Death & Dying Flashcards
Do’s and Don’ts of Bad News
Do:
Provide the full truth, clearly and compassionately.
Reassure pt that medical and emotional support will be made available.
Use active listening, be present and create connection.
Don’t:
Withhold information, judge or make assumptions about what their reaction may be (esp pregnancy, AI)
I’m Sorry
shares the sadness vs. confusion between sympathy/pity/apologies
may take the attention from the pt back to the physician
Stages of Dying
Shock, Denial, Anger, Depression, Bargaining, Acceptance, Decathexis
Hope can be present along the way.
Grief
GRIEF:
Episodic waves of extreme sadness and frequent crying, not pervasive; Patient can still experience pleasure; Feelings of hopelessness are transient; Will improve with time; Natural response to loss
Other symptoms: fatigue, change in appetite, trouble sleeping
multi-faceted response to loss.
the internal, subjective response to loss which is experienced physically, emotionally, cognitively and behaviorally.
The experience differs between individuals, their families and their cultures.
Depression
in contrast to grief
Same sxs as grief, plus:
Unremitting sadness
Inability to enjoy activities that were once pleasurable
Weight loss, loss of self worth
Increased use of alcohol or other drugs
Social isolation
Fixation on death, suicidal thoughts or attempts
critical variables that influence the intensity, duration and resolution of the grief
Relationship and attachment
Perception of preventability
Perception of suffering
Circumstances surrounding the loss
Additional variables affecting perception and intensity:
Concurrent losses and stresses.
Physical variables
The belief system and personality
Serving the bereaved:
Be present, tolerate silences, listen with acceptance and without judgment.
Use first name of deceased; use judgment and be open to asking about memories and thoughts; understand there is no appropriate timeline.
Trying to make someone feel better may have the opposite effect in grief.
Death
Clinical death is the term now used to describe the time at which spontaneous heart beat and respiration has ceased.
(Death is the termination of the biological functions that define a living organism; the absence of blood circulation and vital functions related to blood circulation was considered to be the definition of death (outdated due to CPR and defibrillation). At the onset of an absence of blood circulation, consciousness is usually lost within several seconds. Measurable electrical activity generally stops within 60 seconds of onset of an absence of blood circulation. )
Brain Death
the irreversible cessation of brain activity; cessation of both the higher levels of brain function and the basic functions at the level of the brain stem.
–> can declare a person legally dead even if life support equipment serve to maintain the body’s metabolic processes. NO brainstem activity.
a legal definition of death that emerged in the 1960’s as a response to improved methods allowing for the resuscitation of individuals and the ability thereafter to mechanically keep their heart and lungs working.
What s/sxs or lack there of signify brain death?
The absence of spontaneous respiration.
No response to painful stimuli.
Absence of cranial nerve reflexes: pupillary response to light, the corneal reflex, the pharyngeal or gag reflex and the oculocephalic reflex.
No response to caloric reflex test
S/sxs that may precede death
Diminished food and fluid intake
Incontinence of urine or stool
Breathing patterns may change and become irregular. Cheyne-Stokes breathing is a pattern of rapid and shallow breathing, followed by apnea lasting approximately one minute, then returning to normal or shallow breathing.
Pooling of oropharyngeal secretions are responsible for the “death rattle” sound.
Increasing periods of sleep and decreasing responsiveness to stimuli.
When awake, the patient often becomes increasingly restless and disorientation and confusion may become prominent.
Person may perform repetitive and seemingly purposeless tasks.
The hands and feet and then the arms and legs may become increasingly cool to the touch.
Conditions suggesting a life expectancy of 6 months or less
Cancer patients with brain metastases
Cancer patients with malignant ascites or malignant pleural effusion
Metastatic solid cancers - no treatment planned or none effective (with the exception of patients with breast or prostate cancer)
Severe dementia – as defined by absence of speech, bed bound and incontinent
Central nervous system lymphoma
Severe congestive heart failure or chronic obstructive pulmonary disease that remains symptomatic despite maximal treatment. Such patients will exhibit weight loss, dyspnea and tachycardia at rest and generally one sees a history of frequent hospitalizations.
Conditions suggesting a life expectancy of 3 months or less
In bed greater than 50% of each day
Hypercalcemia (in cancer patients, with the exception of patients with new diagnosis of myeloma or breast cancer)
Cancer and AIDS patients with persistent dyspnea despite treatment
Carcinomatous meningitis or malignant pericardial effusion
Cancers metastasis to liver with jaundice
Conditions suggesting a life expectancy of fewer than 14 days
Minimal to no oral intake of fluids
Anuric with no dialysis
Cooling extremities
Increasingly mottled skin
Cheyne-Stokes respirations
Development of the so called death rattle sound of pooling secretions
Ongoing confusion or delirium with no obvious reversible cause
Signs of Death
Pallor mortis: paleness which happens within the 15 to 120 minutes after the death.
Livor mortis: a settling of the blood in the dependent portion of the body,
Algor mortis: the reduction in body temperature following death. Typ a steady decline.
Rigor mortis: the limbs of the corpse become stiff and difficult to bend or move.
