When death is imminent
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Transcript of When death is imminent
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Introduction
Death is defined as the final stage of life. Develop a realistic attitude toward the topic of death to meet the physical and psychological and spiritual needs of the sister, the family and the community, as they experience the dying process.
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Death trajectories. Lunney JR, et al. Profiles of older Medicare decedents. J Am Geriatr
Soc 2002;50:1108-1112.
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Murray, S. A et al. BMJ 2008;336:958-959
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Murray, S. A et al. BMJ 2008;336:958-959
SYMPTOM PATIENTS (%) SYMPTOM PATIENTS (%)
Pain 84 Edema 28
Easy fatigue 69 Taste change 28
Weakness 66 Hoarseness 24
Anorexia 66 Anxiety 24
Lack of energy 61 Vomiting 23
Dry mouth 57 Confusion 21
Constipation 52 Dizziness 19
Early satiety 51 Dyspepsia 19
Dyspnea 50 Dysphagia 18
Weight loss 50 Belching 18
Sleep problems 49 Bloating 18
Depression 41 Wheezing 13
Cough 38 Memory problems 12
Nausea 36 Headache 11
Most Common Symptoms of Patients with Advanced Cancer
Walsh D, Donnelly S, Rybicki L. Support Care Cancer 2000;8:175-179.
SYMPTOM HOSPICE NURSES SELECTING THE SYMPTOM (%)
Agitation 45
Pain 40
Shortness of breath
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Confusion 33
Pressure ulcers 27
Nausea 26
Fatigue 25
Constipation 24
Depression 22
Anxiety 21
From Johnson DC, Kassner CT, Houser J, Kutner JS. Barriers to effective symptom management in hospice. J Pain Symptom Manage 2005;29:69-79.
Symptoms difficult to manage
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1. Personal experiences 2. Culture Some fear death Others look forward to and accept death
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3. Faith Belief in life after death Reunion with loved ones Punishment for sins
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4. Age
-Adults may develop fears of: pain and suffering, dying alone, separation from loved ones
-Elderly generally have fewer fears
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1. Visits of family members/batch mates, certain sisters
2. Features of resident’s room:pleasant as possiblelighting that meets resident’s preferences
well ventilatedodor free
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Room contains personal items which provide comfort and reassurancePicturesMementosCardsFlowersReligious objects
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1. Attention to skin care2. Hygiene: Good
personal hygiene, Oral hygiene - denture care
3. Bedding changed as needed
4. Back massages
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5. Frequent position changesevery two hoursP.R.N. (= as it is needed)
6. Good body alignmentsupportive devicesprevention of deformities and pressure ulcers
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7. Head of bed elevated to facilitate breathing
8. Modified diet
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Source of strength and comfort
Open and receptiveKnow own feelings about death and do not project those feelings onto the sister.
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EmpatheticCalm and efficient Normal tone of voiceGood listening skillsNon-judgmental
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Accept or be resigned to death
Open and receptiveCommunicate about uncertainties
Fearful or angryDespairing and anxiousHostileThoughtful and meditative
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DENIALDefense mechanismBuffer against realityEmotional escape hatch
Resident may request another opinion
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DENIAL (continued)
Resident may avoid discussion of death
Feeling of, “This can’t be happening to me.”
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ANGERBitterness and turmoilSense of unfairnessBlame of others such as health care workers
Feeling of, “Why me?”
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BARGAININGTurn to religious and spiritual beliefs
Promises to God and others
Comfort and hope when all seems lost
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BARGAINING (continued)Generally know this won’t work
Frustration and anger dissolve into depression
“If only...I will”
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DEPRESSIONBelief that hope is lostOverwhelming despairIntroverted and withdrawnReminiscing and reviewing lifeSleeplessness“I always wanted to”
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ACCEPTANCECalm and subdued interest in lifeStrives to complete unfinished business
Helps loved ones accept deathNeeds others to validate worth of life
“I’ve had a good life.”
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Changes in sensory functions and ability to speakVision
increased secretions in corner of eyes
blurred visionfailing visionno eye movement/staring
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Changes in sensory functions and ability to speak (continued)
Speechbecomes difficulthard to understandmay be unable to speak
Hearing - last function to be lost
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Changes in circulation and muscle toneCirculation
failsheat gradually lost from bodyhands and feet cold to touch and mottled
face becomes pale or gray and mottled
perspiration may increase (diaphoresis)
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Changes in circulation and muscle tone (continued)Muscle tone
body limpjaw may dropmouth may stay partly open
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Changes in Vital SignsRespirations
slowershallowlaboredmay experience dyspnea, apnea, Cheyne-Stokes
mucous collects in the throat and bronchial tubes (death rattle)
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Changes in Vital Signs (continued)
Pulserapidweak and irregular
Blood pressure dropsTemperature
elevatedsubnormal
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Urinary and anal incontinence
Decreased peristalsis, abdominal distention
Release of flatus
Decreased pain
Loss of consciousness
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Calling a priestConfessionLast SacramentWord of God AudioPraying nuns
DHSR Approved Curriculum-Unit 12 41
Support sister’s beloved religious/spiritual practices
Listen respectfully to the beliefsParticipate in religious practices in the place of the sister and share it with her
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Provide religious objects which are dear to the sister:medalspicturesstatuesBibles
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Make them available for support
Use touch as appropriateCourteous and considerate
Respect right to privacyLet family assist with care, if they desire, where appropriate
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Use good communication skills
Listen and provide understanding throughout the grief
Answer questions or refer to the superior
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Health care service offered:in hospitals and extended care facilities
by special facilitiesusually in the sister’s convent
Continuing care provided by team of health professionals
Designed for sisters with terminal illness
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Acceptance of death as imminent (6 months or less)
Assures that individual dies with dignity and comfort
Not concerned with cure or life-saving procedures
Emphasis on pain reliefTrained volunteers and professionals make regular visits.
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Provides counseling for individual and family:EmotionalPsychologicalSpiritual
Family included in all aspects of care as desired
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