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End of Life Care

End of Life Care Let’s talk about it! Death and Dying in America What has changed over the past century?

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Page 1: End of Life Care Let’s talk about it! Death and Dying in America What has changed over the past century?

End of Life Care

Page 2: End of Life Care Let’s talk about it! Death and Dying in America What has changed over the past century?

Let’s talk about it!

•Death and Dying in America

•What has changed over the past century?

Page 3: End of Life Care Let’s talk about it! Death and Dying in America What has changed over the past century?

End of Life Decisions

•What would you do?•What have you done?•What should you do?•Healthcare Surrogate decisions?

Page 4: End of Life Care Let’s talk about it! Death and Dying in America What has changed over the past century?

Advanced Directives•Written instructions that guide health care decision making in accordance with a patient’s wishes, should they lose the ability to speak for self.

Page 5: End of Life Care Let’s talk about it! Death and Dying in America What has changed over the past century?

Advance Directives•Common Forms

–Living Will–Health Care Surrogate Designation

–Do-Not-Resuscitate Order

Page 6: End of Life Care Let’s talk about it! Death and Dying in America What has changed over the past century?

Advance Directives•Do not need lawyer to prepare

•Forms available–Health care facility–Physicians–Internet–Hospice

Page 7: End of Life Care Let’s talk about it! Death and Dying in America What has changed over the past century?

Advance Directives

•WHY?•What if you don’t have Advance Directives?–Role of the nurse

•What care is covered?

Page 8: End of Life Care Let’s talk about it! Death and Dying in America What has changed over the past century?

Death and Dying•Caring for a dying pt is: Opportunity Privilege•Natural part of life

Page 9: End of Life Care Let’s talk about it! Death and Dying in America What has changed over the past century?

End of Life Care

Therapeutic PresenceCheerful - don’t overdoGentle and kindPromote comfortPt is team leader

Page 10: End of Life Care Let’s talk about it! Death and Dying in America What has changed over the past century?

End of Life CareSupportiveEmpatheticAllow maintenance of self-esteem, dignity

Page 11: End of Life Care Let’s talk about it! Death and Dying in America What has changed over the past century?

EOL: Symptom Management

Pain–WHO Analgesic Ladder

Resp. Sx.–Dyspnea, Cough

Page 12: End of Life Care Let’s talk about it! Death and Dying in America What has changed over the past century?

EOL: Symptom Management

G.I. Sx.–Anorexia, Cachexia–Constipation–Diarrhea–Nausea / Vomiting

Page 13: End of Life Care Let’s talk about it! Death and Dying in America What has changed over the past century?

EOL: Symptom Management

General Sx.–Fatigue / Weakness

Psych. Sx.–Depression–Anxiety–Delerium / Agitation / Confusion

Page 14: End of Life Care Let’s talk about it! Death and Dying in America What has changed over the past century?

Care of the familyOK to cry in front ofAllow expressionAllow to stay and helpKeep on even keelOffer chaplain / clergy

Page 15: End of Life Care Let’s talk about it! Death and Dying in America What has changed over the past century?

Care of the familyInvolve social services if necessary

Is healthiest: - be honest - allow to know

Page 16: End of Life Care Let’s talk about it! Death and Dying in America What has changed over the past century?

Kubler-Ross Stages of Dying

1. Denial 2. Anger3. Bargaining4. Depression5. Acceptance6. Detachment

Page 17: End of Life Care Let’s talk about it! Death and Dying in America What has changed over the past century?

HospicePhilosophy of CarePhysical and Emotional comfort

Quality of lifeTerminally ill cared for with dignity

Page 18: End of Life Care Let’s talk about it! Death and Dying in America What has changed over the past century?

HospiceSymptom ControlPalliative CareNot curative measuresMost care given in home

Page 19: End of Life Care Let’s talk about it! Death and Dying in America What has changed over the past century?

Hospice characteristics

AutonomousGoal of care is symptom control

Pt / Family is primary unitInterdisciplinary

Page 20: End of Life Care Let’s talk about it! Death and Dying in America What has changed over the past century?

Hospice characteristics

Specially trainedOn-call servicesSupport for staffBereavement careBased on need, not $$

Page 21: End of Life Care Let’s talk about it! Death and Dying in America What has changed over the past century?

Goal of HospiceDeath with dignityRelief of pain and other distressing sx.

Page 22: End of Life Care Let’s talk about it! Death and Dying in America What has changed over the past century?

Hospice Admission Criteria

Confirmed, terminal dxAgree to goalLife expectancy < 6 mPrimary Caregiver - 24 hrs/day

Agree to DNR

Page 23: End of Life Care Let’s talk about it! Death and Dying in America What has changed over the past century?

Signs of Approaching Death

Failing Circulation–Cold and Mottled Extremities

Decreased U/OV/S Changes

Page 24: End of Life Care Let’s talk about it! Death and Dying in America What has changed over the past century?

Signs of Approaching Death

Resp. CongestionBreathing Pattern Changes

Failing Senses–Hearing last to go!

Page 25: End of Life Care Let’s talk about it! Death and Dying in America What has changed over the past century?

Clinical deathWhen resp and heart beat stop

Note time of cessation

Page 26: End of Life Care Let’s talk about it! Death and Dying in America What has changed over the past century?

Biologic DeathMaintain vital signs with mechanical means

Brain dead

Page 27: End of Life Care Let’s talk about it! Death and Dying in America What has changed over the past century?

Death PronouncementCheck policiesDocument

–Pt. name–Date and time of death–Details of physical exam–Others notified

Page 28: End of Life Care Let’s talk about it! Death and Dying in America What has changed over the past century?

Helping the Family

Prepare the bodyAllow to stay as long as needed

Asst. with phone callsOther notifications

Page 29: End of Life Care Let’s talk about it! Death and Dying in America What has changed over the past century?

Organ DonationFamily MUST be askedEven if have signed driver’s license request

Family has custody of body at death

Page 30: End of Life Care Let’s talk about it! Death and Dying in America What has changed over the past century?

DeathCan death be a good experience??

Fear of death shaped by culture and religion


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