care of the dying and their fam Flashcards
needs of dying patients
physiological needs
physical care including hygiene, pain control, and nutrition
needs of dying patients
psychological needs
sense of control over:
-fear of the unknown
-separation from loved ones
loss of dignity
-pain mangement
-coping with unfinished business and isolation
needs of dying patients
spiritual needs
-love and relatedness
-forgiveness and hope
-exploration of meaning and purpose
describe care of dying
-ensure dignity is maintained
-care for individual and for the loved ones
-routine interventions maintained (hygiene, clean linens, ass for pain and comfort, consult support services, provide for loved ones comfort)
clinical signs of impending death
CV
weak, slow, irregular pulse, decreasing BP
clinical signs of impending death
resp
NOISY, irregular, cheyne stokes resps, apnea
clinical signs of impending death
GI/GU
nausea, flatus, abdominal distention, constipation, incontinence, decreased urine output
clinical signs of impending death
neuro
Difficulty talking or swallowing; loss of voluntary movement, sensation & reflexes; restlessness, decreased level of consciousness, agitation, hallucinations
clinical signs of impending death
skin
Cold, clammy skin; mottling & cyanosis
what is the legal definition of death
Uniform Definition of Death Act (1981): An individual who has sustained either (1) irreversible cessation of all functions of circulatory and respiratory functions or (2) irreversible cessation of all functions of the entire brain, including the brainstem, is dead.
what medical criteria is used to certify a death has occurred
-Cessation of breathing
-No response to deep painful stimuli AND
-Lack of reflexes (gag reflex, corneal reflex) and spontaneous movement
what are some changes of the body after death
Primary flaccidity then rigor mortis (stiffening)
Algor mortis (cooling)
Livor mortis (discoloration)
what are the nursing responsibilities at the time of death
Notification of:
Physician
Loved ones
Spiritual Care
Organ Donation Consultant
Facilitation of legal requirements
Care of the deceased
Care of the loved ones
describe notification of death
-Physician pronounces the death (legal time of death)
- Loved ones
Next of kin or guardian
- Spiritual Care
-Rituals for the deceased
-Care for the loved ones
-Support for the staff
describe care of the deceased
Place a sign on the patient’s door
Relocate room mate
Prepare for loved ones to visit
describe management of personal belongings
Management of deceased’s personal belongings
Remove jewelry, glasses, religious items, personal blanket
Remember to distribute the personal items not worn by the patient (medical devices-walkers, etc)
Give all personal belongings and valuables to the family members
Document who was given what items
If family members are not present, secure items in facility’s secured location
Document what was stored where
All documentation of distribution of effects is part of the permanent medical record
Nurses are responsible for the management of the patient’s belongings
if loved ones are present with the deceased immediately after death:
Provide a conference room for them to have a private space
Provide access to phones, chargers (if possible)
Provide opportunity to meet with facility chaplain
Before they view the deceased prepare the body
Side rails down
Chairs at side of the bed
Evaluate the need for your presence or for privacy
before loved ones leave…
Offer to call funeral home, personal spiritual provider (priest, rabbi, clergy, etc)
Determine if there are special religious
or cultural practices they wish to carry
out
Obtain contact information in case they need to be reached in the next couple of hours
Distribute patient’s personal belongings
describe preparing the deceased’s body
Bathe the body (observing any cultural or religious rituals)
Perform any interventions required for organ or tissue donation
Close eyes
Place dentures in mouth
Ensure patient is in a supine position, HOB at 30°, arms at sides
Remove* all tubes, drains & cover with a clean dressing; change all soiled dressings
*If autopsy will be performed, all tubes and lines must be left in place, but can be disconnected from other equipment
Obtain morgue pack or shroud
Ensure patient is appropriately identified
Maintain facility ID band on wrist
Tag from morgue pack on toe, ankle, or wrist
Another tag will be placed on the outside of the bag
Place abd pads or disposable pad between buttocks
Follow facility protocol for securing extremities and chin
Wrap the patient in the bag or shroud
Place final identification tag on the outside of the bag
describe transferring the deceased
Be aware of any special handling that is required for communicable diseases
Transfer to morgue or funeral home following facility policy
Registered Nurse signs to release the body to the next location
what are some legal requirements r/t death
Completion of the death certificate
Must be signed by the pronouncing physician
Authorization of tissue or organ donation
Authorization for autopsy
Consent for autopsy is obtained by the physician
Release of the body to the morgue or funeral home
Nursing Documentation
Time of death
Persons notified, time of notification
List and disposition of personal belongings
Time deceased was transferred from your care, destination, who transported the deceased
describe organ donation
At the time of death, or when death is imminent, nurses notify the organ donation consultant coordinator for the facility
Nurses provide information to the organ donation consultant regarding the deceased
Consent for donation is obtained by the consultant
Ohio offers “advanced authorization” on drivers’ licenses
describe autopsy
Medical examination after death
used to determine cause of death
Consent must be obtained prior to the completion of an autopsy
The Coroner can over-ride the family’s decision in some cases
describe code status
Code Blue (Code Pink) is called when a person experiences cardiac or respiratory arrest
Code status is a physician/provider order
Provider and patient, or patient’s decision maker, discuss code status
code status
full code
All attempts will be made to resuscitate
code status
DNR
No attempts will be made to resuscitate
code status
DNR specified
Determines what type of resuscitative efforts will be made at the time of the arrest
Compressions only
Medications only
Do not intubate (DNI)
code status
DNR CC
Only comfort measures will be used, no further diagnostic measures
Oxygen is administered
Medications are administered (may include IV fluids, although rare)
Routine hygiene and wound care
describe advanced directives
Legal documents that the patient completes to indicate the patient’s wishes should he or she be unable to make decisions
must be signed by pt prior to them becoming incapacitated
descrube living will
Addresses wishes regarding ‘extraordinary measures’
describe durable power of attorney for healthcare
Indicates who the patient wishes to make their healthcare decisions
are advanced directives the same as DNR orders?
nope
describe palliative care
Focus on providing relief from the symptoms and stress of a serious illness
Goal is to improve quality of life
A subspecialty of medicine that is helpful for persons of any age, with many different diagnoses
describe hospice care
The model for quality compassionate care for people facing a life-limiting illness or injury
Focuses on medical management, pain management, emotional and spiritual support
describe end of life ethical issues
“Death with Dignity laws allow qualified terminally-ill adults to voluntarily request and receive a prescription medication to hasten their death.
California
Colorado
DC
Hawaii
Maine
New Jersey
Oregon
Vermont
Washington
what are some different types of loss
Actual or Perceived
Expected or Unexpected
Maturational Loss
Situational Loss
Anticipatory Loss
describe actual loss
losses that are apparent to others
describe perceived losses
internalized
describe maturational loss
losses that occur as part of normal developmental phase transitions
describe situational loss
losses that come from an unexpected event (ex. natural disasters)
describe anticipatory loss
loss is felt b4 it is experienced
lifespan considerations
infants
dont understand permanence
lifespan considerations
toddler/preschooler
-start to experience separation anxiety
-prek are imaginitive
-can be very confusing
lifespan considerations
school age/adolescent
-usually have experienced a loss at this time
-begin to really understand permanence
-can impact developmental process greatly
lifespan considerations
adult/older adult
adults just start racking up losses and they identify coping strategies that work for them
older adults have it eve worse and are just losing tons and tons of shit
what is grief
Characteristic patterns of physiological and psychological response to a loss
describe mourning
socially prescribed behaviors of one who has experienced a loss (usually of a loved one)
describe bereavement
person’s total response to the loss; physical, social, emotional, and cognitive responses
name some factors that effect grief
Developmental Stage
Cultural Influences
Religious Beliefs
Circumstances of the Death
Available Resources
Stressors
describe altered grieving
Grief can be exaggerated, prolonged or absent.
Most experts agree that expressions of grief present 3 years or longer after the loss are abnormal
Disenfranchised Grief: experience of grieving a loss that is not acknowledged by society
what are engels six stages of grief
what are the kubler-ross 5 stages of grief
describe self care
Examine and clarify your own feelings about death and loss
Take time to grieve
Find a supportive listener: friend, coworker, chaplain
It is acceptable to show your emotions to the deceased’s loved ones
Professional boundaries preclude the need for them to console you
what are some nursing diagnoses r/t death
Anticipatory Grieving
Dysfunctional Grieving
Hopelessness
Powerlessness
Spiritual Distress
The patient asks a nurse to explain a living will. What is the nurse’s best response?
A. It identifies who will pay the patient’s bills
B. It is the agreed upon plan of care
C. It lists specific instructions for health care
D. It specifies if the patient wants to donate organs
C
A terminally ill patient says to her nurse, “My situation is hopeless; I have no control over anything!” Which of the following interventions does the nurse implement?
A. Tell her, “We have explored all treatment options”
B. Encourage her to tell you more about how she is feeling
C. Sit in a chair next to her
D. Do not disclose information about disease progression
E. Hold her hand
B, C, E
Your patient has just returned from a diagnostic test. The results show that he has very advanced cancer. Who is responsible for what, when, and how the patient is told?
A. You, his nurse are.
B. His spouse is.
C. His physician is.
D. The social worker is.
C
