CARE OF DYING PATIENT.pptx

care of dying patients for nursing students

1. E.THABITHAL NURSING TUTOR GANGA COLLEGE OF NURSING COIMBATORE CARE OF TERMINALLY ILL

2. CARE OF TERMINALLY ILL E.THABITHAL NURSING TUTOR GANGA COLLEGE OF NURSING COIMBATORE

3. CARE OF TERMINALLY ILL PATIENT

4. Introduction T here are a wide variety of problems in nursing care for patients with terminally ill. In care, communication is important in the patient-nurse relationship, and particularly at the end of life, effective caring is not possible without communication.

5. DEFINITION Terminally illness is a disease that cannot be cured or adequately treated and that is reasonably expected to result in the death of the patient within a short period of time .this term is more commonly used for progressive disease such as cancer or advanced heart disease than for trauma.

6. HOSPICE PATIENT

7. PURPOSE 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

8. SIGNS OF APPROACHING DEATH Facial appearance Changes in sight, speech, and hearing Respiratory system Circulatory system Gastro intestine system Genito urinary system Skin and musculoskeletal system Central nervous system

9. FACIAL APPROACH Facial muscle relax, cheek become 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. pupil’s fails to react to light, eyes sunken and half closed, speech becomes increasingly difficult, confused, loss of hearing

10. cont...... 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. Rapid 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 reflex disappears, the patient feels the inability to swallow

11. cont...... DEATH RATTLE: a rattling sound hearing in throat caused by secretions that the patient cannot cough longer GENITO URINARY SYSTEM: retention of urine, distension of the bladder, incontinence of urine and stool due to loss of sphincter control SKIN & MUSCULOSKELETAL 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 ofcirculatory 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, heartbeat & respirations Pupil becoming fixed and not reacting to light Absence of all reflexex Rigor motis: 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 discolouration due to the settling of the blood.

13. 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. No more breaths in or out. The jaw is relaxed, the mouth slightly open. No heartbeat is to be felt. There might be a sudden release of bowel and/or bladder. The eyes are staring fixedly on one spot. Most likely, the eyelids are slightly open. The pupils may be enlarged. No more blinking for the eyes. These signs of death are pretty simple and straight forward. The life force has left the body. The body is not functioning any more. The body is dead. There is death.

14. CARE OF DYING PATIENT Psychological support Advance planning for imminent death Financial concerns Legal and ethical concern Helping and patient transition Pain management The patient’s right to information Symptomatic management

15. CARE OF DYING PATIENT PSYCHOLOGICAL SUPPORT:

16. CARE OF DYING PATIENT PSYCHOLOGICAL SUPPORT: The psychological need of a dying person can be summarized as follows: Relief from loneliness, fear & depression maintenance of security, self confidence & dignity maintenance of hope meeting the spiritual needs according to his religion customs.

17. SYMPTOMATIC MANAGEMENT Problems associated with breathing

18. 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 patient’s head and shoulders keep the room well ventilated and keep crowed away periodic suctioning is necessary

19. Problem associated with eating and drinking Anorexia, nausea, and vomiting are commonly seen in dying patient. 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. They may need IV fluids if they tolerate oral fluids, sips of water is given with teaspoon give frequent oral hygiene apply emolients to the dry lips the denture are removed and kept safely

20. Caring 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 arrangemenents will be made immediately the family often wishes to view the body before final preparation are made, they may be allowed if the patient had any valuables, they are handed over to relatives

21. Articles required articles for bath extra bandages and cotton swabs perineal pads sheets restraints for jaw ,hand and legs pair of gloves thumb forceps patient own set of clothes

22. PROCEDURE Warm the cooling extremities by the application of blankets and prevent draft. See that the bedding is light in weight and when the gown is wet with perspiration should be changed. Rub the skin gently with alcohol 70% Place patient in a comfortable position preferably on his side and support back with pillows with head part elevated. Turn him toward the light. Never, darken the room. Make the room airy.

23. cont...... Give special care to the mouth. Relieve excessive dryness of the lips by applying mineral oil with cotton applicator. Give water on some refreshing liquid in Small amount at short interval. Speak distinctly and stand near the patient because the hearing become less acute. Place bedpan or urinal in position periodically. Protect beddings well. Avoid disagreeable odor. The nurse should stay with the patient as long as he shows signs of lie, except for short periods when he may want to be left with a friend, member of the family physician or minister.

24. Routine Procedures to be done as Symptoms of Approaching Death Develop: Notify the doctor. Notify relatives and friends. Call for priest or minister. Call supervisor and Headnurse. Provide privacy (by screening if in the ward ).

25. IDENTIFICATION TAG SHOULD CONTAIN : patient name age registration number relative name address ward number bed number date and time of death cause of death

26. CONCLUSION In conclusion, to care for someone after death is a privilege that shouldn’t be taken lightly, there are many things to consider that integrate all four fundamental patterns of knowing which link in nicely with the 6 c’s Science & Personal Knowledge (Competency/ Commitment) Ethics (Courage, Compassion), Art (Care/Communication), they are all required to ensure patients are cared for well in life and in death.