Chapter 41End of Life Care

Chapter 41End of Life Care

Definitions of DeathDefinitions of Death

• United Nations Vital Statistics: death is the permanent disappearance of every vital sign.

• Brain Death: the death of brain cells determined by a flat electroencephalogram [EEG].

• Somatic Death: determined by the absence of cardiac and pulmonary functions.

• Molecular Death: determined by the cessation of cellular function.

Family Experiences with DeathFamily Experiences with Death

• Past

– Most births and deaths occurred in the home and were viewed as a natural process.

– Dying individuals could be surrounded by and cared for by loved ones in the comfort of their homes.

• Present

– Lowered mortality rates and mobile nuclear families have reduced family experience with death and end of life care.

Family Experiences with Death (cont.)Family Experiences with Death (cont.)

– Most deaths occur in hospital and institutional settings, not the home.

– The separation of individuals from their loved ones during the dying process can be stressful.

Goals of Hospice CareGoals of Hospice Care

• Pain relief

• Symptom control

• Coordinated home care and institutional care

• Bereavement follow-up and counseling

Kubler-Ross Stages of DyingKubler-Ross Stages of Dying

• Denial

• Anger

• Bargaining

• Depression

• Acceptance

Physical Care Needs of the Dying PatientPhysical Care Needs of the Dying Patient

• Pain relief

• Respiratory distress

• Constipation

• Poor nutritional intake

Pain Management for the Dying PatientPain Management for the Dying Patient

• Assess pattern and severity of pain.

• Recommend patient takes analgesic on regular basis.

• Assess patient’s understanding of the analgesic.

• Consider the impact of psychological factors on physical pain.

• Use nonpharmacologic pain relief measures.

Clues to the Presence of PainClues to the Presence of Pain

• Sleep disturbances

• Reduced activity

• Diaphoresis

• Pallor

• Poor appetite

• Grimacing

• Withdrawal

Alternative to Pain MedicationsAlternative to Pain Medications

• Guided imagery

• Hypnosis

• Relaxation exercises

• Massage

• Acupressure

• Acupuncture

Alternative to Pain Medications (cont.)Alternative to Pain Medications (cont.)

• Therapeutic touch

• Diversion

• Application of heat or cold, even

Interventions for Respiratory DistressInterventions for Respiratory Distress

• Elevating the head of the bed

• Administering oxygen

• Administering atropine or furosemide

• Using narcotics

Measures to Promote Nutritional IntakeMeasures to Promote Nutritional Intake

• Assisting with oral hygiene

• Offering a clean and pleasant environment for dining

• Providing pleasant company during mealtime

• Assisting with feeding as necessary

Questions to Assess for Spiritual NeedsQuestions to Assess for Spiritual Needs

• What gives you the strength to face life’s challenges?

• Do you feel a connection with a higher being or spirit?

• What gives your life meaning?

Signs of Imminent Death Signs of Imminent Death

• Decline in blood pressure

• Rapid, weak pulse

• Dyspnea and periods of apnea

• Slower or no pupil response to light

• Profuse perspiration

• Cold extremities

Signs of Imminent Death (cont.)Signs of Imminent Death (cont.)

• Bladder and bowel incontinence

• Pallor and mottling of skin

• Loss of hearing and vision

Stages of Family Acceptance of Death of Loved OneStages of Family Acceptance of Death of Loved One

• Denial

• Anger

• Bargaining

• Depression

• Acceptance

Edwin Schneidman: Working with Family of DeceasedEdwin Schneidman: Working with Family of Deceased

• Total care of a dying person includes contact and rapport with the survivors-to-be.

• It is best to begin work with survivors as soon as possible after the tragedy.

• Remarkably little resistance is met from survivor-victims.

• The role of negative emotions toward the deceased needs to be explored, but not at the beginning.

• The professional plays the important role of reality tester.

• Medical evaluation of the survivors is crucial.

SourceSource

• Eliopoulos, C. (2005).  Gerontological Nursing, (6th ed.).  Philadelphia: Lippincott, Williams & Wilkins (ISBN 0-7817-4428-8).