Sherpath: Death and Dying

Question 1

Physical changes as the end of life approaches include:

Answer 1

-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

Question 2

Signs and Symptoms of Impending Death (Days and Hours)

Answer 2

-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

Question 3

Signs and Symptoms of death

Answer 3

-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

Question 4

Masked Grief

Answer 4

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

Question 5

Chronic Grief

Answer 5

Normal grief reactions that continue over a long period with no progress toward feeling better

Question 6

Delayed Grief

Answer 6

Postponed grief as the person avoids the reality and pain of the loss

Question 7

Exaggerated Grief

Answer 7

Maladaptive or self-destructive behavior such as drug and alcohol abuse

Risk for suicide

Question 8

Anticipatory Grief Cues

Answer 8

-Mom hasnt died yet and i am so tearful. Every time i think about her, i cry

-Sadness or sorrow occuring before death

Question 9

Dysfunctional Grief Cues

Answer 9

-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

Question 10

Hopelessness Cues

Answer 10

-Ill never get another job

-I will never be happy

-Feeling lost and unable to cope, feeling abandoned

Question 11

Lack of knowledge Cues

Answer 11

I do not understand what is happening to my dad

Is it normal for me to be feeling this way

Question 12

Risk for loneliness cues

Answer 12

-I miss having dinner together

-My freinds dont call much; they dont know what to say to me

-Sense of isolation

-Difficulty establishing contact

Question 13

Goals for greif

Answer 13

-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

Question 14

Advance Directives

Answer 14

-Legal documents. Provide people of any age with the opportunity to communicate their wishes about end of life care decisions

Question 15

Nursing care for final days or hours of dying paitent

Answer 15

-Facilitate end of life process with patient and family. (Say good bye and offering closure)

Question 16

Pain medication administration for death and dying patient

Answer 16

Sublingual drops or suppositories

May need to increase rate or dose

Question 17

Nursing problems for dying patient

Answer 17

-Death anxiety

-Impaired oral mucous membrane

-Risk for imparied skin integrity

-Urinary incontinence

-Chronic pain

-Impaired breathing

-Constipation

Question 18

Hospice

Answer 18

Prognosis of 6 months and not ongoing curative treatment

Question 19

The dying persons bill of rights

Answer 19

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.