Care of dying : By: Usha satish khanapurkar1st yr MSc Nsg Care of dying DEFINITION : DEFINITION In 1968, the world medical assembly adopted the following guidelines for physicians as indications of death:-
Total lack of response to external stimuli
No muscular movement, especially breathing
In instances of artificial support, absence of brain waves. IMPENDING DEATH CINICAL MANIFESTATIONS : IMPENDING DEATH CINICAL MANIFESTATIONS LOSS OF MUSCLE TONE:- Relaxation of facial muscles, difficulty speaking, swallowing, loss of gag reflex, nausea, accumulation of flatus, abd. distention, urinary & rectal incontinence, diminished body movement.
SLOWING OF CIRCULATION:- Slower & weaker pulse, decreased BP, cold skin ( first feet then gradually hands, ears & nose.
CHANGE IN RESPIRATION:- Rapid, shallow, irregular, or abnormally slow respiration; noisy breathing, mouth breathing.
SENSORY IMPAIRMENT:- Blurred vision, impaired senses of taste and smell. STATES OF AWARENESSMENIFESTED BY CLIENT & FAMILY : STATES OF AWARENESSMENIFESTED BY CLIENT & FAMILY CLOSED AWARENESS:- Here the client is not made aware of impending death. The family may choose this because i) They don’t completely understand why the client is ill or ii) They believe the client will recover.
Here the nurse is confronted with an ethical problem.
MUTUAL PRETENSE:- Here everyone know that the prognosis is terminal but do not talk about it. Mutual pretense permits the client degree of privacy & dignity, but it places heavy Burdon on the dying person, who has no one in whom to confide.
OPEN AWARENESS:- The client & others know it and feel free to discussing it. This awareness provides opportunity to finalize affairs & even planning for funeral arrangement. THE DYING PERSON’S BILL OF RIGHT : THE DYING PERSON’S BILL OF RIGHT I have right ….
To be treated as a living human being until I die.
To maintain a sense of hopefulness however changing it’s focus may be.
To express my feelings and emotions about my approaching death in my own way.
To participate in decisions concerning my care.
To expect continuing medical & nursing attention even though cure goals must be changed to comfort goals.
Not to die alone.
To be free from pain.
To have my questions answered honestly. THE DYING PERSON’SBILL OF DEATH CONTINUE… : THE DYING PERSON’SBILL OF DEATH CONTINUE… I have right…
Not to be deceived
To have help from & for my family in accepting my death.
To die in peace and with dignity.
To retain my individuality & not to be judged for my decisions which may be contrary to the beliefs of others.
To be cared for by caring, sensitive, knowledgeable people who will attempt to understand my needs & will be able to gain some satisfaction in helping me face my death. HOSPICE & PALLIATIVE CARE : HOSPICE & PALLIATIVE CARE Objectives:-
To minimize loneliness, fear and depression.
To maintain the client’s sense of security, self confidence, dignity and self-worth.
To help the client accept losses.
To provide physical comfort. HOSPICE CARE : HOSPICE CARE The hospice movement was found by the physician cecily saunders ( who died in 2005) in London, England in 1967.
Hospice care is based on holistic concepts, emphasized care to improve quality of life rather than cure.
It supports the client & family through the dying process and supports the family through bereavement. PALLIATIVE CARE : PALLIATIVE CARE As described by the WHO,“ is an approach that improves the quality of life of clients and the families facing the problem associated with life threatening illness, through the prevention and relief of suffering by means of early identification & impeccable assessment and treatment of pain and other problems.”
Types of palliative cares:-
Physiological palliative care
Psychological palliative care
Spiritual palliative care PHYSIOLOGICAL NEEDS OFDYING CLIENT : PHYSIOLOGICAL NEEDS OFDYING CLIENT Slide 11: PHYSIOLOGICAL NEEDS OFDYING CLIENT CONTINUE… PROVIDING SPIRITUAL SUPPORT : PROVIDING SPIRITUAL SUPPORT The nurse has responsibility to ensure that the client’s spiritual needs are attended to, either through direct intervention or by arranging access to individuals who can provide spiritual care.
Specific interventions may include facilitating expressions of feeling, prayer, meditation, reading and discussion with appropriate clergy or spiritual advisor.
It is important for nurses to establish an effective interdisciplinary relationship with spiritual support specialists. Post mortem care : ++ Post mortem care Rigor mortis:- is the stiffening of the body that occurs about 2 to 4 hours after death.
It starts in the involuntary muscles then progresses to the head, neck, trunk & finally extremities.
It results from a lack of ATP which causes the muscle to contract, which in turn immobilizes the joints.
It usually leaves body after 96 hours.
Because deceased person’s family often wants to view the body ,the nurse should see to it that deceased is position to look natural and comfortable, before rigor mortis appears. POST MORTEM CARE CONTINUE… : ++ POST MORTEM CARE CONTINUE… 2 Algor mortis:- is the gradual decrease of body’s temperature after death.
When blood circulation terminates and the hypothalamus ceases to function, body temperature falls about 1 per hour until it reaches room temperature.
Simultaneously the skin loses its elasticity & can easily be broken when removing dressings, adhesive tape. POST MORTEM CARE CONTINUE… : POST MORTEM CARE CONTINUE… Livor mortis:- After blood circulation has ceased, the R.B.C.s break down, releasing hemoglobin, which discolors the surrounding tissues.
This discoloration appears in lower most or dependent areas of the body.
Tissue after death become soft & eventually liquefied by bacterial fermentation.
The hotter the temperature the more rapid the change. Therefore, bodies are often stored in cool places to delay this process.
Embalming prevents the process through injection of chemicals into the body to destroy the bacteria. CARE OF DEAD BODY : CARE OF DEAD BODY In hospitals, after body has been viewed by the family, the deceased’s wrist identification tags left on & additional identification tags are applied.
The body is wrapped in a shrewd.
Nurses have a duty to handled deceased with dignity & label the corpse appropriately.
If not, can cause emotional distress to supervisors & mislabeling can create legal problems. Slide 17: SUPPORTING THE FAMILYOF DYING CLIENT It involve using therapeutic communication to facilitate their expression of feelings.
When nothing can reverse inevitable dying process, the nurse can provide an empathetic & caring presence.
The nurse also explains what is happening, what the family can expect. Family members should be encouraged to participate in the physical care of the dying parson as much as they wish to & are able to.
The nurse must be prepared to encourage & support the family through saying their last good-bye.
After the client dies, the family should be encouraged to view the body, because this has been shown to facilitate the grieving process.
( Rich, 2005 )
They may wish to clip a lock of hair as remembrance. Children should be included in the events surrounding the death, if they wish to. Slide 18: ORGAN DONATION Under the uniform anatomical gift act and the national organ transplant act in the united states, people 18 years or older and of sound mind may make a gift of all or any part of their own bodies for the following purposes:
For medical and dental education
Advancement of medical and dental science
Therapy or transplantation.
The donation can be made by provision in a will or by signing a card like form. This card is usually carried at all times by the person who signs it.
For details about in India , contact:-
Dadhichi Dehadan Mandal, Dombivili,( west)