Death and Dying

Question 1

Elisabeth Kubler-Ross Identified 5 emotional stages of death and dying.

Answer 1

1. Denial
2. Anger
3. Bargaining
4. Depression
5. Acceptance

Question 2

Examples/types of fears associated with death are:

Answer 2

1. Physical
2. Social
3. Emotional

Question 3

Emotional fear of death

Answer 3

Being unprepared for death and for what happens after death.

Question 4

Social fear of death

Answer 4

Separation from family, leaving behind unfinished business

Question 5

Physical fear of death

Answer 5

Helpless, dependent, loss of physical abilities, mutilation of body, pain

Question 6

Interventions for FEARS of death

Answer 6

1. Talk as needed
2. Avoid superficial answers (i.e. “its God’s will”)
3. Provide religious support as the patient desires
4. Stay with the patient as needed
5. Work with families to strengthen and support

Question 7

Pulmonary changes associated with death

Answer 7

1. Unable to oxygenate the body
2. Assess for poor oxygenation such as skin being pale, cyanotic, mottled and cool.
3. In dark skin- assess mucous membranes and palms of hands.

Question 8

Cardiovascular changes associated with death

Answer 8

1. Large load on heart when lungs fail
2. Heart not getting needed oxygen
3. Pumping heart not strong enough to circulate blood
4. Blood backs up causing heart failure
5. Leads to pulmonary and liver congestion

Question 9

Blood circulation changes associated with death

Answer 9

1. Decreased, as heart less able to pump
2. May have a “drenching sweat” as death approaches
3. Pulse becomes weak and irregular
4. If pulse is relatively strong, death is hours away
5. If pulse is weak and irregular, death is imminent (soon)

Question 10

Metabolic changes associated with death

Answer 10

1. Metabolic rate decreases, almost stopping

2. Feces might be retained (constipation) or incontinence might be present (lose control of bowel function)

Question 11

Urinary changes associated with death

Answer 11

1. Urinary output decreases
2. Blood pressure too low for kidney to filter toxins out
3. Further load on cardiovascular system due to increase circulating volume

Question 12

Nervous system changes associated with death

Answer 12

1. Decrease oxygen to the brain, means decreasing brain function (confusion, etc…)
2. Sensation and power lost in legs, first, then arms
3. May remain conscious, semi-conscious, or comatose

Question 13

COMBINATION OF THESE EVENTS LEADS TO CELL DEATH, AND DEATH OF THE ORGANISM (HUMAN)

Answer 13

As pulmonary and cardiovascular systems fail, other body systems begin to fail, also

Question 14

Sensory changes associated with death

Answer 14

1. A dying person turns toward light - sees only what is near
2. Can only hear what is distinctly spoken
3. Touch is diminished - response to pressure last to leave
4. Dying person might turn toward or speak to someone not visible to anyone else
5. Eyes may remain open even if unconscious
6. Person might rally (seem better) just before dying

Question 15

FURTHER Neurological decline at death includes:

Answer 15

1. Pupils might react sluggishly or not at all to light
2. Pain might be significant
3. Assess for pain if person unable to talk: restlessness, tight muscles, facial expressions (grimmace), frowns
4. Provide pain medication as needed

Question 16

AT THE END OF LIFE. . .

Answer 16

1. Death is the end, as we know it, for that person
2. We can only support, listen therapeutically, and
3. Make the person as physically comfortable as possible
4. We can also use our knowledge and expertise to strengthen, support, and prepare the family

Question 17

HEALTHCARE RESPONSIBILITIES-

Answer 17

• *Will vary by institution, but MAY include**
• Family notification if they are not present
• Offer organ donation to the family (if applicable)
• Raise the head of the bed, straighten room, allow family to see patient (if appropriate)
• Shroud the patient
• Complete the paperwork (notification of funeral home or coroner, contact hospital administration, organ donation forms, etc…)