1. GOOD MORNING

2. K.L.E.US INSTITUTE OF NURSING SCIENCES, BELGAUM. SUBJECT:NURSING FOUNDATION TOPIC:CARE OF DYING PATIENT PRESENTED BY, MR. IRANNA A. KAJAGAR SENIOR TUTOR

3. INTRODUCTION Life begin with birth and ends with death. clients death is often viewed as personal failure on the part of health personnel. The family turns to the nurse for support and assistance. To provide effective care nurse must have reconciled his or her own feelings about death and must understand the phases of grieving & dying and should be able to recognize their manifestations.

4. Cont.. Death will come to all people at some time. caring allows the patient to die with dignity. an important aspect of patient care is to the patient sense of identity & self esteem. every person has the right to die with dignity.

5. MEETING THE NEEDS OF DYING INDIVIDUAL Assessing needs Explaining the clients condition and treatment Maintaining good communication Promoting self care & Self Esteem Allowing family members to assists in care. Meeting clients needs. Physiological needs Psychological needs Spiritual needs

6. STAGES OF DYING (DR.ELIZABETH KUBLER ROSS) DENIAL ISOLATION ANGER BARGAINING DEPRESSION ACCEPTANCE

7. GRIEF AND STAGES OF GRIEF REACTION # Grief is the emotional pain caused by a loss. Engel (1964) was among the first to define six stages of grief reaction. Which includes the following steps. Shock And Disbelief Developing Awareness: Shows physical and emotional response such as anger, crying why y me? Restitution: Act of giving back Idealization: Acceptance of loss Outcome:

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

9. Facial appearance. Facial muscle relax, cheek becomes 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. The pupils fails to react to light. Eyes are sunken and half closed. Speech becomes increasingly difficult, confused. Loss of Hearing.

10. 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. Radial 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 reflux disappears; the patient feels the inability to swallow,

11. DEATH RATTLE-A rattling sound heard in throat caused by secretions that the patient cannot cough longer. GENITO URINARY SYSTEM-Retention of urine, distention of the bladder, incontinence of urine and stool due to loss of sphincter control. SKIN AND MUSCULO SKELETAL 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 of circulatory 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, heart beat and respirations Pupil becoming fixed and not reacting to light Absence of all refluxes. Rigor mortis: 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 discoloration due to the settling of the blood.

13. CARE OF THE DYING PATIENT Psychological support: The psychological need of a dying person can be summarized as follows: Relief from loneliness, fear and depression. Maintenance of security, self confidence and dignity. Maintenance of hope. Meeting the spiritual needs according to his religious customs. The dying person may be shifted to privet room, or privacy is maintained by putting the screen, so that other patients may not be disturbed by the unpleasant sight, the crises and other disturbances.

14. 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 the patients head and shoulders may make breathing easier. Keep the room well ventilated and keep crowed away. Periodic suctioning is necessary.

15. Problem associated with eating and drinking: Anorexia, nausea, and vomiting are commonly seen in dying patient person. 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. Most of them may require I.V fluids. If they can tolerate the oral fluids, sips of water is given with teaspoon. That will help the patient to keep the mouth moist. Give frequent oral hygiene. Apply emollients to the dry lips. The denture are removed and kept safely.

16. Problem associated with elimination: Constipation, retention of urine and incontinence of urine and stool are some of problem faced by the patient. Catheterization has to be done Through skin and Perineal care is to be given, to keep the patient clean and to prevent skin breakdown. Problem associated with immobility: Frequent skin care should be given with particular attention to the pressure point. Patient should be comfortably placed and their position frequently changed in the bed.

17. Problem associated with sense organ: Since the patient loses sight, before given any care to the patient, the nurse should touch the patient and say what she is going to do. Since the hearing is retained longer, speak only what is appropriate. Avoid whispering any think in patient room. Speak distinctly so that patient may understand what is done for him. Since the eyes are opened, protect the eyes from corneal ulceration with protective ointment.

18. Problem associated with rest and sleep: Patient may distressing symptoms in these patients. Patient should not be disturbed while sleeping. The visitors should be instructed not to disturbed the patient during his resting. Maintain calm and quit environment. Problem associated with cleanliness and grooming: Cleanliness and appearance are important until the end. Cleanliness of the skin, hair, mouth, and cloth has to be maintained.

19. CARING FOR 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 arrangements will be made immediately. The family often wishes to view the body before final preparations are made, they may be allowed. If the patient had any valuables, they are handed over to the relatives

20. PURPOSES 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

21. ARTICLES REQUIRED Articles for bath Extra bandages and cotton swabs Perineal pads Sheets Restraints for jaw, hands and legs. Pair of gloves Thumb forceps Patients own set of clothes.

22. PROCEDURE Wash hands and put on gloves Soon the death is pronounced, remove the backrest, extra pillows and gently put the patient in a supine position with the head elevated on the pillow. Positioning is important after death, because of rigor mortis. close the patients eyes and mouth. Remove all tubes and other devices from the patients body.

23. Cont.. Consult close relatives before preparing the body for removal from the ward to the mortuary where the relatives will receive the body. If the relatives require, the nurse should help them to sponge the patient as necessary. brush and comb hair. Replace soiled dressing with cleaned ones. Apply perineal pads and plug the rectum & vagina (in females) with cotton balls. Provide clean cloths(own).

24. Cont.. Take care of valuables and personal belongings by handing over to members of family. Allow members of family to see the patient & remain in the room & remember that the body is still dear to someone. Close the body from side to side and head to foot with the sheet.

25. Cont Prepare the identification slip and attach it to the patients pack sheet. Attach a special label if the patient had a contagious disease. Transfer the body to the mortuary. Remove contaminated articles from room.

26. IDENTIFICATION TAG SHOULD CONTAIN Patient name Age Registration number Relatives name (specify) Address Ward number Bed number Date and time of death Cause of death

27. CONCLUSION When death cannot be prevented it becomes imperative that the doctor and nurse do all whatever is necessary to make dating less difficult for the patient. the dying patient has a variety of needs ranging from the need for open communication to physiological and spiritual needs. they should maintain self care as long as possible. families of the dying patient may like to assist in providing care. The nurse should provide emotional support for the grieving family.

28. THANK YOU