1. Linda S. Williams / Paula D. Hopper Copyright © 2011. F.A. Davis Company Understanding Medical Surgical Nursing, 4th Edition Chapter 17 Nursing Care of Patients at the End of Life

2. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition A Good Death  Patients Want  Pain and Symptom Management  Ability to Make Own Decisions  Dying That is Not Prolonged  Minimal Burden on Family  Remaining Time for Relationships

3. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Identifying Impending Death  Weight Loss  Increased Pain and/or Dyspnea  Increasing Weakness  Increasing Dependence for ADLs  Difficulty Swallowing  Poor Renal or Cardiac Function

4. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Simultaneous Care Model

5. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Advance Medical Directive  Living Will  Durable Medical Power of Attorney

6. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition End of Life Choices  Cardiopulmonary Resuscitation (CPR)  Do Not Resuscitate Orders (DNRs)  Artificial Feeding and Hydration  Hospitalization  Hospice Care

7. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Success of CPR Hospitalized Patients10%–15% Survival Hospitalized Elderly<5% Survival Patients at Home<5% Survival Nursing Home Residents1%–2% Survival

8. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Communication  Take Time to Listen  Answer Questions Honestly  Help to Identify Choices  Allow Verbalization of Fears  Remember Nonverbal Behaviors

9. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition The Dying Process  Eating and Drinking  Breathing Changes  Oral Secretions  Temperature  Bowel and Bladder  Sleeping  Mental Status  Terminal Restlessness  Unconsciousness

10. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Nursing Diagnoses  Impaired Gas Exchange  Ineffective Airway Clearance  Imbalanced Nutrition  Impaired Oral Mucous Membrane  Impaired Comfort

11. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Nursing Diagnoses (cont’d)  Hypo or Hyperthermia  Acute Confusion  Disturbed Sensory Perception  Anticipatory Grieving

12. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Post Mortem Care  Check Cultural Preferences  Remove Tubes and Equipment  Bathe and Dress Patient  Replace Dentures  Use Dressings or Diapers PRN  Allow Family Time with Deceased

13. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Grieving  Shock and Disbelief  Experience the Loss  Reintegration