Class 14: End of life care Flashcards
what influences our attitudes about death?
- nurses need to analyze their own feelings about death and dying to be affective caregivers
- age, if its expected, culture, religion, beliefs
palliative care/hospice care
focuses on the physical, emotional, social and spiritual needs of dying people and their families
PRT (palliative response team)
social worker and nurse
goals of palliative care
- assist in controlling the pain and symptoms of the illness
- ensure the death is a natural process
- provide compassionate care in a comfortable and peaceful environment
signs and symptoms of impending death
- sleeping longer
- decreased intake of food
- confusion/agitation
- difficulty swallowing
- irregular breathing or apnea
- respiratory congestion
- irregular pulse
- decreased BP
- loss of bowel and bladder control (catheter)
- increased temperature
- decreased urine output and constipation
- requests to settle “unfinished business”
- cool legs/edema
- reporting seeing people who have died
signs of imminent death
- individual in a coma or semi-coma
- severe agitation or hallucinations
- dramatic changes in breathing patterns (long periods of apnea)
- severely increased respiratory congestion
- inability to swallow fluids
- mottling of extremities
physical care needs of the dying
- pain
- dyspnea/respiratory distress
- nausea
- vomiting
- anorexia/cachexia
- constipation
- dehydration
- delirium
- oral health concerns
- fatigue
supporting friends and family members who have lost someone or will lose them soon
- be aware of the stages of grief and grieving
- allow them to grieve
- encourage them to be with pt
- allow for differences (wanting/not wanting to view the body)
- recognize religious and cultural differences in how they cope
- support them physically and emotionally (how they want to be involved)
- give permission to take care of themselves
MOST
medical orders for scope of tx
pronouncing death as an LPN
- LPN’s have the capacity to pronounce death when it is anticipated
- collaborate with health care team about who will pronounce
- recognize signs of anticipated death
- identify who should notify family and which family member to notify
anticipated death
-client is irreversibly and irreparably terminally ill.
-death is expected by family and health care team
-client advance directive (for instructions) indicate that life sustaining interventions are to be withheld. (NO CODE)
-evidenced by absence of:
response to verbal stimuli, heart sounds at the apex and carotid pulse, spontaneous respirations, pupillary response to light
pronouncing death
- support familys values and traditions
- notify coroner if appropriate
- document appropriately
- provide appropriate post-mortem care
- pronouncement of death has legal implications (know the policy, know the law, know when to call the RN, the MD, the coroner)
when it is a coroners case
when a person dies…
- suddenly and unexpectedly
- result of pregnancy (up to 1 yr post partum)
- result of violence, misadventure, negligence, misconduct, malpractice, suicide
- from disease, sickness, unknown cause, not treated by medical practitioner
- from any other cause that might require investigation
- in a correctional institution, lock up or prison
- is a patient of or committed to an institution to which the Mental Health Act apples
- is a pt transferred from a prison or mental institute
care of the body after death
- treat body with dignity and sensitivity
- provide care ASAP after death
- policies/procedures are facility-specific
- prepare to appear natural and comfortable
- place supine with arms at sides or across abdomen
- place small pillow/folded towel under head
- hold eyelids closed for a few moments, if open
postmortem care
- insert dentures
- wash soiled body parts
- dress in clean gown or clothes, brush/comb hair and cover to shoulders with clean linen
- removes any tubes according to policy
- remove extraneous equipment, dirty linens, extra supplies
- cover drainage sites
- ensure id bracelet present and legible
- offer family opportunity to view body
- remove jewellery and present along with other valuables/belongings to family
- offer to contact support services (social services or clergy)
- the family becomes the client
- a rolled up towel under chin will close mouth
- shroud/body bag/packing of orifices
- transport body to morgue or call mortician
- identify communicable diseases PRN
- ensure appropriate disposition of belongings
- document all events surrounding death
