CARE OF DEATH PATIENT .pptx

care of death and dying patients

1. POOJA SEN NURSING LECTURER (MHN)

2. MEANING OF DEATH T he end of life. The total and permanent cessation ( end) of all the vital functions of an organism.

3. DEFINITION OF DEATH Death is the cessation of circulatory, respiratory & brain function that sustain a living organism. Death is defined as permanent cessation of all vital bodily function. Death is defined as the irreversible cessation of all vital functions especially as indicated by permanent stoppage of the heart, respiratory and higher brain function.

4. incidence OF DEATH Death it is estimated that there are over 56 million deaths occurring annually which translates to approximately 4.6 million deaths monthly ,  150,000 daily , 6,000 hourly , 106 every minute , and nearly 2 deaths every second . In India, approximately 26789 deaths are reported per day.

5. TYPES OF DEATH SOMATIC DEATH / SYSTEMIC DEATH / CLINICAL DEATH CELLULAR DEATH / MOLECULAR DEATH OTHER TYPES- NATURAL DEATH SUCIDE DEATH ACCIDENT DEATH HOMICIDE DEATH

6. TYPES OF DEATH SOMATIC DEATH / SYSTEMIC DEATH / CLINICAL DEATH – It means complete & irreversible stoppage of vital function. Absence of pulse ( carotid pulse) Absence of heart sound. A flat electrocardiogram. Absence of breath sound on through auscultation of chest. Dilated or fixed pupil, not respond to light. Absence of motor response.

7. TYPES OF DEATH Cellular or molecular death – It means death of tissue & cells of body individually. BRAIN DEATH

8. Other TYPES OF DEATH NATURAL death – Natural is defined as death caused solely by disease or natural process. If natural death is hastened by injury (such as a fall or drowning in a bathtub), the manner of death is not considered natural.

9. TYPES OF DEATH SUCIDE death – “Suicide is when people direct violence at themselves with the intent to end their lives and they die because of their actions”.

10. TYPES OF DEATH accidental death – Accidental death as an event that strictly occurs because of an accident. Deaths from car crashes, slips, choking, drowning, machinery, and any other situations that can't be controlled.

11. TYPES OF DEATH homicide death – Homicide is a broad term that can apply to both intentional and unintentional killing. It comes from French and Latin roots. It means a death caused by another person. Homicide describes the manner of death. Practically speaking, an intentional killing such as murder and a killing in self-defense are both homicides.

12. RANDO R PROCESS MODEL

13. RANDO SIX R’ s OF GRIEVING R- RECOGNIZING THE LOSS . ( Awareness & understand that it has happened) R- REACTING TO THE SEPARATION . ( People React Emotionally To Their Loss) R- RECOLLECTING MEMORIES OF THE DECREASE ( People May Review Memories Of Their Lost Relationship, day To Day Moments That Were Experienced Together) R- RELINQUISH The Old Attachment ( Find Out The New Ways Of Living, realizing and accepting that the world has truly changed and there is no turning back) R- READJUSTING To The New Environment ( New Coping Skills) R- REINVESTING SELF ( Energy Once Turned Inward On Grief Begins To Be Focused Outward Again.

14. SIGNS OF IMPENDING DEATH Amongst the signs of death actually having occurred are things such as …… There is no response to either questions or touching. Body temperature drops. No more breaths in or out. The jaw is relaxed, the mouth is slightly open. No heartbeat is to be felt. Blood pressure decline. Mottled veins. There might be sudden release of bowel and bladder. The eyes are staring fixed on one spot, most likely the eyelids are slightly open. No more blinking for the eyes. These sign of death are pretty simple & straight forward, the life force has left the body. The body is not functioning any more. The body is dead.

15. SIGNS FOR APPROCHING DEATH / PHYSIOLOGICAL CHANGES AFTER DEATH

16. FACIAL EXPRESSION Facial muscles relax. Facial structu re may change. Mouth structure may collapse Loss of muscles tone Sunken eye s

17. CHANGES IN SIGHT,SPEECH & HEARING Sight gradually fail. The pupil fail to react to light. Eyes are sunken & half closed. Speech gradually decreased. Loss of hearing.

18. CHANGES IN RESPIRATORY SYSTEM Respiration becomes irregular, rapid & slow breath (Cheyne strokes respiration- involves a period of fast, slow breathing) . DEATH RATTLE (Terminal respiration secretion) soft, wet crackling, snoring or gurgling sound-a rattling sound heard in throat caused by secretions that the patient can not cough longer.

19. CHANGES IN CIRCULATORY SYSTEM Circulatory changes cause alteration in the temperature, pulse & respiration. Radial pulse gradually fails, once it stop the apical pulse may continue for some time.

20. CHANGES IN GESTROINTESTINAL SYSTEM Hiccoughs, nausea, vomiting, abdominal distention are seen. The gag reflux disappears , the patient feels the inability to swallow.

21. CHANGES IN URINARY SYSTEM Retention of urine. Distention of the bladder. Incontinence of urine & stool due to loss of sphincter control.

22. CHANGES IN MUSCULO SKELETAL SYSTEM The skin may become pale, cool & sweats lot ( cold sweat) Ears & nose are cold to touch. Skin pale & mottled veins due to congestion of bloods in veins as a result of circulatory failure.

23. CHANGES IN CENTRAL NERVOUS SYSTEM Reflexes & pain are gradually lost. Patient may be restlessness due to lack of oxygen.

24. Signs of clinical death

25. SIGNS OF CLINICAL DEATH Absent of all vital functions. Pupil become fixed and not reacting to the light. Absence of all reflexes. Rigor Mortis ( stiffing of the body after death) Post partem hypostasis – it is dark red or bluish discoloration due to the settling of the blood.

26. DYING PATIENT’S BILL OF RIGHTS

27. RIGHTS OF DYING PATIENT I have the right to be treated as a living human until die . I have the right to maintained a sense of hopefulness . I have the right to express my feeling & emotions about my approaching death in my own way . I have the right to participate in decision concerning in my care ( Honest answer to questions). I have right to expect continuing medical & nursing attention even through cure goals must be changed into comfort goals .

28. RIGHTS OF DYING PATIENT I have the right to not die alone . I have the right to be free of pain . I have the right to retain my individuality and not to be judge for my decision ( explore & change religious beliefs). I have the right to expect the respectful treatment of the human body after death .

29. RIGHTS OF DYING PATIENT I have right to Die at home in familiar surroundings. I have right to withdraw from social contact if desired. I have the right to be cared for by caring ,sensitive, knowledgeable people who will attempt to understand my needs & will be able to gain some satisfaction in helping me face my death.

30. DEATH DECLRATION CERTIFICATE A document issued by the government to the nearest relatives of the decreased, stating the date, fact and cause of death. It is essential to register death to prove the time and date of death.

31. DEATH CERTIFICATE is required for following purpose Withdrawal of money from death persons bank account. For insurance policy. For getting fixed deposit transferred . Share transferred For getting father’s job. For legal purpose.

32. Documents required for DEATH CERTIFICATE Proof of birth An affidavit specifying the date and time of death. A copy of the ration card. Person requesting the death certificate is required to provide the evidence of relationship with the decreased and complete address with the nationality.

33. CARE OF DYING PATIENT Life begin with birth and ends with death. client death is often viewed as personal failure on the part of health personnel. The family turn to the nurse for support and assistance to provide effective care nurse must have reconciled his or her own feeling about death & must understand the phase of grieving & dying and should be able to recognize their manifestation.

34. CARE OF DYING PATIENT To provide effective care of dying individual nurse must have reconciled his her own feelings about death and must be understand the phases of grieving & dying and should be able to recognize their manifestations. Every person has the right to die with dignity. Nurse must understand the influence of dignified death and the profound effect it has on the family and those close to the person who died .

35. CARE OF DYING PATIENT Physiological needs Comfort Physical environment Psychological need Spiritual need

36. CARE OF DYING PATIENT Psychological support – The psychological needs of a dying person can be summarized as follow….. Relief from loneliness, fear and depression. Even through in the presence of the nurse, the family members should be encouraged and invited to participate in the client care, if they desire to do so and the client is willing. Maintains of hope. Meeting the spiritual needs according to his religious customs.

37. CARE OF DYING PATIENT Problem associated with breathing – The dying person who is restless or short of breath may be given……. Oxygen inhalation to remove his discomfort. Elevation of the patient ‘s head and shoulders may make breathing easier. Keep the room well ventilated and keep crowed away. Periodic suctioning is necessary.

38. CARE OF DYING PATIENT Problem associated with eating and drinking – Anorexia nervosa & vomiting are commonly seen in dying patient person. They are unable to take and form of food and if they taken, they are unable to retain food . The patient is unable to swallow even the sips of water pored in the mouth, most of them may require IV 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.

39. CARE OF DYING PATIENT Problem associated with eating and drinking – Give frequent oral hygiene. Apply emollients to dry lips. The dentures are removed and kept safely.

40. CARE OF DYING PATIENT Problem associated with elimination – Constipation ,retention of urine and incontinence of urin 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.

41. CARE OF DYING PATIENT 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.

42. CARE OF DYING PATIENT 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.

43. CARE OF DYING PATIENT Problem associated with rest and sleep – Patient should not be disturbed while sleeping. The visitors should be instructed not to disturbed the patient during the resting. Maintains calm and quite environment.

44. CARE OF DYING PATIENT 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. Gentle massage with soothing lotion are comforting. Bed bath is adequate if the client cannot get into the tub or sit in the shower chair.

45. CARE OF DYING PATIENT Comfort – Pain relief as prescribed. Keep the patient clean and dry. Provide safe and non- threatening environment. Provide a respectful, careful attitude to provide psychological comfort by establishing good rapport.

46. CARE OF DYING PATIENT Physical environment – A physical environment can significantly increases the client comfort,like non slippery floor, side rails in the rooms , support to walk independently to washroom, availability of call bell in room. Adequate lighting, provide night light if patient requires. Provide quite and calm environment. Analgesics are prescribed for the pain and it may be cause sedation.

47. CARE OF DYING PATIENT Spiritual Needs – The nurses play a major role in promoting the dying clients spiritual comfort . Dying persons are among the most vulnerable members of the human family. Pray with the client. Read religious literature aloud at the patient requested. Play religious music or songs.