Death and dying/terminologyDeath and dying/terminology

Hospice Hospice

Postmortem carePostmortem care

Rigor mortisRigor mortis

Death rattleDeath rattle

MoribundMoribund

Stages of grieving as defined by Stages of grieving as defined by Kubler-RossKubler-Ross

Denial Denial

AngerAnger

BargainingBargaining

DepressionDepression

AcceptanceAcceptance

Emotional and spiritual needs of Emotional and spiritual needs of terminally ill residentsterminally ill residents

Contact with loved Contact with loved ones ones

CommunicationCommunication

Expression of Expression of emotions ie., guilt, emotions ie., guilt, anger, frustration, anger, frustration, anxiety, depressionanxiety, depression

ReminiscenceReminiscence

Emotional and spiritual needs of Emotional and spiritual needs of terminally ill residents #2terminally ill residents #2

ApproachesApproaches

Respect religious Respect religious cultural practicescultural practices

Provide Provide physical/emotional/spiphysical/emotional/spiritual comfort to ritual comfort to resident and familyresident and family

Accept resident Accept resident emotionsemotions

The Dying Patient’s Bill of RightsThe Dying Patient’s Bill of RightsBe treated as a human Be treated as a human beingbeing

Hope Hope

Freedom to express Freedom to express feelings/emotionsfeelings/emotions

Medical and nursing Medical and nursing carecare

The Dying Patient’s Bill of Rights The Dying Patient’s Bill of Rights #2#2

Not to die aloneNot to die alone

Freedom from painFreedom from pain

HonestyHonesty

Help for self/family in accepting Help for self/family in accepting deathdeath

The Dying Patient’s Bill of Rights The Dying Patient’s Bill of Rights #3#3

Die in peace and dignityDie in peace and dignity

Retain individuality and beliefsRetain individuality and beliefs

Expect respect of body after deathExpect respect of body after death

Sensitive, knowledgeable careSensitive, knowledgeable care

Impending signs of deathImpending signs of deathCold hands and Cold hands and feetfeet

Diaphoresis Diaphoresis

PalePale

Loss of muscle Loss of muscle tonetone

Impending signs of death #2Impending signs of death #2

Labored respirationsLabored respirations

““Death Rattle”Death Rattle”

Weak, irregular pulse or slow pulseWeak, irregular pulse or slow pulse

Respiration Respiration

Impending signs of death #3Impending signs of death #3

Blank staring expression Blank staring expression

Jaw dropsJaw drops

Cheyne-Stokes respirationsCheyne-Stokes respirations

Moribund signsMoribund signs

No pulseNo pulse

No respirationNo respiration

No blood pressureNo blood pressure

Pupils fixed and dialatedPupils fixed and dialated

Care and comfort measures for the Care and comfort measures for the dying residentdying resident

Pain managementPain management

HygieneHygiene

Oral hygieneOral hygiene

Communication/Communication/

supportsupport

Care and comfort measures for the Care and comfort measures for the dying resident #2dying resident #2

Positioning/turningPositioning/turning

Provide comfortProvide comfort

Attend to phychosocial needsAttend to phychosocial needs

Spiritual supportSpiritual support

Procedures and responsibilities for Procedures and responsibilities for postmortem carepostmortem care

Assist with postmortem care as Assist with postmortem care as directed by nursedirected by nurse

Follow facility proceduresFollow facility procedures

Provide privacy, support and comfortProvide privacy, support and comfort

Vital Signs / Terminology #2Vital Signs / Terminology #2

FebrileFebrile

MetabolismMetabolism

MucosaMucosa

PyrexiaPyrexia

Vital Signs / Terminology #3Vital Signs / Terminology #3

PulsePulse

ApicalApical

BrachialBrachial

CarotidCarotid

RadialRadial

arrhythmiaarrhythmia

Vital Signs / Terminology #4Vital Signs / Terminology #4

BradycardiaBradycardia

TachycardiaTachycardia

BoundingBounding

Pulse deficitPulse deficit

threadythready

Vital Signs / Terminology #5Vital Signs / Terminology #5

RespirationRespiration

ApneaApnea

Cheyne-StokesCheyne-Stokes

OrthopneaOrthopnea

Shallow breathingShallow breathing

Kussmaul’s respirationKussmaul’s respiration

Vital Signs / Terminology #6Vital Signs / Terminology #6

HyperventilationHyperventilation

CyanosisCyanosis

DiaphragmDiaphragm

dyspneadyspnea

Vital Signs / Terminology #7Vital Signs / Terminology #7

Blood pressureBlood pressure

Aneroid manometerAneroid manometer

DiastolicDiastolic

HypertensionHypertension

HypotensionHypotension

diaphragmdiaphragm

Vital Signs / Terminology #8Vital Signs / Terminology #8

SphygmomanometerSphygmomanometer

StethoscopeStethoscope

SystolicSystolic

bellbell

Vital Signs / PurposesVital Signs / Purposes

Temperature,pulse,respiration and Temperature,pulse,respiration and blood pressureblood pressure

Assess functioning of vital organsAssess functioning of vital organs

Signify changes in the bodySignify changes in the body

Vital Signs / ObservationsVital Signs / Observations

Color and temperature of the skinColor and temperature of the skin

How is the patient actingHow is the patient acting

What does the patient tell you about What does the patient tell you about the way he/she feelsthe way he/she feels

TemperatureTemperature

Balance between heat gained and Balance between heat gained and heat lostheat lost

The hypothalamus is the regulation The hypothalamus is the regulation centercenter

Heat ProductionHeat Production

Heat is produced by cellular activity, Heat is produced by cellular activity, food metabolism, muscle activity, food metabolism, muscle activity, and some hormonesand some hormones

InfectionInfection

Brain injuryBrain injury

External factorsExternal factors

Heat lossHeat loss

Heat is lost from the body through Heat is lost from the body through the skin, the lungs in breathing, and the skin, the lungs in breathing, and by eliminationby elimination

SweatingSweating

Increased respiratory rateIncreased respiratory rate

Increased flow of blood to skinIncreased flow of blood to skin

Heat conservationHeat conservation

Reducing perspirationReducing perspiration

Decreasing the flow of blood to the Decreasing the flow of blood to the skinskin

ShiveringShivering

Nursing measures to raise the Nursing measures to raise the temperaturetemperature

Increase the temperature in the Increase the temperature in the roomroom

Add coverings to the bodyAdd coverings to the body

Provide hot liquids to drinkProvide hot liquids to drink

Give warm baths or soaksGive warm baths or soaks

Nursing measures to lower the Nursing measures to lower the temperaturetemperature

Decrease the temperature in the Decrease the temperature in the roomroom

Remove coverings from the bodyRemove coverings from the body

Offer cool liquids to drinkOffer cool liquids to drink

Provide cool bath or spongingProvide cool bath or sponging

Direct fan toward bodyDirect fan toward body

Major Pulse sitesMajor Pulse sites

Carotid Carotid

ApicalApical

BrachialBrachial

RadialRadial

FemoralFemoral

PoplitealPopliteal

Dorasalis pedisDorasalis pedis

Factors that increase pulseFactors that increase pulse

ExerciseExercise

Strong emotionsStrong emotions

FeverFever

PainPain

ShockShock

HemorrhageHemorrhage

AnemiaAnemia

Factors that decrease pulseFactors that decrease pulse

Rest Rest

DepressionDepression

DrugsDrugs

Respiratory center depressionRespiratory center depression

Qualities of pulseQualities of pulse

RateRate

RhythmRhythm

StrengthStrength

RespirationRespiration

Respiration is defined as the Respiration is defined as the exchange of oxygen and carbon exchange of oxygen and carbon dioxide in the lungsdioxide in the lungs

It is regulated in the brain by the It is regulated in the brain by the medullamedulla

Factors that increase respiratory Factors that increase respiratory raterate

Exercise Exercise

Strong emotionStrong emotion

InfectionInfection

Increased body temperatureIncreased body temperature

Increased metabolismIncreased metabolism

Factors that decrease respiratory Factors that decrease respiratory raterate

Rest / SleepRest / Sleep

DepressionDepression

Respiratory center depressionRespiratory center depression

Qualities of RespirationQualities of Respiration

RateRateRhythmRhythmDepthDepthEffort Effort DiscomfortDiscomfortPositionPositionSoundsSoundsColorColor

Abnormal breathing patternsAbnormal breathing patternsLaboredLaboredOrthopneaOrthopneaStertorousStertorousAbdominalAbdominalShallowShallowDyspneaDyspneaTachypneaTachypneaBradypneaBradypnea

Blood pressureBlood pressurePressure exerted against walls of Pressure exerted against walls of blood vesselsblood vesselsSystolic pressureSystolic pressureDiastolic pressureDiastolic pressureThumping soundsThumping soundsSounds correspond to numbersSounds correspond to numbersFirst sound heard is systolic pressureFirst sound heard is systolic pressureLast sound heard is diastolic pressureLast sound heard is diastolic pressure

Factors that raise blood pressureFactors that raise blood pressure

Strong emotionStrong emotionExerciseExerciseExcitementExcitementPainPainDecrease of blood vessel sizeDecrease of blood vessel sizeDigestionDigestionCuff that is too narrow or too looseCuff that is too narrow or too looseCuff below heart levelCuff below heart level

Factors that lower blood pressureFactors that lower blood pressure

Rest/SleepRest/Sleep

Lying downLying down

DepressionDepression

ShockShock

HemorrhageHemorrhage

Cuff that is too wideCuff that is too wide

Cuff above the heart levelCuff above the heart level

Equipment needed to measure Equipment needed to measure blood pressureblood pressure

ManometerManometer

CuffCuff

StethoscopeStethoscope

Guidelines to take blood pressureGuidelines to take blood pressure

Is commonly measured at the Is commonly measured at the brachial arterybrachial arteryDo not use arm that is injured, has Do not use arm that is injured, has an intravenous infusion, or is in a an intravenous infusion, or is in a castcastPatient should be at restPatient should be at restApply blood pressure cuff to bare Apply blood pressure cuff to bare armarmUse appropriate sized cuffUse appropriate sized cuff

Charting vital signsCharting vital signsReport abnormal TPR and blood Report abnormal TPR and blood pressure to nursepressure to nurseRecord on hospital flow sheets, Record on hospital flow sheets, graphic records, and nurse assistant graphic records, and nurse assistant notesnotesWrite the blood pressure as a Write the blood pressure as a fraction: systolic/diastolic e.g., fraction: systolic/diastolic e.g., 120/80120/80Note location, e.g., 150/90, thighNote location, e.g., 150/90, thigh