52 End-of-Life Care · Explain how to assist with postmortem care. Perform the procedure described in this chapter. Care of the Body After Death Assisting with post-mortem care PPT

Mosby’s Textbook for Nursing Assistants, 8th ed.

Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Sorrentino

LESSON PLANTeaching Focus

At the completion of this chapter, students will be able to define the key terms and key abbreviations. They will be able to describe terminal illness, the factors that affect attitudes about death, how different age-groups view death, the five stages of dying, palliative care, and hospice care. They will be able to explain how to meet the needs of the dying person and family. Students will be able to explain the purpose of the Patient Self-Determination Act and what is meant by a “Do Not Resuscitate” order. They will be able to identify the signs of approaching death and the signs of death. Students will be able to assist with post-mortem care and perform the procedure described in this chapter. They will also be able to explain how to promote PRIDE in the person, the family, and themselves.

Instructor’s Preparation I. Read/Review

A. Chapter 52 in the Textbook B. The Outline and Classroom Activities following these lesson plans C. PowerPoint slides for Chapter 52 D. Electronic Image for Chapter 52 E. Workbook and Competency Evaluation Review for Chapter 52

II. Collect/Prepare A. PowerPoint slides B. Handouts C. Flip charts D. Colored markers E. Chapter Student Assignment (p. 1125)

III. Make sure the necessary equipment is available and in good working order. IV. Contact each guest speaker to confirm the day, date, time, and location that he or she is expected.

A. Ask each speaker if he or she requires any special equipment or supplies. Make sure these are available.

Key Terms

advance directive palliative care rigor mortisautopsy post-mortem care terminal illnessend-of-life care reincarnation

VideoMosby's NursingAssistant VideoSkills

Legend

ESLREVOLVE StudentLearning Resource

EILREVOLVE InstructorLearning Resource

PPTPowerPointSlides

CDStudent CD-ROM

Video ClipProcedure

VIDEO VIDEOCLIP

WBWorkbook

WB

End-of-Life Care52

____________________________________________________________________________________ Chapter 52 End-of-Life Care 1113



Procedure List

Assisting with Post-mortem Care (p. 829 in Textbook, p. 441 in Workbook and Competency Evaluation Review)

Additional ResourcesPowerPoint Slides 1–24 (EILR)Electronic Image (EILR)

LESSON 52.1

PretestStudent Assignment, p. 1125Workbook and Competency Evaluation Review, Chapter 52

Background AssessmentQuestion: What are some factors that influence a person’s attitudes about death?Answer: Experiences, culture, religion, and age influence attitudes about death. Attitudes about death often change as a person grows older and with changing circumstances.

Focus on Quality of Care QuestionQuestion: A resident you are caring for has a terminal illness. The person is receiving hospice care. What can you do to make the person’s room comfortable and pleasant?Answer: The person’s room should be well lit and well ventilated. Remove unnecessary equipment. To the extent possible, keep out of sight unpleasant equipment that needs to be in the person’s room (drainage containers, suction machines, and so on). Let the person and the family arrange mementos, cards, and other personal items as they wish. The room should reflect the person’s choices. It should be pleasant for the person and the family.

OBJECTIVES CONTENT TEACHING RESOURCES

Define the key terms and key abbreviations listed in this chapter.

Introduction ■ PPT 1, 2 (EILR)

Key Terms in Textbook, p. 822Key Abbreviations in Textbook, p. 822Teamwork and Time Management: End-Of-Life Care in Textbook, p. 823

Describe palliative and hospice care. Terminal Illness ■

Types of Care ■

Palliative Care �

Hospice Care �

PPT 3–4 (EILR)Guest (representative from a hospice agency)

Describe the factors that affect attitudes about death.Describe how different age-groups view death.

Attitudes About Death ■

Culture and Spiritual �

Needs

Age �

PPT 5–7 (EILR)Caring About Culture: Death Rites in Textbook, p 824Focus on Communication: Culture and Spiritual Needs in Textbook, p. 824

Describe the five stages of dying. The Stages of Dying ■ PPT 8 (EILR)

Explain how to meet the needs of the dying person and family.

Comfort Needs ■ PPT 9 (EILR)

Focus on Communication: Comfort Needs in Textbook, p. 825Focus on Children and Older Persons: Comfort Needs in Textbook, p. 825

1114 Chapter 52 End-of-Life Care ________________________________________________________________________________________





Physical Needs ■

Pain �

Breathing problems �

Vision, hearing, and �

speech

Mouth, nose, and skin �

Nutrition �

Elimination �

The person’s room �

Mental and Emotional �

Needs

PPT 10–17 (EILR)


The Family ■ PPT 18 (EILR)

Classroom Activity, p. 1118Guest (spiritual leader from nursing center or hospice)

52.1 HOMEWORK/ASSIGNMENTS:

52.1 INSTRUCTOR’S NOTES/STUDENT FEEDBACK:

LESSON 52.2

Focus on Quality of Care QuestionQuestion: A resident on the unit is dying. You notice that some of your co-workers avoid going into the person’s room. They also avoid answering the person’s signal light. What can you do?Answer: You should report your observations to the nurse. Your co-workers may be uncomfortable with death and dying. However, they cannot neglect caring for the person. The nurse can help resolve the situation and can ensure that the person receives the quality of care needed.

OBJ ECTIVES CONTENT TEACHING RESOURCES

Explain the purpose of the Patient Self-Determination Act.Explain what is meant by a “Do Not Resuscitate” order.Identify the signs of approaching death and the signs of death.

Legal Issues ■

The Patient Self- �

Determination Act

Living wills �

Durable power of �

attorney for health care

“Do Not Resuscitate” �

orders

Signs of Death ■

PPT 19, 20 (EILR)Classroom Activity, p. 1118Handouts (samples of a living will and a durable power of attorney)

PPT 21, 22 (EILR)





Explain how to assist with postmortem care.Perform the procedure described in this chapter.

Care of the Body After ■

Death

� Assisting with post-mortem care

PPT 23, 24 (EILR) Electronic Image (EILR)

Classroom Activity, p. 1119Fig. 52-1 in Textbook, p. 828Delegation Guidelines: Care of the Body After Death in Textbook, p. 828Promoting Safety and Comfort: Care of the Body After Death in Textbook, p. 828Procedure demonstration and return demonstration (p. 829 in Textbook, p. 441 in Workbook and Competency Evaluation Review)

Explain how to promote PRIDE in the person, the family, and yourself.

Focus on PRIDE ■ Focus on PRIDE: The Person, Family, and Yourself in Textbook, p. 830

Chapter Review Review Questions, Chapter 52 ■ Quiz, p. 1126Test Bank, p. 1127

52.2 HOMEWORK/ASSIGNMENTS:

52.2 Instructor’s Notes/student feedback:

OUTLINE AND CLASSROOM ACTIVITIES

I. INTRODUCTION (LESSON 52.1)A. End-of-life care describes the support and care given

during the time surrounding death.B. Death may be sudden or expected.C. Health team members see death often.

1. Many are unsure of their feelings about death.D. Your feelings about death affect the care you give.

1. You will help meet the dying person’s physical, psychological, social, and spiritual needs.

2. You must understand the dying process.a. Then you can approach the dying person with

caring, kindness, and respect.

Review with students Teamwork and Time Management: �

End-of-Life Care on p. 823 in the Textbook.Allow time for questions and discussion. �

II. TERMINAL ILLNESSA. An illness or injury for which there is no reasonable

expectation of recovery is a terminal illness.B. Doctors cannot predict the exact time of death.

1. A person may have days, months, weeks, or years to live.

C. Modern medicine has found cures or has prolonged life in many cases.

D. Research will bring new cures.E. Hope and the will to live strongly influence living and

dying.1. Many people have died for no apparent reason

when they have lost hope or the will to live.F. Types of care

1. Palliative carea. Involves relieving or reducing the intensity of

uncomfortable symptoms without producing a cure.

b. The intent is to improve the person’s quality of life and provide family support.

c. Settings include hospitals, nursing centers, and the person’s home.

2. Hospice carea. The focus is on the physical, emotional, social,

and spirtitual needs of the dying persons and their families.




b. Often the person has less than 6 months to live.c. The goal is to improve quality of life, focusing

on pain relief and comfort.d. Hospitals, nursing centers, and home care

agencies offer hospice care.e. It may be a separate agency.

III. ATTITUDES ABOUT DEATHA. Experiences, culture, religion, and age influence

attitudes about death.1. Attitudes about death often change as a person

grows older and with changing circumstances.B. Dying people often need hospital, nursing center,

hospice, or home care.C. The family often is involved in the person’s care.D. When death occurs, the funeral director is called.

1. He or she takes the body to the funeral home to prepare it for funeral practices.

E. Many adults and children never have had contact with a dying person.1. They have not seen the process of dying and death.

a. It is frightening, morbid, and a mystery.F. Culture and spiritual needs

1. Practices and attitudes about death differ among cultures.

Review with students Caring About Culture: Death Rites on �

p. 824 in the Textbook.Allow time for questions and discussion. �

2. Spiritual needs relate to the human spirit and to religion and religious beliefs.

3. Attitudes about death are closely related to religion.a. Some believe in an afterlife; others do not.

(1) Reincarnation is the belief that the spirit or the soul is reborn in another human body or in another form of life.

b. Many people strengthen their religious beliefs when dying.(1) Religion provides comfort for the dying

person and the family.c. Many religions practice rites and rituals during

the dying process and at the time of death.

Review with students Focus on Communication: Culture �

and Spiritual Needs on p. 824 in the Textbook.Allow time for questions and discussion. �

G. Age1. Adults fear:

a. Pain and sufferingb. Dying alonec. Invasion of privacyd. Loneliness and separation from loved ones

2. Adults worry about the care and support of those left behind.

3. Adults often resent death because it affects plans, hopes, dreams, and ambitions.

Review with students Focus on Children and Older �

Persons: Age on p. 824 in the Textbook.Allow time for questions and discussion. �

IV. THE STAGES OF DYINGA. Dr. Elisabeth Kübler-Ross described five stages of

dying.1. Denial is the first stage.

a. The person refuses to believe that he or she is dying.

b. “No, not me” is a common response.c. This stage can last for a few hours or days, or

much longer.(1) Some people are still in denial when they

die.2. Anger is stage two.

a. The person thinks, “Why me?”b. There is anger and rage.c. Dying persons envy and resent those with life

and health.d. Anger is normal and healthy.

(1) Do not take the person’s anger personally.3. Bargaining is the third stage.

a. The person now says, “Yes, me, but …”b. Often the person bargains with God for more

time.c. Bargaining is usually private and spiritual.

4. Depression is the fourth stage.a. The person thinks, “Yes, me,” and is very sad.b. The person mourns things that were lost and the

future loss of life.c. The person may cry or say little.

5. Acceptance is stage five.a. The person is calm and at peace.b. Unfinished business is completed.c. The person accepts death.d. This stage may last for many months or years.

(1) Reaching the acceptance stage does not mean that death is near.

6. Dying persons do not always pass through all five stages.a. A person may never get beyond a certain stage.b. Some move back and forth between stages.c. Some people stay in one stage.

V. COMFORT NEEDSA. Comfort is a basic part of end-of-life care.

1. It involves physical, mental and emotional, and spiritual needs.

2. Comfort goals are to:a. Prevent or relieve suffering to the extent possibleb. Respect and follow end-of-life wishes

B. The dying persons may want:1. Family and friends present2. To talk about their fears, worries, and anxieties3. To be alone4. To talk during the night




C. You need to listen and use touch.1. Let the person express feelings and emotions in his

or her own way.a. You do not need to say anything.

(1) Being there for the person is what counts.2. Touch shows caring and concern when words

cannot.a. Sometimes the person does not want to talk but

needs you nearby.b. Silence, along with touch, is a powerful and

meaningful way to communicate.D. Some people may want to see a spiritual leader.E. Some want to take part in religious practices.

1. Provide privacy during prayer and spiritual moments.

2. Be courteous to the spiritual leader.3. Handle religious objects with care and respect.

Review with students Focus on Communication: Comfort �

Needs on p. 825 in the Textbook.Review with students Focus on Children and Older �

Persons: Comfort Needs on p. 825 in the Textbook.Allow time for questions and discussion. �

VI. PHYSICAL NEEDSA. Dying may take a few minutes, hours, days, or weeks.B. To the extent possible, independence is allowed.

1. As the person weakens, basic needs are met.C. The person may depend on others for basic needs and

activities of daily living.1. Every effort is made to promote physical and

psychological comfort.D. The person is allowed to die in peace and with dignity.E. Pain

1. A dying person may or may not experience pain.2. Always report signs and symptoms of pain at once

(Chapter 28).3. Pain management is important.

a. Preventing and controlling pain is easier than relieving pain.

F. Breathing problems1. Shortness of breath and difficulty breathing are

common end-of-life problems.2. Semi-Fowler’s position and oxygen are helpful.3. Noisy breathing (death rattle) is common as death

nears.a. This is due to mucus collecting in the airway.b. These may help:

(1) The side-lying position(2) Suctioning by the nurse(3) Drugs to reduce the amount of mucus

G. Vision, hearing, and speech1. Vision blurs and gradually fails.2. The person naturally turns toward light.

a. A darkened room may frighten the person.3. The eyes may be half-open.

a. Secretions may collect in the eye corners.4. Because of failing vision:

a. Explain what you are doing to the person or in the room.

b. The room should be well lit.c. Avoid bright lights and glares.

5. Good eye care is essential (Chapter 20).6. Hearing is one of the last functions lost.

a. Even unconscious persons may hear.b. Always assume that the person can hear.

(1) Speak in a normal voice.(2) Provide reassurance and explanations about

care.(3) Offer words of comfort.(4) Avoid topics that could upset the person.

7. Speech becomes harder.a. Anticipate the person’s needs.b. Do not ask questions that need long answers.c. You must talk to the person.

H. Mouth, nose, and skin1. Oral hygiene promotes comfort.

a. Give routine mouth care if the person can eat and drink.

b. Frequent oral hygiene is given as death nears and when taking oral fluids is difficult.

2. Crusting and irritation of the nostrils can occur.a. Carefully clean the nose.b. Apply lubricant as directed by the nurse and the

care plan.3. Circulation fails and body temperature rises as

death nears.a. The skin feels cool and is pale and mottled

(blotchy).b. Perspiration increases.c. You need to:

(1) Provide skin care and bathing.(2) Prevent pressure ulcers.(3) Change linens and gowns whenever needed.(4) Provide light bed coverings as needed.

I. Nutrition1. Nausea, vomiting, and loss of appetite are common

at the end of life.2. Some persons are too tired or too weak to eat.

a. You may need to feed them.3. Do not force the person to eat or drink.

a. This may add to discomfort.4. Report refusal to eat or drink to the nurse.

J. Elimination1. Urinary and fecal incontinence may occur.

a. Use incontinence products or bed protectors as directed.

b. Give perineal care as needed.2. Constipation and urinary retention are common.

a. Enemas and catheters may be needed.b. Provide catheter care according to the care plan.

K. The person’s room1. Provide a comfortable and pleasant room.

a. It should be well lit and well ventilated.2. Remove unnecessary equipment.

a. Equipment upsetting to look at is kept out of the person’s sight if possible.

3. Arrange within the person’s view mementos, pictures, cards, flowers, and religious items.




4. The person and the family arrange the room as they wish.

L. Mental and emotional needs1. Mental and emotional issues are very personal.2. Some persons are anxious or depressed or they have

specific fears and concerns.a. The doctor may order drugs for anxiety or

depression.3. Simple measures may soothe the person

a. Touchb. Holding a handc. Back massaged. Soft lightinge. Music at a low volume

VII. THE FAMILYA. This is a hard time for the family.

1. Show that you care by being available, courteous, and considerate.

2. Use touch to show your concern.B. Family members usually are allowed to stay as long as

they wish.1. The health team makes them as comfortable as

possible.C. Respect the right to privacy.

1. Do not neglect care because the family is present.2. Most agencies let family members help give care.

D. The family may be very tired, sad, and tearful.1. The family goes through stages like the dying

person.a. Family members need support, understanding,

courtesy, and respect.b. A spiritual leader may provide comfort.

(1) Communicate this request to the nurse at once.

Invite a spiritual leader who works for a nursing center or �

hospice to talk to the class about the role of the spiritual leader:

In meeting the needs of the dying person and the family �

In helping members of the health care team deal with the �

death of persons they care forAllow time for questions and discussion. ■

VIII. LEGAL ISSUES (LESSON 52.2)A. Much attention is given to the right to die.B. Consent is needed for any treatment.

1. When able, the person makes care decisions.C. Some people make end-of-life wishes known.D. The Patient Self-Determination Act

1. The Patient Self-Determination Act and the Omnibus Budget Reconciliation Act of 1987 (OBRA):a. Give persons the right to accept or refuse

medical treatmentb. Give the right to make advance directives

(1) An advance directive is a document stating a person’s wishes about health care when that person cannot make his or her own decisions.

(2) Advance directives usually forbid certain care if there is no hope of recovery.

(3) Living wills and durable power of attorney for health care are common advance directives.(a) Quality of care cannot be less because

of the person’s advance directives.(4) Health care agencies must inform all persons

of the right to advance directives on admission.(a) This information is provided in writing.(b) The medical record must document

whether or not the person has made them.

Write the following terms on a flip chart in outline form. �

Use a variety of colored markers.The Patient Self-Determination Act �

Advance directive �

Living will �

Durable power of attorney (for health care) �

“Do Not Resuscitate” orders �

Call on students to write the definition of each term on ■

the flip chart.Provide samples of a living will and a durable power of �

attorney for the class to read and discuss.Allow time for questions. �

2. Living willsa. A living will is a document about measures that

support or maintain life when death is likely.b. A living will may instruct doctors:

(1) Not to start measures that prolong dying(2) To remove measures that prolong dying

3. Durable power of attorney for health carea. This advance directive gives the power to make

health care decisions to another person.(1) When a person cannot make health care

decisions, the person with durable power of attorney can do so.

E. “Do Not Resuscitate” orders1. Doctors often write “Do Not Resuscitate” (DNR) or

“No Code” orders for terminally ill persons.a. This means that the person will not be

resuscitated.(1) The person is allowed to die with peace and

dignity.b. The orders are written after consulting with the

person and family.(1) The family and the doctor make the

decision if the person is not mentally able to do so.

c. Some advance directives address resuscitation.d. You may not agree with care and resuscitation

decisions.(1) You must follow the person’s or family’s

wishes and the doctor’s orders.(a) If these are against your personal,

religious, and cultural values, discuss the matter with the nurse.




IX. SIGNS OF DEATHA. There are signs that death is near.

1. In the weeks before death, the following may occur:a. Restlessness and agitationb. Shortness of breathc. Depressiond. Anxietye. Drowsinessf. Confusiong. Constipation or incontinenceh. Nauseai. Loss of appetitej. Healing problemsk. Swelling on the hands, feet, or other body areasl. Pauses in breathing

2. As death nears, these signs may occur fast or slowly:a. Movement, muscle tone, and sensation are lost.

(1 This usually starts in the feet and legs.(2) When mouth muscles relax, the jaw drops.

(a) The mouth may stay open.(b) The facial expression is often peaceful.

b. Peristalsis and other gastro-intestinal functions slow down.(1) Abdominal distention, fecal incontinence,

nausea, and vomiting are common.c. Body temperature rises.

(1) The person feels cool or cold, looks pale, and perspires heavily.

d. Circulation fails.(1) The pulse is fast, weak, and irregular.(2) Blood pressure starts to fall.

e. The respiratory system fails.(1) Slow or rapid and shallow respirations are

observed.(2) Mucus collects in the airway.

(a) This causes the death rattle that is heard.f. Pain decreases as the person loses

consciousness.(1) Some people are conscious until the

moment of death.B. The signs of death include no pulse, no respirations,

and no blood pressure.1. Pupils are fixed and dilated.

C. A doctor determines that death has occurred.1. He or she pronounces the person dead.

X. CARE OF THE BODY AFTER DEATHA. Care of the body after death is called post-mortem

care.1. A nurse gives post-mortem care.

a. You may be asked to assist.B. Post-mortem care begins when the doctor pronounces

the person dead.C. Post-mortem care is done to maintain a good

appearance of the body.

1. Discoloration and skin damage are prevented.2. Valuables and personal items are gathered for the

family.D. The right to privacy and the right to be treated with

dignity and respect apply after death.E. Within 2 to 4 hours after death, rigor mortis develops.

1. Rigor mortis is the stiffness or rigidity of skeletal muscles that occurs after death.

2. The body is positioned in normal alignment before rigor mortis sets in.

F. In some agencies, the body is prepared only for viewing by the family.1. The funeral director completes post-mortem care.

G. Sometimes an autopsy is done.1. An autopsy is the examination of the body after

death.a. Its purpose is to determine the cause of death.

2. The coroner or the medical examiner can order an autopsy.a. Or the family can request one.

3. Follow agency procedures when an autopsy is to be done.a. Post-mortem care is not given.

H. Post-mortem care involves moving the body.1. Moving the body can cause remaining air in the

lungs, stomach, and intestines to be expelled.a. When air is expelled, sounds are produced.

(1) These are normal and expected.

I. Assisting with post-mortem care

Review with students the following: �

Delegation Guidelines: Care of the Body After Death on �

p. 828 in the TextbookPromoting Safety and Comfort: Care of the Body After �

Death on p. 828 in the TextbookFocus on PRIDE: The Person, Family, and Yourself on �

p. 830 in the TextbookAllow time for questions and discussion. �

Use the procedure checklist provided on p. 441 in the �

Workbook and Competency Evaluation Review.Demonstrate the procedure for assisting with post-mortem �

care.Have each student practice and perform a return �

demonstration of the procedure.Use a roundtable discussion format. Encourage students to �

discuss their feelings about caring for the body after death.

PROCEDURE DEMONSTRATION AND RETURN DEMONSTRATION (Lesson 52.2)

Assisting With Post-mortem Care.




LECTURE OUTLINE

Slide 1

Slide 3

Slide 4

A person may have days, months, weeks, or years to live. �

Modern medicine has found cures or has prolonged life in many cases. Research will bring �

new cures. However, many people have died for no apparent reason when they have lost hope or the will to live.

The health team sees death often. Many team members are not sure of their feelings about �

death.Your feelings about death affect the care you give. �

You will help meet the dying person’s physical, psychological, social, and spiritual needs. �

Review the � Teamwork and Time Management: End-of-Life Care Box on p. 823 in the Textbook.

The person may opt for palliative care and then change to hospice care. �

Palliative care involves relieving or reducing the intensity of uncomfortable symptoms �

without producing a cure. The intent is to improve the person’s quality of life and provide family support.Pain relief and comfort are stressed in hospice care. The goal is to improve quality of life. �

Follow-up care and support groups for survivors are also services of hospice. Hospice also �

provides support for the health team to help deal with a person’s death.

Slide 2

Slide 5 Many adults and children never have had contact with a dying person. They have not seen �

the process of dying and death. It is frightening, morbid, and a mystery.Review the � Caring About Culture: Death Rites Box on p. 824 in the Textbook.




Slide 8

Slide 9 Comfort is a basic part of end-of-life care. For spiritual needs, see “Culture and Spiritual �

Needs” on p. 824 in the Textbook.Dying persons may want family and friends present. They may want to talk about their �

fears, worries, and anxieties.Some want to be alone. Often, they need to talk during the night. �

You do not need to say anything. Being there for the person is what counts. Silence, along �

with touch, is a powerful and meaningful way to communicate.Review the � Focus on Communication: Comfort Needs Box on p. 825 in the Textbook.Review the � Focus on Children and Older Persons: Comfort Needs Box on p. 825 in the Textbook.

Slide 6 Many people strengthen their religious beliefs when dying. Religion provides comfort for �

the dying person and the family.Many religions practice rites and rituals during the dying process and at the time of death. �

Prayers, blessings, scripture readings, and religious music are common and sources of �

comfort as well as visits from a minister, priest, rabbi, or other cleric.See the � Caring About Culture: Death Rites Box on p. 824 in the Textbook.Review the � Focus on Communication: Culture and Spiritual Needs Box on p. 824 in the Textbook.

Slide 7

Slide 10 Body processes slow. The person is weak. Changes occur in levels of consciousness. �

The person may depend on others for basic needs and activities of daily living. �

Review the � Focus on Children and Older Persons: Age Box on p. 824 in the Textbook.

The stages of dying are also known as the “stages of grief.” Grief is the person’s response �

to loss.Some people are still in denial when they are dying. �

Anger is normal and healthy. Do not take the person’s anger personally. �

Often, the person bargains with God or a higher power for more time. Bargaining is usually �

private and spiritual.The person mourns things that were lost and the future loss of life. The person may cry or �

say little.Reaching the acceptance stage does not mean that death is near. �

A person may never get beyond a certain stage. Some people stay in one stage. �




Slide 13

Slide 14 Frequent oral hygiene is given as death nears and when taking oral fluids is difficult. �

Carefully clean the nose. Apply lubricant as directed by the nurse and the care plan. �

Linens and gowns are changed as needed. �

Although the skin feels cool, only light bed coverings are needed. However, observe for �

signs of cold. Prevent drafts and provide more blankets.

Slide 11 Always report signs and symptoms of pain at once. �

The nurse can give pain-relief drugs. Preventing and controlling pain is easier than �

relieving pain.Turn the person slowly and gently. Follow the care plan to prevent and control pain. �

Slide 12

Slide 15 The doctor can order drugs for nausea and vomiting. �

Some persons are too tired or too weak to eat. You may need to feed them. Favorite foods �

may help loss of appetite, so may small, frequent meals.Do not force the person to eat or drink. Doing so may add to discomfort. Report refusal to �

eat or drink to the nurse.Use incontinence products or bed protectors as directed. Give perineal care as needed. �

Follow the care plan for catheter care. �

An open window for fresh air may help some people. For others, a fan circulating air is �

helpful.

The person turns toward light. A darkened room may frighten the person. �

Because of failing vision, explain who you are and what you are doing to the person or in �

the room.The room should be well lit. However, avoid bright lights and glares. �

Speak in a normal voice. Provide reassurance and explanations about care. �

Anticipate the person’s needs. Do not ask questions that need long answers. Despite speech �

problems, you must talk to the person.




Slide 18

Slide 19 Much attention is given to the right to die. Many people do not want machines or other �

measures keeping them alive.Advance directives usually forbid certain care if there is no hope of recovery. �

Quality of care cannot be less because of the person’s advance directives. �

Agencies must inform all persons of the right to advance directives on admission. This �

information is in writing. The medical record must document whether or not the person has made them.

Slide 16 The room should be well lit and well ventilated. �

Equipment that is upsetting to look at (suction machines, drainage containers) is kept out of �

the person’s sight if possible.Mementos, pictures, cards, flowers, and religious items provide comfort. Arrange them �

within the person’s view.

Slide 17

Slide 20 When a person cannot make health care decisions, the health care proxy can do so. �

You may not agree with care and resuscitation decisions. You must follow the person’s or �

the family’s wishes and the doctor’s orders. If these are against your personal, religious, and cultural values, discuss the matter with the nurse.

The doctor may order drugs for anxiety or depression. �

Simple measures may soothe the person—touch, holding a hand, back massage, soft �

lighting, music at a low volume.

You may find it hard to find comforting words. Use touch to show your concern. �

Help make the family as comfortable as possible. �

Most agencies let family members help give care. �

Communicate the request for a spiritual leader to the nurse at once. �




Slide 23

Slide 24 In some agencies, the body is prepared only for viewing by the family. The funeral director �

completes post-mortem care.The coroner or the medical examiner can order an autopsy, or the family can request one. �

Moving the body can cause remaining air in the lungs, stomach, and intestines to be �

expelled. When air is expelled, sounds are produced. They are normal and expected.Review the � Delegation Guidelines: Care of the Body After Death Box on p. 828 in the Textbook.Review the � Promoting Safety and Comfort: Care of the Body After Death Box on p. 828 in the Textbook.

Slide 21

Slide 22 The facial expression is often peaceful. �

Abdominal distention, fecal incontinence, nausea, and vomiting are common. �

The person feels cool or cold, looks pale, and perspires heavily. �

The pulse is fast or slow, weak, and irregular. Blood pressure starts to fall. �

Mucus collects in the airway. Breathing sounds are noisy and gurgling—commonly called �

the death rattle.The doctor pronounces the person dead. The cause, time, and place are noted for the death �

certificate.Review the signs of death listed on p. 827 in the Textbook. �

Discoloration and skin damage are prevented. �

Valuables and personal items are gathered for the family. �

Documents

52 End-of-Life Care · Explain how to assist with postmortem care. Perform the procedure described in this chapter. Care of the Body After Death Assisting with post-mortem care PPT