODY AFTER DEATH  Care of the body after death is called postmortem care.  Postmortem care: Begins when the doctor pronounces the person dead Begins when the doctor pronounces the person dead Is done to maintain a good appearance of the body Is done to maintain a good appearance of the body  The right to privacy and the right to be treated with dignity and respect apply after death.  Within 2 to 4 hours after death, rigor mortis develops.

19. Slide 19 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  QUALITY OF LIFE  Quality of life is important to dying persons and their families.  A person has the right to die in peace and with dignity.