DEATH and DYING

“ To everything there is a season, and a time to every purpose under heaven: A time to be born, and a time to die . . . . “

Ecclesiastes 3: 1-2

DEATH

End of life Cessation of apical pulse, RR, and BP Natural part of life, something to be experienced by every living thing Viewed as personal failure on part of health personnel

Thanatology – study of death and its medical and psychological effects.

Causes of Death

Diseases Accidents Wars Homicides and suicides Sacrificial death Legal execution Abortion, infanticide, genocide

Nurse’s Feelings about Death and Dying

Questions the nurse should ask herself to clarify her feelings If I could control the event that result in my death, where would I want to

be? What cause of death would I choose? Whom would I want to have present during my terminal illness.

What fears do I have about death ? How would I answer these same questions for a patient for whom I have been

caring? How could I improve the quality of care for a terminally ill patient for whom I am

caring? If I were a member of the patient’s family, what things would I want nurses do for

me? Important Concepts

Grief – characteristic pattern of psychological and physiological responses a person experiences after the loss of a significant person

Bereavement – state of desolation that occurs as the result of a loss, particularly death.

Mourning – socially prescribed behavior after death of significant other Anticipatory grief – Physiologic and psychologic responses to impending loss of a

significant person, object, belief or relationship. Loss – actual or potential situation in which something that is valued is changed,

no longer available or gone. Actual loss – identified by others and can arise either in response or

anticipation of situation. Perceived loss – experienced by person but cannot be verified by others.

Stages of Grieving

Formulated by Dr. Elisabeth Kubler-Ross Studied emotional responses to death and dying These stages do not always follow one another or they may overlap. The duration

of any stage varies from the individual.

Stages of Grieving

Denial and Isolation

Anger

Bargaining

Depression

Acceptance

Patient says Death happens to others but not to him. He isolates himself from reality.

Pt. says –

“ No, not me. “

Stages of Grieving

Denial and Isolation

Anger

Bargaining

Depression

Acceptance

Characterized by rage and anger. The pt is very critical or everyone and everything. Anger is the pt’s defense mechanism but his real anger lies with health and life.

- “Why me?”

Stages of Grieving

Denial and Isolation

Anger

Bargaining

Depression

Acceptance

Anger has ordinarily subsided. Time for truce, and the patient now tries to barter for more time.He often make promises to God is he is a believer in exchange for more time.

- “ Yes me, but ….”

Stages of Grieving

Denial and Isolation

Anger

Bargaining

Depression

Acceptance

State of mourning over past losses and the present loss of his own life and is very sad time. Pt tend not to speak much and often cries. The nurse sits quietly as the pt goes through his own period.

- “Yes me. “

Nurses’ Role

Recognize the patient’s needs. Not one’s own and attempt to meet them. Allow and encourage the patient to talk and to express his emotions freely in a

nonjudgmental environment Be available to the patient Respect patient’s behavior Listen to the patient while he speaks.

Meeting Psychological Needs of Terminally ill Patients

Fear of catastrophic force of death Role of listening Role of communication Role of touch Meeting nutritional and fluid needs Caring for mouth, nose, eyes and skin Promoting elimination Protecting from harm/preventing injury Caring for the environment Providing comfort

Signs of Impending Clinical Death

Loss of muscle tone Relaxation of the facial muscle Difficulty speaking Difficulty swallowing Decreased activity of the GI with N/V, accumulation of flatus, abdominal

distention and retention of feces Possible urinary and rectal incontinence Diminished body movement

Slowing of circulation Diminished sensation Mottling and cyanosis of the extremities Cold skin, first in feet and later in hands, ears, nose but the client fell

warm because of elevated temperature

Changes in vital signs Decelerated and weaker pulse Decrease blood pressure Rapid, shallow, irregular or abnormally slow respiration: Cheyne-Stokes

respirations; noisy breathing or death rattle, mouth breathing Sensory impairment

Blurred vision Total lack of response to external stimuli No muscular movement, especially breathing No reflexes Flat encephalogram If with artificial support, absence of electric current from the brain for at

least 24 hours.

Post Mortem Care

BODY CHANGES Rigor Mortis – stiffening of the body that occurs about 2-4 hours after

death. – Lack of ATP which is not synthesized because of lack of

glycogen in the body Algor Mortis – gradual decrease of the body’s temperature after death. Livor Mortis – discoloration of the skin which appears in the lowermost or

dependent areas of the body due to RBC breakdown releasing hemoglobin Purpose; To clean and prepare the patient’s body before it is transported out of

the unit Equipments:

Bath basin with tap water Patient's wash cloth and bath towel Wrap sheet

Patient’s gown Patient’s clothes (optional) Yellow plastic bag

Mortuary box Cotton balls (2 packs) Micropore Rubber bands (2 pcs) Death tags with rubber bands (2 pcs) Calen gloves 4x4 pcs gauze (2 pcs) Glass rod Linen charge slip

Disposable face mask

Death forms Notice of death (3 copies) Death tags (2 pcs) Death certificate (4 copies) from admission office

Prepares to carry out the procedure 1. Checks completeness of mortuary box 2. Accomplishes the ff:

a. Notice of Death and death tags b. Secure death certificate form from admission office c. Request the resident/physician to accomplish the death certificate

3. Sends the following forms to : a. Notice of death – Admission office, Billing office and Nursing unitb. Death certificate

4. Informs the relatives of discharge procedure, securing funeral service, availability of hospital chaplain and autopsy procedure (if necessary)

Brings the needed equipments to the bedside Explains post mortem care to the immediate relatives Provides privacy Washes hands Performs actual procedure

Wear clean gloves, gowns and face mask Makes all itemized list of all personal belongings, endorses them to

immediate relatives and ask them to affix their signatures in the logbook Aligns body with arms at the side and places patient in a supine position Closes patient’s eyes by grasping eyelashes of the upper lid and pulling it

upward and downward over the eyes Places back dentures and closes patient’s mouth (Optional) Removes all contraptions (except radiation implants) and apply new dressings Provides sponge bath Packs all orifices with pieces of gauze/cotton balls

Dresses the body with patient’s gown or clothes. Attaches one death tag around the wrist, fold the patient’s hand over the chest and

position legs. Cover the body with wrap sheet Attaches the other death tag to the foot part of the sheet Transports the body to the morgue

Performs After Care procedure Discards all used supplies in a yellow plastic bag Removes al linen items and places it in a separate yellow Cleans and disinfects al equipments used Accomplishes ands sends housekeeping request for scheduling Replenishes mortuary box

Records the following: Time patient was pronounced dead Time post mortem care was rendered Observations noted during post mortem care Staff who rendered the post mortem care Staff who transported the cadaver to the morgue Time the cadaver was transported to the morgue

Immediate relative who considered to the autopsy (optional)