CARE OF DYING PERSON PREPARED BY : CHRISTIAN RAVEINA

ASSESSING NEEDS The nurse assesses knowledge base of the client &

family related to the client’s illness & pervious care determines the perception of present situation,

strength & weakness so that can be used in planning care

coping behaviors of client & family

PSYCHOLOGICAL SUPPORT person passes through 5 stagesnurse needs to be truthful but sensible in all their dealing

with patient to be warm supportive & understanding develop such relation that pt. tell you what he knows about

his condition try to use his own words when talking to him no one really knows that what the future holds and

miraculous recoveries may occur

PSYCHOLOGICAL NEEDS OF DYING PT. Relief from loneliness, fear & depression Maintenance of security, self confidence & dignity

Maintenance of hope Meeting the spiritual needs according to his custom

Nurse’s attitude toward the relatives should be sympathetic, careful & meaningful

They should be given enough time to dying person Dying person may be shifted a private room, so

that other patients may not be disturbed by the unpleasant sight, the cries & other disturbances

Otherwise , the privacy can be maintained by using screen

SYMPTOMATIC MANAGEMENT

PROBLEM ASSOCIATED WITH THE BREATHING O2 inhalation may be given to ease his comfort Elevation of patients head & shoulders may make

breathing easier Keep the room well, ventilated & keep crowds

away Periodic suctioning is necessary in order to

maintain patency of airway Change position frequently at least 2 hourly

PROBLEMS ASSOCIATED WITH EATING & DRINKING Anorexia, nausea & vomiting are commonly seen

problems in the dying persons. They may be unable to swallow even the sips of water

IV fluids should be given If they can tolerate oral fluids, sips of fluids should

be given Maintain frequent oral hygieneApply emollients to dry lips Dentures should be removed & kept safely

PROBLEMS ASSOCIATED WITH ELIMINATION

Constipation, retention of urine & incontinence of urine & stools are some of the problems faced by the patient

Each problem is prevented or at least treated if possible

PROBLEMS ASSOCIATED WITH IMMOBILITY

Patients should be comfortably placed & their position frequently changed in bed

Frequent skin care should be done to prevent pressure ulcer

PROBLEMS ASSOCIATED WITH SENSE ORGANS Since the patient loses sight, so before giving

any care to patient, the nurse should touch the patient & speak appropriate words

Avoid any type of whispering before the patient

Protect the eyes from corneal ulceration

PROBLEMS ASSOCIATED WITH REST & SLEEP

All the possible care should be given to the patient for alleviating pain & discomfort

Patient should not be disturbed when sleeping

PROBLEMS ASSOCIATED WITH CLEANLINESS & GROOMING

Cleanliness & appearance are important until the last breath end

Cleanliness of skin, care of hair, care of mouth, clean clothing are also very important

CARE OF DEAD PATIENT

INTRODUCTION Death is considered when patient’s respirations & heart

ceased to function for several minutes Usually, breathing stops first, the heart stops beating a few

minutes later The absence of brain wave activity as measured by an

electro encephalogram is usually used to confirm that death has occurred

Nurse’s goal as health professionals is to try to understand other’s way of coping with death & to support their coping abilities

CAUSES OF DEATH when death is not sudden its actual cause is

most often cancer related Since cancer is the second leading cause of

death, next to cardiovascular problems The most common causes of death are

infection, organ failure, infection & hemorrhage , cardiac arrest

CLINICAL SIGNS OF DEATH Sensation & power of motion as well as reflexes are lost

first in the legs & then gradually in arms Peripheral circulation fail to work due to which body

become cold & clammy Pulses stop accelerating Pupils become dilated & fixedRespiration stops Heart stops working Absence of brain wave

PROCEDURE

•Close the door & pull curtains around the bed & screen the dead body • prepare the patient for family viewing :• Place dead body in supine position with the head on a small pillow, arms by the sides, palms down(or) with hands folded on abdomen •Close the eyes by gently holding the eyelids closed for a few moments. Place dentures in the mouth according to agency policy, otherwise remove it & close the mouth. If necessary close it with a roll keeping under chin •Comb the hair

•Determine whether there will be tissue/organ donations, autopsy on request. Remove & document equipment. Remove/cut the secure tubes, catheters, dressings & other attachments as agency policy •Remove jewellery/ornaments of any type from the dead body. All the jewelleries are removed, listed & instructed to the closest relative & receipt obtained for that delivery

•Remove all the appliances used for the care of the patient. If Ryle’s tube was inserted for feeding the patient, remove it after aspirating the stomach contents. If the oxygen was administered, remove it all comfort devices used for the patient should be removed. Adhesive marks are to be removed •Place clean absorbent pads in case of any drainage •Change the bed linens & gown as needed

•Allow the family to spend time with the patient. Stay with family to provide support (or) if they wish, leave them alone with patient • Involve the family in doing after death care according to cultural needs

• If possible, hand over the personal articles & valuable to the family of deceased one •Once the family leaves, the equipment near the dead body & pack it with tags, dressing, absorbent pads •Put gloves •Remove the gown, wash body of any soiled areas (or) drainage. Assess appearance of skin & any marks

•Cover the body with sheet. Check identification carefully & attach identification tags on toe, wrist or ankle according to agency policy •Place identification tag on the outside of the sheet covering body •Gently transfer the body to the morgue stretcher. Use side rails or stretcher straps •Remove gloves, wash hands, tidy room •Transport the body to the morgue as not noticeable as possible •Take the body to the morgue & sign the log book according to agency policy

•Record & report as appropriate :• Vital signs & time of absence of same • Events leading to the death • Time when the physician declared death • Any marks, wounds, bruises on the body before death (or) made during care of the body • Removal (or) securing of drains & tubes • Time of notification of family • Removal of jewellery (or) securing of items left on & removal (or) replacement of dentures • Consent forms, release forms signed • Time when body was taken to the morgue

Nurses needed to listen & provide small acts of kindness that will make families feel cared for

She can walk with family to the front door of the hospital

the gentle action of the nurse at the time of death can gently assist the family

Thank you…