8/14/2019 Discharge Care and Rehabilitation

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DISCHARGE CARE ANDREHABILITATION

DEFINITION OF TERMS Death-cessation of Life Rehabilitative Care-process of

restoring the highest level of possible wellness and returningthe persons ability to live andwork as normally as possible

Postmortem Care-care of bodyafter death to preventdiscoloration and otherprocesses that occur after deathand preserve dignity of thedeceased

Grief- total response to theemotional experience related toloss

Bereavement- subjectiveresponse experienced by thesurviving loved ones after loss

Mourning- behavioral processthrough which grief is eventuallyresolved or altered

Dysfunctional Grieving- consistsof an extended time of depression, severe physiologicsymptoms, suicidal thoughtsafter a loss

Loss- any actual or potentialsituation in which valuedobjects/persons has changed oris no longer accessible to theindividual

MODES OF DISCHARGE1. As Ordered by Doctor2. Against Medical Advice3. Death

CONCEPT OF DEATHa. infancy to 5 yrs.- death is reversibleb. 5-9 yrs.- death is final but can beavoided

c. 9-12 yrs.- fear of death;understands own mortalityd. 12-18 yrs.- may fantasize thatdeath can be defied and therefore actrecklesslye. 18-45 yrs.- attitudes towards deathmay be affected by religious andcultural beliefsf. 45-65 yrs.- accepts own mortalityg. 65 and up- perceives death in theirown understanding

CLINICAL SIGNS OF IMPENDING DEATH Loss of muscle tone Slowing of Circulation Changes in Respiration Sensory Impairment

SIGNS OF EMOTIONAL DEATH Withdrawal/Preparing to let go Vision-like experiences Letting go Saying goodbye

PHYSIOLOGIC CHANGES AFTER DEATHwhat? when?/rate? IX others

RigorMortis

stiffening 2-4 hrs position body properly; placedentures; close eyes and mouth

due to loss of ATP

AlgorMortis

cooling 1 degreeCelsius/hr

place blanket over patient cessation of metabolism

Livor lividity 30 mins. then 6-10hrs. after

due to accumulation of blood insmall blood vessels

Putrefaction

softening/decomposition

24-30 hrs. embalming due to bacterial action

END OF LIFE CARE1. Cooling of Extremities- provide

blanket2. Decreased Appetite- offer

glycerin swabs3. Incontinence- provide diaper4. Congestion and Gurgling-

elevate head, suctionsecretions5. Sleepiness- allow adequate rest6. Sleeplessness- soothing music;

reduce no. of visitors

MANIFESTATIONS OF GRIEF1. Verbalization of loss2. Crying3. Sleep disturbance4. Loss of appetite

5. Difficulty concentrating TYPES OF LOSS

1. Actual- verified by others2. Perceived- verified by self only

CATEGORIES OF LOSS External Object- thing is lost

Familiar Object- environmentchanged Aspect of Self- physical or

psychological Significant Others

LEGAL ASPECTS OF DEATH Advance Directives/Durable

Power of Atty.-must be

witnessed by 2 people and isnotarizeda. Health Care Proxyb. Living Will

Autopsy Certification of Death DNR Euthanasia Inquest

TYPES OF GRIEF1. Abbreviated-brief but genuinely

felt2. Anticipatory- occurs before loss3. Disenfranchised- unable to

acknowledge grief to others4. Dysfunctional- unresolved and

inhibited

KUBBLER ROSS STAGES OF GRIEFSTAGE IXDenial verbally support but do not reinforce denialAnger do not take anger personally; help client understand that anger is normal

Bargaining listen attentively and encourage client to talk to relieve guilt or irrationalfearDepression allow client to express sadness; convey caring by touchAcceptance encourage participation in tx program