1. Understanding the dying process and needs of the resident nearing the end of life. Nursing Fundamentals 7243 1 2.04 Unit A Nurse Aide Workplace Fundamentals Essential Standard NA2.00 Apply communication and interpersonal skills and physical care that promote mental health and meet the social and special needs of residents in long-term care. Indicator 2.04 Understand the Dying Process and Needs of the Resident Nearing the End of Life.

2. COMMON PHYSICAL SIGNS OF IMPENDING DEATH Nursing Fundamentals 7243 2 2.04 VITAL SIGNS Changes in VITAL SIGNSTEMPERATURE: Rising or below- normal

3. COMMON PHYSICAL SIGNS OF IMPENDING DEATH Nursing Fundamentals 7243 3 2.04 VITAL SIGNS Changes in VITAL SIGNSRESPIRATIONS: Slow, irregular alternating with rapid, shallow aka Cheyne-Stokes

4. COMMON PHYSICAL SIGNS OF IMPENDING DEATH Nursing Fundamentals 7243 4 2.04 VITAL SIGNS Changes in VITAL SIGNSRESPIRATIONS: “fish out of water breathing” aka Agonal Breathing

5. COMMON PHYSICAL SIGNS OF IMPENDING DEATH Nursing Fundamentals 7243 5 2.04 VITAL SIGNS Changes in VITAL SIGNSRESPIRATIONS: Rattling or gurgling sound referred to as Death Rattle

6. Nursing Fundamentals 7243 6 2.04 Elevate HOB to facilitate breathing

7. COMMON PHYSICAL SIGNS OF IMPENDING DEATH Nursing Fundamentals 7243 7 2.04 BOWEL AND BLADDER ELIMINATION Changes in BOWEL AND BLADDER ELIMINATION URINARY AND ANAL INCONTINENCE

8. COMMON PHYSICAL SIGNS OF IMPENDING DEATH Nursing Fundamentals 7243 8 2.04 BOWEL AND BLADDER ELIMINATION Changes in BOWEL AND BLADDER ELIMINATION DECREASED PERISTALSIS DECREASED PERISTALSIS ABDOMINAL DISTENTION ABDOMINAL DISTENTION RELEASE OF FLATUS RELEASE OF FLATUS

9. COMMON PHYSICAL SIGNS OF IMPENDING DEATH Nursing Fundamentals 7243 9 2.04 DECREASED PAIN

10. COMMON PHYSICAL SIGNS OF IMPENDING DEATH Nursing Fundamentals 7243 10 2.04 DECREASED INTAKE OF FOOD AND FLUID

11. Nursing Fundamentals 7243 11 2.04 Modify diet.Modify diet. Do not force feed.Do not force feed. Fluids most important.Fluids most important.

12. COMMON PHYSICAL SIGNS OF IMPENDING DEATH Nursing Fundamentals 7243 12 2.04 Disorientation and confusion, loss of consciousness

13. NURSE AIDE CARE FOR THE DYING RESIDENT Nursing Fundamentals 7243 13 2.04 Observe “Care Points” in previous slides related to sensory function

14. NURSE AIDE CARE FOR THE DYING RESIDENT Nursing Fundamentals 7243 14 2.04 Care of Nose and Mouth: Give mouth care often; if resident unconscious, every two hours Give mouth care often; if resident unconscious, every two hours Apply lubricant such as a lip balm, to lips and nose Apply lubricant such as a lip balm, to lips and nose Olive oil is a good lubricant for lips Olive oil is a good lubricant for lips

15. NURSE AIDE CARE FOR THE DYING RESIDENT Nursing Fundamentals 7243 15 2.04 Care of SKIN: Give bed baths and incontinence care as needed Bathe perspiring patients often Keep skin clean and dry Change sheets and clothes for comfort Keep sheet wrinkle free

16. NURSE AIDE CARE FOR THE DYING RESIDENT Nursing Fundamentals 7243 16 2.04 Care of SKIN: Reposition resident often, use supportive devices as needed Reposition resident often, use supportive devices as needed At least every 2 hours or prn At least every 2 hours or prn

17. NURSE AIDE CARE FOR THE DYING RESIDENT Nursing Fundamentals 7243 17 2.04 Promote COMFORT: Observe for signs of pain and report them! Observe for signs of pain and report them! Frequent changes of position, back massage, and body alignment Frequent changes of position, back massage, and body alignment Elevate head of bed (HOB) to facilitate breathing Elevate head of bed (HOB) to facilitate breathing

18. NURSE AIDE CARE FOR THE DYING RESIDENT Nursing Fundamentals 7243 18 2.04 Control ENVIRONMENT: Place resident’s favorite objects and photographs where resident can see them Place resident’s favorite objects and photographs where resident can see them Provide appropriately lit and well-ventilated room without odor Provide appropriately lit and well-ventilated room without odor Place call bell in reach, even if resident unresponsive Place call bell in reach, even if resident unresponsive

19. Nursing Fundamentals 724319 Control Environment Features of resident’s room: –Contains personal items which provide comfort and reassurance PicturesPictures MementosMementos CardsCards FlowersFlowers Religious objectsReligious objects 2.04

20. Nursing Fundamentals 724320 Nurse Aide Role - Respect Treat religious objects with care and respect:Treat religious objects with care and respect: –medals –pictures –statues –Bibles Encourage family and friends to be includedEncourage family and friends to be included 2.04

21. Nursing Fundamentals 724321 Nurse Aide’s Role - Support Source of strength and comfortSource of strength and comfort Open and receptiveOpen and receptive Know own feelings about death and do not project those feelings onto resident.Know own feelings about death and do not project those feelings onto resident. 2.04

22. Nursing Fundamentals 724322 Nurse Aide’s Role - Support EmpatheticEmpathetic Calm and efficientCalm and efficient Normal tone of voiceNormal tone of voice Good listening skillsGood listening skills Non-judgmentalNon-judgmental 2.04

23. Nursing Fundamentals 724323 Nurse Aide Role Support to Family & Friends Offer comfort measures such as drinks, food, chairs, blankets etc. within facility policy.Offer comfort measures such as drinks, food, chairs, blankets etc. within facility policy. Use good communication skills Use good communication skills Listen and provide understanding throughout the grief/loss stagesListen and provide understanding throughout the grief/loss stages Answer questions or refer to supervisorAnswer questions or refer to supervisor 2.04

24. Nursing Fundamentals 724324 Nurse Aide Role Support to Family & Friends Available for supportAvailable for support Use touch as appropriateUse touch as appropriate Courteous and considerateCourteous and considerate Respect right to privacyRespect right to privacy Let family assist with care, if they desire, where appropriateLet family assist with care, if they desire, where appropriate 2.04

25. Nursing Fundamentals 724325 Nurse Aide Role – Spiritual Support Priest, rabbi, minister or other clergy may be contacted at request of resident or familyPriest, rabbi, minister or other clergy may be contacted at request of resident or family Privacy to be provided when clergy with residentPrivacy to be provided when clergy with resident 2.04

26. Nursing Fundamentals 724326 Nurse Aide Role – Spiritual Support Support resident’s religious/spiritual practices even if different from that of nurse aideSupport resident’s religious/spiritual practices even if different from that of nurse aide Listen respectfully to religious/spiritual beliefsListen respectfully to religious/spiritual beliefs Participate in religious practices if asked and acceptableParticipate in religious practices if asked and acceptable 2.04

27. Nursing Fundamentals 7243272.04

28. Nursing Fundamentals 724328 Hospice Care Hospice Care offered:Hospice Care offered: –in hospitals and extended care facilities –by special facilities –usually in the individual’s home Continuing care provided by team of health professionalsContinuing care provided by team of health professionals Designed for residents with terminal illnessDesigned for residents with terminal illness 2.04

29. Nursing Fundamentals 724329 Hospice Care Acceptance of death as imminent (6 months or less)Acceptance of death as imminent (6 months or less) Assures that individual dies with dignity and comfortAssures that individual dies with dignity and comfort Not concerned with cure or life-saving proceduresNot concerned with cure or life-saving procedures Emphasis on pain reliefEmphasis on pain relief Trained volunteers and professionals make regular visits.Trained volunteers and professionals make regular visits. 2.04

30. Nursing Fundamentals 724330 Hospice Care Provides counseling for individual and family:Provides counseling for individual and family: –Emotional –Psychological –Spiritual –Financial –Bereavement Family included in all aspects of care as desiredFamily included in all aspects of care as desired 2.04

31. Nursing Fundamentals 7243312.04

32. Nursing Fundamentals 724332 Reasons for Postmortem Care Prevent discoloration and skin damagePrevent discoloration and skin damage Maintain good appearance of bodyMaintain good appearance of body Identify body and prepare for transportationIdentify body and prepare for transportation Position body in normal alignmentPosition body in normal alignment Arrange time family to view the bodyArrange time family to view the body 2.04

33. Nursing Fundamentals 724333 Postmortem Care – Genenral Guidelines Begin care when instructed by supervisorBegin care when instructed by supervisor Treat body to privacy, respect and gentlenessTreat body to privacy, respect and gentleness Give care before rigor mortis sets inGive care before rigor mortis sets in 2.04

34. Understanding the dying process and needs of the resident near the end of life. 34  END  2.04 2.04Nursing Fundamentals 7243