Week 14: Assessing the Dying Patient

Question 1

Kubler-Ross model

Answer 1

Stages of grief – non-linear, non-cyclical; not everyone will experience all 5 stages:
1. DENIAL

2. ANGER
3. BARGAINING
4. DEPRESSION
5. ACCEPTANCE

Question 2

Assessment

Answer 2

Identify needs and goals of care for shared-decision making and care that is congruent with the pt’s wishes

Health history:
1. Biographical – age, race, religion/spirituality, advanced directives, marital status, and power of attorney (POA)

2. Current health status – length of illness, meds., and allergies
3. Family history
4. Review of systems
5. Psychosocial

Question 3

Care of the deceased pt

Answer 3

Last offices/last rights/laying out (washing the body)

Check for any special requirements (i.e. Rituals, timing, organ donation, laying out preferences)

Observe/note:

1. Remove lines and leads, unless referred to coroner
2. Infection – use body bag/special precautions
3. Cover broken skin with gauze
4. Fluid leakage from nasal, oral, and rectal passages – purge fluid

States:

1. RIGOR MORTIS –Stiffening lasting 24 hrs.
2. LIVOR MORTIS – Mottled and pale (30min-2 hrs. after death)
3. ALGOR MORTIS – Death chill

Question 4

After care of the family

Answer 4

Family care:
1. Special needs – cultural/religious/personal preference

2. Pt’s belongings – signed for/check local policy
3. Provision of information regarding death certificate
4. Support for family/children/grandchildren – expected vs. unexpected death; counseling/bereavement support