CARE OF TERMINALLY ILL

care of terminally patients for bsc nursing and gnm 1st year

1. Mrs DEVINA VICHRAM NURSING TUTOR GANGA COLLEGE OF NURSING CARE OF TERMINALLY ILL PATIENT

2. CARE OFTERMINALLY ILL PATIENT

3. Concepts of grieving Three major concepts associated with grieving are loss grief mourning.

4. LOSS Loss is the absence of a possession or future possession with the response of grief and the expression of mourning. The feeling of loss can be associated with the loss of health, changes in relationships and roles, and eventually the loss of life. After a patient dies, the family members and other survivors experience loss

5. GRIEF Grief is the emotional response to a loss, defined as the individualized and personalized feelings and responses that an individual makes to real, perceived, or anticipated loss. These feelings may include anger, frustration, loneliness, sadness, guilt, regret, and peace. Grief affects survivors physically, psychologically, socially, and spiritually.

6. MOURNING Mourning is the outward, social expression of loss. Individuals outwardly express loss based on their cultural norms, customs, and practices, including rituals and traditions. Some cultures may be very emotional and verbal in their expression of loss, such as wailing or crying loudly. Other cultures are stoic and show very little reaction to loss.

7. Types of Grief There are five different categories of grief: Anticipatory grief Acute grief Normal grief Disenfranchised grief Complicated grief.

8. Stages of Grief

9. Care of the Dying Patient Care of the dying patient generally refers to care in the last days or hours of life. The goals of care during the last hours and days of life are to ensure comfort and dignity. Good palliative care does not hasten death.In humanitarian settings, where healthcare providers may not have expertise in palliative care, identifying when patients are at this stage of life can be challenging. In addition, during this time, physical symptoms can be difficult to control; the best way to ensure they are well managed is to anticipate the symptoms and develop a management plan.

10. EUTHANASIA Euthanasia, also called mercy killing, act or practice of painlessly putting to death persons suffering from painful and incurable disease or incapacitating physical disorder or allowing them to die by withholding treatment or withdrawing artificial life-support measures.

11. TYPES OF EUTHANASIA Active euthanasia“aggressive” euthanasia. Passive euthanasia Voluntary euthanasia Involuntary euthanasia Self-administered euthanasia Other-administered euthanasia Assisted Mercy-killing Physician-assisted suicide:

12. Deathbed Will A Deathbed Will is a Last Will Testament that is created and executed when the testator (the person distributing his/her property) is facing imminent death.

13. D ying declaration A dying declaration is a statement made by a declarant, who is unavailable to testify in court (typically because of the declarant's death), who made the statement under a belief of certain or impending death. The statement must also relate to what the declarant believed to be the cause or circumstances of the declarant's impending death.

14. Organ donation Organ donation begins with determining which patients may be suitable donors. To be an organ donor, the patient must have sustained a neurologic injury resulting in brain death. According to the Uniform Determination of Death Act, an individual is dead when there is irreversible cessation of circulatory and respiratory functions or irreversible cessation of all functions of the brain, including the brain stem

15. Organ donation process Potential donor identification → brain death determination → referral to OPO → donor screening for acceptable organs → approaching the family → authorization from family → OPO evaluation → donor management → organ recovery → organ placement

16. MEDI LEGAL ISSUES All brought dead cases should be informed to the nearest police station by the medical officer on duty Death certificate should not be issued in such brought dead cases or MLC before post mortum is done Identifition marks of the examinee should be noted Documents should be maintained including death summary, ivestigations carried out and the treatment given Birth and death registrations are mandatory Detailed infmation includig name, age, gender, religion, address etc should be included

17. cont........... Information regarding cause of death, time of death evidenced by 12 lead ecg should be safeguarded in MLC death , dead body to be released only to the police and not to the relatives Any samples if needed to be preserved while filling death register , MLC register, etc short forms should be avoided documents should be under custody of concerned personal along

18. Care of unit after death Cleaning: Cleaning with warm water and detergent is a process that removes visual dirt and contamination and in most cases is effective for decontaminating both equipment and the environment. Disinfection: sodium hypochlorite is the most common hallogen used

19. Types of cleaning Routine General Cleaning: Routine cleaning of the environment should be undertaken at least daily. Thorough cleaning with neutral detergent and water is commonly used. If soiling (with blood and/or bodily fluids) is evident, then general cleaning should be followed with a disinfectant clean - using a chlorine releasing product/sodium hypochlorite or a chlorine dioxide solution.

20. Enhanced Cleaning: During an outbreak of infection or an unusual increase in the incidence of a particular organism, enhanced routine cleaning (minimum twice daily) is recommended. This will entail cleaning/disinfecting the environment including frequently touched surfaces such as bed tables, bed rails, the arms of chairs, sinks, call bells, door handles and push plates, and any area/piece of equipment that may potentially be contaminated. Depending on the type of outbreak in the healthcare facility,

21. Terminal Cleaning Following an outbreak or increased incidence of infection Following discharge, transfer or death of a patient who has had a known infection Following isolation/contact precaution nursing of a patient

22. Terminal cleaning procedure: Gather all equipment required for the terminal clean at the point of use e.g. mop bucket, mop, disposable colour coded cloths, disposable roll, yellow clinical waste bags & tags, alginate & red bags, wet floor sign, vacuum cleaner fitted with a HEPA filter. Don Personal Protective Equipment (PPE), i.e. disposable apron and gloves, before entering the room, discard all disposables in the room/bed space/unit (e.g. hand towels, magazines, bottles, toilet rolls, etc.) All materials must be disposed of as clinical waste.

23. CONT........ Prepare cleaning/disinfecting solutions in a container (dilution as per manufacturer’s instruction). Do not mix chemicals and only use a cleaning product provided by your employer. Ventilation of the area/room being cleaned must be adequate; if there is no window, the door should be left open when applying hypochlorite/chlorine dioxide solutions.

24. CONT........ Disinfectant solutions should be used as per Manufacturer’s instructions, particularly the contact time. Also the Control of Substances Hazardous to Health (COSHH) regulations must be adhered to when using chemical disinfectants. After cleaning, rinse with water (if rinsing is required) before drying. In particular it is important to rinse chlorine containing solutions from stainless steel surfaces to prevent corrosion.

25. CONT........ Use disposable cloths/paper roll for cleaning during the terminal clean. Where available and appropriate, use disposable mop heads. After use, these should be disposed into a clinical waste bag before leaving the area/room. Ensure that PPE is changed when moving from one room/area to another and dispose into a clinical waste bag.

26. CONT........ Always decontaminate your hands after removing and disposing of PPE. Avoid leaving and re-entering the area until the terminal clean is fully completed.

27. AUTOPSY An autopsy, also known as a post-mortem examination A specialized surgical procedure used to determine the cause and manner of death. The cause of death is the medical reason explaining why a patient passed. The manner of death is the circumstances surrounding the death.

28. EMBALMING A method of preserving a dead body by removing the blood and replacing it with fluids, such as formaldehyde, which discourage the growth of the organisms responsible for putrefaction. TYPES OF EMBALMING 1. Arterial embalming : It involves the injection of embalming chemicals into the blood vessels usually via the right common carotid artery. Blood is drained from the right jugular vein.

29. 2. Cavity embalming It is the suction of the internal fluids of the cadaver and the injecting embalming chemicals into body cavities by using an aspirator and trocar 3 . Hypodermic embalming Is injecting embalming chemicals under the skin as needed.

30. 4. Surface embalming Supplements the other methods especially for visible, injured body parts.