1 good aging gerontology geriatrics. 2 lecture no. 12 death & dying by dr. hala yehia
Post on 16-Dec-2015
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Objectives
• At the end of this lecture the student will be able to:• Define death & dying• Identify special needs of dying client• Mention nursing role for dying client• Describe stages of dying• List signs of death • explain nursing role in spiritual preparations for death• Discuss nurse's role in meeting family needs • Define hospice care
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Death & Dying
ThanatologyStudy of death The description of study of the phenomena of death, and of psychological mechanisms for coping with death
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Definitions
Death absolute cessation of vital functions
Dying process of losing these functions
Good deathFree from avoidable distress and suffering
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Special Needs Of Dying client• Visits with family/significant others
• Features of Client's room:
–pleasant as possible
–well ventilated
–odor free
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Special Needs Of Dying Resident(continued)
• Features of client’s room:–Contains personal items which
provide comfort and reassurance• Pictures• Mementos• Cards• Flowers• Religious objects
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Caring For client When Death Is Imminent
Nurse Role
• Open and receptive• Know own feelings about
death and do not project those feelings on to client.
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Caring For client When Death Is Imminent and Following Death
Nurse Role(continued)
• Empathetic• Calm and efficient • Normal tone of voice• Good listening skills• Non-judgmental
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How Do Most People Cope With Dying and Death?
• DENIAL–Defense mechanism–Buffer against reality–client may request
another opinion
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Five Stages of Grief, Death and Dying as Described
• DENIAL (continued)
–client may avoid discussion of death
–Feeling of, “This can’t be happening to me.”
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Five Stages of Grief, Death and Dying as Described
• ANGER
–Confused and anger
–Sense of unfairness
–Blame of others such as health care workers
–Feeling of, “Why me?”
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Five Stages of Grief, Death and Dying as Described
• BARGAINING
–Turn to religious and spiritual beliefs
–Promises to God and others
–Comfort and hope when all seems lost
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Five Stages of Grief, Death and Dying as Described
• BARGAINING (continued)–Generally know this
won’t work–Frustration and anger
dissolve into depression
–“If only...I will”
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Five Stages of Grief, Death and Dying as Described
• DEPRESSION–Belief that hope is lost–Overwhelming despair–Introverted and withdrawn–Remembering and reviewing life–Sleeplessness–“I always wanted to”
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Five Stages of Grief, Death and Dying as Described
• ACCEPTANCE–Calm –Strives to complete unfinished
business–Helps loved ones accept death–Needs others to validate worth of life–“I’ve had a good life.”
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Signs Of Approaching Death
• Changes in sensory functions and ability to speak–Vision
• increased secretions in corner of eyes
• blurred vision• failing vision• no eye movement/staring
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Signs Of Approaching Death
• Changes in sensory functions and ability to speak (continued)
–Speech• becomes difficult• hard to understand• may be unable to speak
–Hearing - last function to be lost
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Signs Of Approaching Death
• Changes in circulation and muscle tone–Circulation
• fails• heat gradually lost from body• hands and feet cold to touch and mottled
• face becomes pale or gray and mottled
• perspiration may increase (diaphoresis)
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Signs Of Approaching Death
• Changes in circulation and muscle tone (continued)–Muscle tone
• body limp• jaw may drop• mouth may stay partly open
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Signs Of Approaching Death
• Changes in Vital Signs–Respirations
• slower• shallow• labored• may experience dyspnea, apnea, mucous collects in the throat and bronchial tubes (death rattle)
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Signs Of Approaching Death
• Changes in Vital Signs (continued)–Pulse
• rapid• weak and irregular
–Blood pressure drops–Temperature
• elevated• subnormal
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Signs Of Approaching Death
• Urinary and anal incontinence
• Decreased peristalsis, abdominal distention
• Release of flatus
• Decreased pain
• Loss of consciousness
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Nurse ’s Role In Spiritual Preparation For Death
• clergy may be contacted at request of client or family
• Privacy to be provided when clergy with client
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Nurse ‘s Role In Spiritual Preparation For Death(continued)
• Support client’s religious/spiritual practices even if different from that of nurse.
• Listen respectfully to religious/spiritual beliefs
• Participate in religious practices if asked and acceptable
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Nurse’s Role In Spiritual Preparation For Death(continued)
• Treat religious objects with care and respect:–medals–pictures–statues– Encourage family and
friends to be included
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Nurse’s Role In Meeting Family Needs
• Available for support• Use touch as appropriate• Respect right to privacy• Let family assist with
care, if they desire, where appropriate
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Nurse’s Role In Meeting Family Needs
(continued)
• Use good communication skills
• Listen and provide understanding throughout the grief/loss stages
• Answer questions or refer to supervisor
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Hospice Care
• Health care service offered:– in hospitals and extended care
facilities–by special facilities–usually in the individual’s home
• Continuing care provided by team of health professionals
• Designed for clients with terminal illness
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Hospice Care(continued)
• Acceptance of death as imminent (6 months or less)
• Assures that individual dies with dignity and comfort
• Not concerned with cure or life-saving procedures
• Emphasis on pain relief• Trained volunteers and professionals
make regular visits.
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Hospice Care(continued)
• Provides counseling for individual and family:–Emotional–Psychological–Spiritual–Financial–Bereavement
• Family included in all aspects of care as desired
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Postmortem Care
• Care Of Body After (Post) Death (Mortem) –Begin care when instructed by
supervisor–Treat body to privacy, respect and
gentleness–Give care before rigor mortis sets in
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Postmortem Care(continued)
• Reasons for Postmortem Care–Prevent discoloration and skin
damage–Maintain good appearance of body–Identify body and prepare for
transportation–Position body in normal alignment–Arrange time family to view the body
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