1.  What physical changes do you think take place as the body begins to die? BELLRINGER

2. Jackilyn Malone, RN, BSN Montgomery County ATC PHYSICAL CHANGES THROUGH DEATH & DYING

3.  Cessation of heart & lung function  OR  Cessation of whole brain function DEATH

4.  Dying is different for everyone emotionally  1. different for each and every patient  2. different for each person involved in the process  Patient, family member, physician, nurse, CAN  Physical changes that indicate death is approaching are pretty consistent

5.  The heart is a pump  As it grows weaker, it is unable to pump blood with enough force to circulate blood throughout the body.  Blood carries oxygen  Decrease of Blood =  Cool blue skin  Mottling  Sweating that cools the body temperature CARDIAC SYSTEM

6.  Pulse  Becomes weak, thready & eventually irregular  Stronger  Death is usually hours away  Weaker  Death usually occurs within a couple of hours  Apical pulse might be necessary, sometimes can’t feel in other sites CARDIAC SYSTEM

7.  Grab a stethoscope! APICAL PULSE SITE

8.  Not enough blood= not enough oxygen  Weakness = lungs not expanding = decrease in gas exchange  Cheyne Stokes breathing  Hyperpneic & apneic phases https://www.youtube.com/watch?v=VkuxP7iChYY Death rattle https://www.youtube.com/watch?v=VOcTNQcPwPQ RESPIRATORY SYSTEM

9.  Metabolism decreases  Appetite decreases  May become constipated OR incontinent  Urine output decreased  Sight decreased  Periods of consciousness/unconsciousness  Sleeping for longer period OTHER PHYSICAL CHANGES

10.  May see and speak to people who aren’t there  May have visions of Jesus or a light  OR  May have visions with scary images MENTAL CHANGES

11.  Sometimes before death, a person will have a short period of increased clarity and consciousness.  This is called terminal lucidity  https://www.youtube.com/watch?v=ud7 7u9xuDro https://www.youtube.com/watch?v=ud7 7u9xuDro MENTAL CHANGES

12.  What is the #1 symptom patients are afraid of when dying?  PAIN

13.  Identify the cause  May be secondary  Use medications  Use cautions with narcotics that will depress the respiratory system  Non-pharmacologic methods  Healing touch  Massage  Prayer/meditation PAIN WHILE DYING

14.  Hospice care  Provides humane and compassionate care for people in the last phases of an incurable disease so that they may live as fully and comfortably as possible  Focus is on quality rather than length of life  Allows patient to die with dignity and in comfort COMFORT IN DEATH

15.  Can be provided in home, at LTCF or at hospital.  Offers comfort (physical/emotional/spiritual) for patient and family. Help through the grieving process  Nurses  Doctors  Clergy  Counselors HOSPICE CARE

16.  Once the Patient has passed away (died, expired), it must be confirmed by medical personnel.  One MD or  Two RN’s PRONOUNCING DEATH

17.  You will have a short quiz. Please turn it in to the homework tray. EXIT SLIP