Sherpath: Death and Dying Flashcards
Physical changes as the end of life approaches include:
-Weakness and fatigue
-Increased drowsiness and sleeping with decreased responsiveness
-Decrease intake and swallowing reflex
-Surges of energy as transitioning to death
-Changes in bowel and bladder function: constipation, diarrhea, and incontinence
Signs and Symptoms of Impending Death (Days and Hours)
-Decrease urine output
-Circulatory changes in extremiteis, nose, fingers, with color changes as cyanosis, pallor, or mottling
-Vital sign changes: Decrease BP or increase/decrease PR
-Changes in breathing: Periods of apnea that increase with time, labored or irregular breathing, or cheyene stokes breathing
-Death rattle from inability to clear throat or swallow
Signs and Symptoms of death
-No heartbeat or respirations
-Involuntary release of stool and urine as muscles relax
-No verbal response or response to touch
-Body temp decrease
-Shut eyelids and jaw drop
-Color of skin pales and then turns bluish
-Rigor mortis
Masked Grief
Behavior that interferes with normal day-to-day life; this person is unaware that his or her behavior conceals the grief process
Heartburn or rapid heart rate
Chronic Grief
Normal grief reactions that continue over a long period with no progress toward feeling better
Delayed Grief
Postponed grief as the person avoids the reality and pain of the loss
Exaggerated Grief
Maladaptive or self-destructive behavior such as drug and alcohol abuse
Risk for suicide
Anticipatory Grief Cues
-Mom hasnt died yet and i am so tearful. Every time i think about her, i cry
-Sadness or sorrow occuring before death
Dysfunctional Grief Cues
-I just cant get any closure
-Deep grieving for years
-Alcohol
-Physical symptoms like heartburn and rapid pulse
-I can’t get anyone to talk ab out my ex-wifes death
Hopelessness Cues
-Ill never get another job
-I will never be happy
-Feeling lost and unable to cope, feeling abandoned
Lack of knowledge Cues
I do not understand what is happening to my dad
Is it normal for me to be feeling this way
Risk for loneliness cues
-I miss having dinner together
-My freinds dont call much; they dont know what to say to me
-Sense of isolation
-Difficulty establishing contact
Goals for greif
-Use effective coping strategies
-Makes psychosocial adjustment to life changes
-Accommodates grief
-Accepts reality of the loss
-Maintains meaningful relationships
-Experiences resolution of grief with plans for a postive future
Advance Directives
-Legal documents. Provide people of any age with the opportunity to communicate their wishes about end of life care decisions
Nursing care for final days or hours of dying paitent
-Facilitate end of life process with patient and family. (Say good bye and offering closure)
Pain medication administration for death and dying patient
Sublingual drops or suppositories
May need to increase rate or dose
Nursing problems for dying patient
-Death anxiety
-Impaired oral mucous membrane
-Risk for imparied skin integrity
-Urinary incontinence
-Chronic pain
-Impaired breathing
-Constipation
Hospice
Prognosis of 6 months and not ongoing curative treatment
The dying persons bill of rights
I have the right to be treated as a living human until I die.
I have the right to maintain a sense of hopefulness, however changing its focus may be.
I have the right to be cared for by those who can maintain a sense of hopefulness, however changing this might be.
I have the right to express my feelings and emotions about my approaching death in my own way.
I have the right to participate in decisions concerning my care.
I have the right to expect continuing medical and nursing attention even though “cure” goals must be changed to “comfort” goals.
I have the right not to die alone.
I have the right to be free from pain.
I have the right to have my questions answered honestly.
I have the right to retain my individuality and not be judged for my decisions that may be contrary to beliefs of others.
I have the right to expect that the sanctity of the human body will be respected after death.
I have the right to be cared for by caring, sensitive, knowledgeable people who will attempt to understand my needs and be able to gain some satisfaction in helping me face my death.
