2. K.L.E.US INSTITUTE OF NURSING SCIENCES, BELGAUM.
SUBJECT:NURSING FOUNDATION TOPIC:CARE OF DYING PATIENT PRESENTED
BY, MR. IRANNA A. KAJAGAR SENIOR TUTOR
3. INTRODUCTION Life begin with birth and ends with death.
clients death is often viewed as personal failure on the part of
health personnel. The family turns to the nurse for support and
assistance. To provide effective care nurse must have reconciled
his or her own feelings about death and must understand the phases
of grieving & dying and should be able to recognize their
manifestations.
4. Cont.. Death will come to all people at some time. caring
allows the patient to die with dignity. an important aspect of
patient care is to the patient sense of identity & self esteem.
every person has the right to die with dignity.
5. MEETING THE NEEDS OF DYING INDIVIDUAL Assessing needs
Explaining the clients condition and treatment Maintaining good
communication Promoting self care & Self Esteem Allowing family
members to assists in care. Meeting clients needs. Physiological
needs Psychological needs Spiritual needs
7. GRIEF AND STAGES OF GRIEF REACTION # Grief is the emotional
pain caused by a loss. Engel (1964) was among the first to define
six stages of grief reaction. Which includes the following steps.
Shock And Disbelief Developing Awareness: Shows physical and
emotional response such as anger, crying why y me? Restitution: Act
of giving back Idealization: Acceptance of loss Outcome:
8. SIGNS OF APPROACHING DEATH Facial appearance. Changes in
sight, speech, and hearing. Respiratory system. Circulatory system.
Gastro intestinal system. Genito urinary system. Skin and musculo
skeletal system. Central nervous system.
9. Facial appearance. Facial muscle relax, cheek becomes
flaccid moving in and out with each breath. Facial structure may
change so the dentures cannot be worn, mouth structure may
collapse, loss of muscles tone & prominent cheeks, pale, sunken
eyes. CHANGES IN SIGHT, SPEECH, AND HEARING.- Sight gradually fail.
The pupils fails to react to light. Eyes are sunken and half
closed. Speech becomes increasingly difficult, confused. Loss of
Hearing.
10. RESPIRATORY SYSTEM-Respiration becomes irregular, rapid and
shallow breath or very slow & Sertorius due to the presence of
secretions. CIRCULATORY SYSTEM.-Circulatory changes cause
alterations in the temperature, pulse and respirations. Radial
pulse gradually fails. Once it stops, the apical pulse may continue
for some time. Usually the pulsations are seen even after the
patient has stopped breathing. GASTRO INTESTINAL SYSTEM.-Hiccoughs,
Nausea, Vomiting, abdominal distensions are seen. The gag reflux
disappears; the patient feels the inability to swallow,
11. DEATH RATTLE-A rattling sound heard in throat caused by
secretions that the patient cannot cough longer. GENITO URINARY
SYSTEM-Retention of urine, distention of the bladder, incontinence
of urine and stool due to loss of sphincter control. SKIN AND
MUSCULO SKELETAL SYSTEM.-The skin may become pale, cool and sweats
lot (cold sweats).Ears and nose are cold to touch. Skin is pale
& mottled due to congestion of blood in the veins as a result
of circulatory failure. CENTRAL NERVOUS SYSTEM.-Reflexes and pain
are gradually lost. Patient may be restless due to lack of oxygen
and due to raised body temperature, although the body surface is
cool.
12. SIGNS OF CLINICAL DEATH Absence of pulse, heart beat and
respirations Pupil becoming fixed and not reacting to light Absence
of all refluxes. Rigor mortis: Stiffing of the body after death.
The arms & legs cannot be bent or straightened while rigor
mortis is present unless the tendons are torn. POSTMORTEM
HYPOSTASIS-It is a dark red or bluish discoloration due to the
settling of the blood.
13. CARE OF THE DYING PATIENT Psychological support: The
psychological need of a dying person can be summarized as follows:
Relief from loneliness, fear and depression. Maintenance of
security, self confidence and dignity. Maintenance of hope. Meeting
the spiritual needs according to his religious customs. The dying
person may be shifted to privet room, or privacy is maintained by
putting the screen, so that other patients may not be disturbed by
the unpleasant sight, the crises and other disturbances.
14. SYMPTOMATIC MANAGEMENT Problem associated with breathing:
The dying person who is restless, apprehensive and short of breath
may be given- Oxygen inhalation to remove his discomfort. Elevation
of the patients head and shoulders may make breathing easier. Keep
the room well ventilated and keep crowed away. Periodic suctioning
is necessary.
15. Problem associated with eating and drinking: Anorexia,
nausea, and vomiting are commonly seen in dying patient person.
They are unable to take any form of food and if they taken, they
are unable to retain the food. The patient is unable to swallow
even the sips of water poured in the mouth. Most of them may
require I.V fluids. If they can tolerate the oral fluids, sips of
water is given with teaspoon. That will help the patient to keep
the mouth moist. Give frequent oral hygiene. Apply emollients to
the dry lips. The denture are removed and kept safely.
16. Problem associated with elimination: Constipation,
retention of urine and incontinence of urine and stool are some of
problem faced by the patient. Catheterization has to be done
Through skin and Perineal care is to be given, to keep the patient
clean and to prevent skin breakdown. Problem associated with
immobility: Frequent skin care should be given with particular
attention to the pressure point. Patient should be comfortably
placed and their position frequently changed in the bed.
17. Problem associated with sense organ: Since the patient
loses sight, before given any care to the patient, the nurse should
touch the patient and say what she is going to do. Since the
hearing is retained longer, speak only what is appropriate. Avoid
whispering any think in patient room. Speak distinctly so that
patient may understand what is done for him. Since the eyes are
opened, protect the eyes from corneal ulceration with protective
ointment.
18. Problem associated with rest and sleep: Patient may
distressing symptoms in these patients. Patient should not be
disturbed while sleeping. The visitors should be instructed not to
disturbed the patient during his resting. Maintain calm and quit
environment. Problem associated with cleanliness and grooming:
Cleanliness and appearance are important until the end. Cleanliness
of the skin, hair, mouth, and cloth has to be maintained.
19. CARING FOR THE BODY AFTER DEATH After the physician has
pronounced death legally documented the death in the medical
record, care of the body is usually performed by the nurse. An
autopsy consent may be requested & obtained if required. If the
patient is to be an organ donor arrangements will be made
immediately. The family often wishes to view the body before final
preparations are made, they may be allowed. If the patient had any
valuables, they are handed over to the relatives
20. PURPOSES Make body look as natural & beautiful as
possible. Perform his last duty tenderly. Protect other patients
from unpleasant sights and sounds which could frighten them
21. ARTICLES REQUIRED Articles for bath Extra bandages and
cotton swabs Perineal pads Sheets Restraints for jaw, hands and
legs. Pair of gloves Thumb forceps Patients own set of
clothes.
22. PROCEDURE Wash hands and put on gloves Soon the death is
pronounced, remove the backrest, extra pillows and gently put the
patient in a supine position with the head elevated on the pillow.
Positioning is important after death, because of rigor mortis.
close the patients eyes and mouth. Remove all tubes and other
devices from the patients body.
23. Cont.. Consult close relatives before preparing the body
for removal from the ward to the mortuary where the relatives will
receive the body. If the relatives require, the nurse should help
them to sponge the patient as necessary. brush and comb hair.
Replace soiled dressing with cleaned ones. Apply perineal pads and
plug the rectum & vagina (in females) with cotton balls.
Provide clean cloths(own).
24. Cont.. Take care of valuables and personal belongings by
handing over to members of family. Allow members of family to see
the patient & remain in the room & remember that the body
is still dear to someone. Close the body from side to side and head
to foot with the sheet.
25. Cont Prepare the identification slip and attach it to the
patients pack sheet. Attach a special label if the patient had a
contagious disease. Transfer the body to the mortuary. Remove
contaminated articles from room.
26. IDENTIFICATION TAG SHOULD CONTAIN Patient name Age
Registration number Relatives name (specify) Address Ward number
Bed number Date and time of death Cause of death
27. CONCLUSION When death cannot be prevented it becomes
imperative that the doctor and nurse do all whatever is necessary
to make dating less difficult for the patient. the dying patient
has a variety of needs ranging from the need for open communication
to physiological and spiritual needs. they should maintain self
care as long as possible. families of the dying patient may like to
assist in providing care. The nurse should provide emotional
support for the grieving family.