Chapter 37. End-of-Life Care. Copyright 2019 by Elsevier, Inc. All rights reserved.
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1 Chapter 37 End-of-Life Care Copyright 2019 by Elsevier, Inc. All rights reserved.
2 Lesson 37.1 Define the key terms and key abbreviations in this chapter. Describe palliative care and hospice care. Describe the factors affecting attitudes about death. Describe the 5 stages of dying. Explain how to meet the needs of the dying person and family. Explain the purposes of the Patient Self- Determination Act. Copyright 2019 by Elsevier, Inc. All rights reserved. 2
3 Lesson 37.1 (Cont.) Describe 3 advance directives. Identify the signs of approaching death and the signs of death. Explain how to assist with post-mortem care. Perform the procedure in this chapter. Explain how to promote PRIDE in the person, the family, and yourself. Copyright 2019 by Elsevier, Inc. All rights reserved. 3
4 The Dying Person Sometimes death is sudden. Often it is expected. An illness or injury from which the person will not likely recover is a terminal illness. Your feelings about death affect the care you give. Copyright 2019 by Elsevier, Inc. All rights reserved. 4
5 Terminal Illness Many illnesses and diseases have no cure. The body cannot function after some injuries. Terminally ill persons can choose palliative care or hospice care. The person may opt for palliative care and then change to hospice care. Copyright 2019 by Elsevier, Inc. All rights reserved. 5
6 Attitudes About Death Many people fear death. Some look forward to and accept death. Attitudes about death often change as a person grows older and with changing circumstances. Practices and attitudes about death differ among cultures. Attitudes about death are closely related to religion. Reincarnation is the belief that the spirit or soul is reborn in another human body or in another form of life. Copyright 2019 by Elsevier, Inc. All rights reserved. 6
7 Age Infants and toddlers do not understand the nature or meaning of death. Between 2 and 6 years old, children think death is temporary. Between 6 and 11 years, children learn that death is final. Adults fear pain and suffering, dying alone, and the invasion of privacy. Older persons usually have fewer fears than younger adults. Some welcome death. Copyright 2019 by Elsevier, Inc. All rights reserved. 7
8 The Stages of Dying Dr. Elisabeth Kübler-Ross described five stages of dying. Stage 1: Denial ( No, not me is a common response.) Stage 2: Anger (The person thinks, Why me? ) Stage 3: Bargaining (The person now says, Yes, me, but ) Stage 4: Depression (The person thinks, Yes, me and is very sad.) Stage 5: Acceptance (The person is calm and at peace.) Copyright 2019 by Elsevier, Inc. All rights reserved. 8
9 The Stages of Death Dying persons do not always pass through all five stages. A person may never move beyond a certain stage. Some move back and forth between stages. Some people stay in one stage. Copyright 2019 by Elsevier, Inc. All rights reserved. 9
10 Comfort Needs Dying people have psychological, social, and spiritual needs. You need to listen and use touch. Some people may want to see a spiritual leader or take part in religious practices. Provide privacy during prayer and spiritual moments. Be courteous to the spiritual leader. Handle the person s religious objects with care and respect. Copyright 2019 by Elsevier, Inc. All rights reserved. 10
11 Physical Needs Vision, hearing, and speech Vision blurs and gradually fails. Hearing is one of the last functions lost. Speech becomes harder. Mouth, nose, and skin Crusting and irritation of the nostrils can occur. Circulation fails and body temperature rises as death nears. Elimination Urinary and fecal incontinence may occur. Constipation and urinary retention are common. Copyright 2019 by Elsevier, Inc. All rights reserved. 11
12 Promoting Comfort Measures to promote comfort include: Skin care Personal and oral hygiene Back massages Good alignment Pain-relief drugs ordered by the doctor and given by the nurse Frequent position changes Supportive devices Turning the person slowly and gently Semi-Fowler s position for breathing problems Provide a comfortable and pleasant room. Copyright 2019 by Elsevier, Inc. All rights reserved. 12
13 The Family This is a hard time for the family. Show you care by being available, courteous, and considerate. Use touch to show your concern. Respect the right to privacy. Do not neglect care because the family is present. The family goes through stages like the dying person. A spiritual leader may provide comfort. Copyright 2019 by Elsevier, Inc. All rights reserved. 13
14 Legal Issues The Patient Self-Determination Act and the Omnibus Budget Reconciliation Act of 1987 (OBRA): Give persons the right to accept or refuse medical treatment. Give the right to make advance directives. Copyright 2019 by Elsevier, Inc. All rights reserved. 14
15 Legal Issues (Cont.) An advance directive is a document stating a person s wishes about health care when that person cannot make his or her own decisions. A living will is a document about measures that support or maintain life when death is likely. Durable power of attorney for health care gives the power to make health care decisions to another person. A Do Not Resuscitate (DNR) order means that the person will not be resuscitated. Copyright 2019 by Elsevier, Inc. All rights reserved. 15
16 Signs of Death These signs that death is near occur rapidly or slowly: Movement, muscle tone, and sensation are lost. Peristalsis and other gastro-intestinal functions slow down. Body temperature rises. Circulation fails. The respiratory system fails. Pain decreases as the person loses consciousness. Some people are conscious until the moment of death. Copyright 2019 by Elsevier, Inc. All rights reserved. 16
17 Signs of Death (Cont.) The signs of death include no pulse, no respirations, and no blood pressure. The pupils are fixed and dilated. A doctor determines that death has occurred and pronounces the person dead. Copyright 2019 by Elsevier, Inc. All rights reserved. 17
18 Care of the Body After Death Care of the body after death is called postmortem care. Post-mortem care: Begins when the doctor pronounces the person dead. Is done to maintain a good appearance of the body. Copyright 2019 by Elsevier, Inc. All rights reserved. 18
19 Care of the Body After Death (Cont.) Within 2 to 4 hours after death, rigor mortis develops. Rigor mortis is the stiffness or rigidity of skeletal muscles that occurs after death. When an autopsy is to be done, post-mortem care is not done. An autopsy is the examination of the body after death. Follow agency procedures when an autopsy is to be done. Copyright 2019 by Elsevier, Inc. All rights reserved. 19
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