Critical care nursing UNIT Lecture 8.pptx

Critical care nursing UNIT Lecture 8.pptx

1. Sub: Critical Care Nursing Unit I : Conceptual Foundations in Critical Care Nursing Topic: Bereavement and Death and Dying Lecture: 8 Mansoor ul Haq (Lecturer) MPH, BSN, PNS, LUMHS, Jamshoro

2. Grief - Is the Emotional Reaction to Loss.( e.g. many people who divorce experience grief, loss of a body part, a job, a house or a pet.). Bereavement- State of grieving during which a person goes through grief reaction. (e.g. when a person neglects their own health to an extreme) Mourning -Period of acceptance of loss and grief during which the person learns to deal with the loss. (e.g. a person returning to normal living habits)

3. Dying Dying is the process of approaching death, including the choices and action involved in that process Irreversible cessation of circulatory, respiratory & brain function. We may help the dying patient meet his /her. Physiological needs Spiritual needs Emotional needs

4. Meeting Physiological needs of the dying patient. Providing personal hygiene measures Controlling pain Relieving respiratory , difficulties Assisting with movement nutrition, hydration and elimination Providing comfort to the patient and relieving pain.

5. Spiritual support Identify patient spiritual needs Respect the beliefs the patients Be willing to listen and discuss issues of spiritually Demonstrate empathy

6. Emotional support Compassion (Desire to help ) Responsiveness to emotional needs Maintain a positive attitude Expressing empathy

7. Death The irreversible cessation of all vital functions especially as indicated by permanent stoppage of the heart ,respiration, and brain activity the end of life. Death is the cessation or permanent termination of all the biological functions that sustain a living organism.

8. Causes of Dying & Death IHD. Accidents Cancer. COPD Suicide. Lung cancer HTN, Heart diseases. Cerebrovascular disease. Lower respiratory tract infection.

9. Sign & Symptoms Facial Appearance Facial muscle relax. Loss of muscle tone. Pale skin. Sunken eyes. Respiratory system Irregular. Cheyne- stoke’s respiration (rapid & slow). Stertorous (sound like snoring) due to secretion.

10. Gastrointestinal system Nausea & vomiting. Abdominal distension Inability to swallow. Central nervous system Loss of reflexes & pain. Restless due to lack of oxygen Raised body temperature.

11. Sight, Speech & Hearing Gradual sight fails. Pupil fail to react to light Sunken eyes Difficult speech- confused Hearing gradually becomes low. Circulatory system Alteration in vital signs. Rapid pulse gradually fails.

12. Genito-urinary system Retention of urine. Distended bladder. Incontinence of urine & stool. Skin & musculoskeletal system Pale skin. Cold sweats. Ears & nose are cold at touch Stiff muscles.

13. Signs Of Clinical Death Absence of pulse, heart beat & respiration. Fixed pupils & non-reactive to light. Absence of reflexes. Algor Mortis- Rapid cooling of the body. Rigor mortis(a stiffening of body after death due to muscle fixation. i.e. jaw-neck arms, trunk-legs) Livor Mortis-Purple discoloration of skin in dependent area cyanosis

14. Management A - Airway maintenance with cervical spine control. B - Breathing & ventilation. C - Circulation with hemorrhage control. D - Disability, neurological status. E - Exposure/Environmental control complete undress the patient, but prevent hypothermia.

15. Oxygen inhalation. Suctioning. Positioning. Well- ventilation. Medication as prescribed. IV fluids, oral fluids, or sips of water. Perineal care, skin care, mouth care, eye care & clean clothing's. Rest & sleep.

16. Psychological Support Relief from loneliness, fear & depression. Maintenance of security, self-confidence & dignity. Maintenance of hope & spiritual comfort. Maintenance of a comfortable & peaceful environment. Use therapeutic communication. Protect against Isolation. Assist with end- of- life decision making.

17. Palliative Care Palliative care is the prevention, relief, reduction or soothing of symptoms of disease or disorders throughout the entire course of an illness, including care of dying and bereavement follow-up for the family.

18. Five Principles of Palliative Care (Hospice Care) Respects the goals, likes and choices of the dying patient. Looks after medical, emotional, social, and spiritual needs of the dying person. Supports the needs of the family members. Helps patient gain access to needed healthcare providers and appropriate settings. Builds ways to provide excellent end of life care.

19. Care of Body after Death Death declaration/ Death certificate by physician. Autopsy (written permission for post mortem) Customs & principles are kept in mind. Positioning- body straitened & arms laid at the side. Eyes are closed as in sleep. Dentures are removed & prop chin in position with bandaging.

20. All orifices are to be plugged with cotton to prevent escape of body discharges. Remove ornaments and list them to relatives. Prevention of spread of diseases (i.e. sealing body) Send body clean and neatly dressed. An identification tag for body. If relatives are present then body is handed over them with proper written legal authority permission. Maintain record of death and inform to authority for register of deaths. Care of unit.

21. Islamic Culture Deceased body is ritualistically washed, wrapped, cried over, prayed for and buried. Non-Muslims should not touch the body. Autopsies (written permission for post mortem/dissection) are not allowed. Organ donation is sometimes allowed

22. Spiritual and Religious Beliefs Spiritual resources include faith in a higher power, communities of support, friends, a sense of hope and meaning in life, and religious practices. Spiritual integration occurs when an individual come to terms with his or her life and puts life’s pieces together in a way consistent with one’s entire life.

23. Law During Handover Death Body Federal and state law require that institutions develop policies and procedures for certain events that occur after death. Requesting organ or tissue donation Autopsy Certifying and documenting the occurrence of a death. Providing safe and appropriate post mortem care.

24. 1. Organ or Tissue Donation The person requesting organ or tissue donation provides information about who can legally give consent, which organs or tissues can be donated, associated costs and how donation will affect burial. 2. Autopsy Family members give consent for an autopsy, the surgical dissection of a body after death to determine the exact cause and circumstances of death or discover the pathway of disease. Law sometimes require that an autopsy be performed when death is due to homicide, suicide, accidents etc.

25. 3. Certificate and Documentation Documentation of a death provides a legal record of the events. The registered nurse gathers information and records. A licensed professional witnesses the signing of forms (body handover to belongings) Nursing documentation becomes relevant in high risk management or legal reporting. Family members deserve and expects clear description of death. State law and policy of agency govern the sharing of written medical record information, which usually involves a written request.

26. Post Mortem Care The nurse provide care of body after death. Human body deserves the same respect and dignity as a living person and needs to be prepared in a manner consistent with the client’s cultural and religious belief.

27. Documentation of End of Life Care Name, Age, Sex, Cause of Death Time and date of death and all actions taken to respond to impending death. Name of healthcare provider certifying the death. Persons notified of the death. (Health providers, family members, organ requests team, morgue, funeral home, spiritual care providers.) Request for organ or tissue donation made and by whom. Special preparation of body .(desired or required)

28. Medical tubes, devices, or lines left in or on body. Personal articles left on body. Personal articles given to family with description, date, time to whom given. Location of body identification tags. Time of body transfer and destinations. Any other information on family requests that clarify special circumstances.

29. References Morton. G.P & Fontain . K.D., (2013)., Essentials of Critical Care Nursing. A Holistic Approach. Lippincott Williams & Wilkins.