Unit 12 Caring For Resident When Death Is Imminent and Following Death

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Unit 12Caring For Resident When Death Is
Imminent and Following Death

• Nurse Aide I Course

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Caring for Resident When Death Is Imminent and
Following Death

• Introduction
• Death is defined as the final stage of life. ?
  The nurse aide will need to develop a realistic
  attitude toward the topic of death to meet the
  physical and psychological needs of the resident
  and the family as they experience the dying
  process. ? This unit also includes care of the
  body following death.

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Factors Influencing Attitudes
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• 12.0 Explore personal feelings concerning the
  concept of death.

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Caring For Resident When Death Is Imminent and
Following Death

• Factors influencing attitudes 
• Personal experiences 
• Culture 
• Some fear death 
• Others look forward to and accept death 

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Caring For Resident When Death Is Imminent and
Following Death(continued)

• Factors influencing attitudes 
• Religion 
• Belief in life after death 
• Reunion with loved ones 
• Reincarnation 
• Punishment for sins 
• No afterlife 

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Caring For Resident When Death Is Imminent and
Following Death(continued)

• Factors influencing attitudes 
• Age
• Children view death as temporary

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Caring For Resident When Death Is Imminent and
Following Death(continued)

• Factors influencing attitudes
• Age 
• Adults may develop fears of
• pain and suffering
• dying alone
• separation from loved ones
• Elderly generally have fewer fears

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Special Needs Of Dying Resident
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• 12.1 Identify the special needs of a dying
  resident.

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Special Needs Of Dying Resident

• Visits with family/significant others
• Features of residents room
• pleasant as possible
• lighting that meets residents preferences
• well ventilated
• odor free

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Special Needs Of Dying Resident(continued)

• Features of residents room
• Contains personal items which provide comfort and
  reassurance
• Pictures
• Mementos
• Cards
• Flowers
• Religious objects

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• 12.2 Identify eight comfort measures that may be
  used with the dying resident.

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Special Needs Of Dying Resident(continued)

• Comfort Measures
• Attention to skin care
• Good personal hygiene
• Oral hygiene - denture care
• Bedding changed as needed
• Back massages

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Special Needs Of Dying Resident(continued)

• Comfort Measures
• Frequent position changes
• every two hours
• P.R.N.
• Good body alignment
• supportive devices
• prevention of deformities and pressure ulcers

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Special Needs Of Dying Resident(continued)

• Comfort Measures
• Head of bed elevated to facilitate breathing
• Modified diet

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Caring For Residents When Death Is Imminent
And Following Death
Nurse Aide's Role
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• 12.3 Describe the nurse aides role in
  relationship to the to the needs of the dying.

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Caring For Resident When Death Is Imminent and
Following DeathNurse Aides Role

• Source of strength and comfort
• Open and receptive
• Know own feelings about death and do not project
  those feelings onto resident.

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Caring For Resident When Death Is Imminent and
Following DeathNurse Aides Role(continued)

• Empathetic
• Calm and efficient
• Normal tone of voice
• Good listening skills
• Non-judgmental

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Individual Resident's Reaction to Death
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• 12.4 Review the various reactions residents may
  have as they face death.

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Individual Residents Reaction To Death

• Accept or be resigned to death
• Open and receptive
• Communicate about uncertainties
• Fearful or angry
• Despairing and anxious
• Hostile
• Thoughtful and meditative

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Five Stages Of Grief, Death And Dying As
Described By Dr. Elisabeth Kubler-Ross
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• 12.5 List and describe the five stages of grief,
  death and dying.

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Five Stages of Grief, Death and Dying as
Described by Dr. Elizabeth Kubler-Ross

• DENIAL
• Defense mechanism
• Buffer against reality
• Emotional escape hatch
• Resident may request another opinion

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Five Stages of Grief, Death and Dying as
Described by Dr. Elizabeth Kubler-Ross

• DENIAL (continued)
• Resident may avoid discussion of death
• Feeling of, This cant be happening to me.

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Five Stages of Grief, Death and Dying as
Described by Dr. Elizabeth Kubler-Ross

• ANGER
• Bitterness and turmoil
• Sense of unfairness
• Blame of others such as health care workers
• Feeling of, Why me?

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Five Stages of Grief, Death and Dying as
Described by Dr. Elizabeth Kubler-Ross

• BARGAINING
• Turn to religious and spiritual beliefs
• Promises to God and others
• Comfort and hope when all seems lost

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Five Stages of Grief, Death and Dying as
Described by Dr. Elizabeth Kubler-Ross

• BARGAINING (continued)
• Generally know this wont work
• Frustration and anger dissolve into depression
• If only...I will

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Five Stages of Grief, Death and Dying as
Described by Dr. Elizabeth Kubler-Ross

• DEPRESSION
• Belief that hope is lost
• Overwhelming despair
• Introverted and withdrawn
• Reminiscing and reviewing life
• Sleeplessness
• I always wanted to

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Five Stages of Grief, Death and Dying as
Described by Dr. Elizabeth Kubler-Ross

• ACCEPTANCE
• Calm and subdued interest in life
• Strives to complete unfinished business
• Helps loved ones accept death
• Needs others to validate worth of life
• Ive had a good life.

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Signs of Approaching Death
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• 12.6 Recognize the signs of approaching death.

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Signs Of Approaching Death

• Changes in sensory functions and ability to speak
• Vision
• increased secretions in corner of eyes
• blurred vision
• failing vision
• no eye movement/staring

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Signs Of Approaching Death

• Changes in sensory functions and ability to speak
  (continued)
• Speech
• becomes difficult
• hard to understand
• may be unable to speak
• Hearing - last function to be lost

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Signs Of Approaching Death

• Changes in circulation and muscle tone
• Circulation
• fails
• heat gradually lost from body
• hands and feet cold to touch and mottled
• face becomes pale or gray and mottled
• perspiration may increase (diaphoresis)

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Signs Of Approaching Death

• Changes in circulation and muscle tone
  (continued)
• Muscle tone
• body limp
• jaw may drop
• mouth may stay partly open

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Signs Of Approaching Death

• Changes in Vital Signs
• Respirations
• slower
• shallow
• labored
• may experience dyspnea, apnea, Cheyne-Stokes
• mucous collects in the throat and bronchial tubes
  (death rattle)

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Signs Of Approaching Death

• Changes in Vital Signs (continued)
• Pulse
• rapid
• weak and irregular
• Blood pressure drops
• Temperature
• elevated
• subnormal

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Signs Of Approaching Death

• Urinary and anal incontinence
• Decreased peristalsis, abdominal distention
• Release of flatus
• Decreased pain
• Loss of consciousness

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Nurse Aide's Role In Spiritual Preparation For
Death
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• 12.7 Define the role of the nurse aide in the
  spiritual preparation for death.
• 12.8 Contrast the spiritual preparation for death
  practiced by those of various religions.

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Nurse Aides Role In Spiritual Preparation For
Death

• Priest, rabbi, minister or other clergy may be
  contacted at request of resident or family
• Privacy to be provided when clergy with resident

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Nurse Aides Role In Spiritual Preparation For
Death(continued)

• Support residents religious/spiritual practices
  even if different from that of nurse aide
• Listen respectfully to religious/spiritual
  beliefs
• Participate in religious practices if asked and
  acceptable

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Nurse Aides Role In Spiritual Preparation For
Death(continued)

• Treat religious objects with care and respect
• medals
• pictures
• statues
• bibles
• Encourage family and friends to be included

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Nurse Aide's Role In Meeting Family Needs
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• 12.9 Identify the needs of the family as they
  encounter the dying process.

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Nurse Aides Role In Meeting Family Needs

• Available for support
• Use touch as appropriate
• Courteous and considerate
• Respect right to privacy
• Let family assist with care, if they desire,
  where appropriate

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Nurse Aides Role In Meeting Family
Needs(continued)

• Use good communication skills
• Listen and provide understanding throughout the
  grief/loss stages
• Answer questions or refer to supervisor

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Hospice Care
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• 12.10 Discuss the hospice philosophy.

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Hospice Care

• Health care service offered
• in hospitals and extended care facilities
• by special facilities
• usually in the individuals home
• Continuing care provided by team of health
  professionals
• Designed for residents with terminal illness

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Hospice Care(continued)

• Acceptance of death as imminent (6 months or
  less)
• Assures that individual dies with dignity and
  comfort
• Not concerned with cure or life-saving procedures
• Emphasis on pain relief
• Trained volunteers and professionals make regular
  visits.

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Hospice Care(continued)

• Provides counseling for individual and family
• Emotional
• Psychological
• Spiritual
• Financial
• Bereavement
• Family included in all aspects of care as desired

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Postmortem Care Care Of The Body After (Post)
Death (Mortem)
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• 12.11 Discuss the meaning of postmortem care.

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Postmortem Care

• Care Of Body After (Post) Death (Mortem)
• Begin care when instructed by supervisor
• Treat body to privacy, respect and gentleness
• Give care before rigor mortis sets in

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• 12.12 List five reasons for doing postmortem
  care.

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Postmortem Care(continued)

• Reasons for Postmortem Care
• Prevent discoloration and skin damage
• Maintain good appearance of body
• Identify body and prepare for transportation
• Position body in normal alignment
• Arrange time family to view the body

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Demonstration and Return Demonstration
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• 12.13 Demonstrate the procedure for postmortem
  care.

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The End