care of dying patient for nursing FON subject

this power point is regarding care of dying patient and death for nursing students.

1. CARE of DYING

2. Cassen (1991) suggests seven essential features in management of dying Concern Empathy compassion involvement are essential Competence Skill and knowledge can be as reassuring as warmth and concern. patients benefit immeasurably from the reassurance that their providers will not allow them to live or die in pain.

3. Communication Allow patients to speak their minds and get to know them. Children If children want to visit the dying ,it is generally advisable ;they bring consolation to dying patients . Cohesion Family cohesion reassures both the patient and family. The clinician who gets to know the family maximise patient support and is prepared to help family through bereavement.

4. Cheerfulness A gentle ,appropriate sense of humor can be palliative ;a somber or anxious demeanor should be avoided Consistency Continuing , persistent attention is highly valued by patients who often fear that they are a burden and will be abandoned; consistent physician involvement mitigates these fears.

5. Signs of Dying This includes the following changes: Loss of appetite Decreased oral fluid intake and decreased thirst Increasing weakness and /or fatigue Decreasing blood perfusion ,including decreased urine output peripheral cyanosis and cool extermities Neurologic dysfunction including delirium which can include confusion hallucination Pitting edema develops especially in legs

6. Movement and sensation are gradually lost Temperature elevation will be there but skin feels cold and clammy. Pulse becomes irregularly ,weak and fast Bp falls as the peripheral circulation decreases. The skin cyanosed as circulation decreases. respiration becomes noisy. Reflexes disappears . Urine decreases. Pain usually subsides. Mentally alertness varies . Jaw and facial muscles relax with the expression becoming peacefull .

7. Nursing care of dying patient Creating a peaceful environment to the patients liking. Preparing instructions about whom to call (usually not all)when death occurs . Give the relatives time to witness what is happening . Creating and using rituals that can help mark the occasion in the respectful way. When death occurs ,families should encouraged to take whatever time they need to feel what has happened,and say their goodbyes .there is no need to rush the body to a funeral home ,and some families want to say with the body for a period of time after death.

8. Meeting physical needs A patient in the terminal stages of a disease ,is given all the nursing care possible to ensure the most comfort and freedom from pain . Physical comfort is important as well as emotional and spiritual comfort .

9. Meeting nutritional needs . Patients suffer discomfort due to decreased gastrointestinal activity . Nutrients and fluids are given intravenously when they are not tolerated orally. Sips of water is given as long the swallowing reflex is present . When there is problem gauze soaked with water ,may be placed in the patients mouth for him to suck and moisten the mouth.

10. Meeting special needs Mucus that collects in the throat is removed by placing the patient in a lateral position ,wiping it away , or by suctioning. Frequent oral hygiene is done to keep the mouth free of dried secretions, and feeling fresh to the patient. Vaseline or cream is applied to the lips to keep them soft. The nostrils are kept clean and lubricated as necessary. The eyes are cleaned with cotton balls and normal saline. Bath the patient and change the linen needed. Light weight covering should be used. Heavy covering seems to be uncomfortable to dying patient.

11. Urinary and fecal incontinence often occur due to relaxing of the sphincter muscles. Pads are used to keep the bed linen from being soiled . Frequent changes of position. Pain is a great problem in some diseases. The doctor orders sufficient medication to control pain. Nursing measurements for pain are used to make the patient comfortable on a minimum medication. Dimness and shadows are confusing and increase a sense of loneliness. So we have to provide adequate light.

12. Meeting emotional needs Touch is an important method of communication with dying person. The patients appropriates someone holding his hand or plying hand on a arm, his head or some other part of the body . It conveys a feeling of caring and concern. Speak in a normal voice to the patient . Do not speak in a whisper in patients presence.

13. Signs of death Absence of heartbeat and respirations. Fixed pupils. Skin color turns to a waxen pallor and extremities may darken. Body temperature drops. Muscles and sphincter relax, sometimes resulting in release of stool and urine.

14. death Death is present when an individual has sustained either irreversible cessation of circulatory and respiratory functions or irreversible cessation of all functions of the entire brain ,including the brain stem. The supportive nursing care during death is as follows :to give compassionate nursing care and support to the family and patient during the griving and dying process, the nurse should consider the five aspects of human functioning . By using the nursing process ,the nurse does an assessment of each aspect ; physical emotional, intellectual sociocultural and spiritual to fully understand and adequately provide interventions in this areas .