NURSING 104

NURSING CARE OF THE TERMINALLY ILL AND DECEASED CLIENT Loss, Death, & Grief

OBJECTIVES  Define the types of loss  Describe the grief process & stages of grief  Explain the goals of end-of-life care  List clinical signs of approaching death  Define death  Describe Kubler-Ross stages of death

TYPES OF LOSS DDefinition - Occurs when a valued person, object, or situation is changed or made inaccessible so that its value is diminished or removed. BBeing deprived of or being without something that one once had

ACTUAL LOSS  Any loss of a person or object that can no longer be felt, heard, known or experienced by the individual  Loss of a body part, role at work, loss of a child

PERCEIVED LOSS AAny loss that is uniquely defined by the grieving client LLoss of confidence LLoss of youth LLoss of financial independence

MATURATIONAL VS SITUATIONAL LOSS  Maturational loss a child goes to school for the first time  Situational- sudden, unpredictable such as an auto accident and being unable to work

GRIEF AND MOURNING  Grief is the emotional response to a loss  Grieving is the psychological, social, and physical reaction to the perception of significant loss  Mourning is the period of acceptance of loss and grief during which the person learns to deal with the loss

TYPES OF GRIEF  Normal or uncomplicated  Anticipatory  Complicated-difficulty progressing through the stages of grieving –Chronic –Delayed –Exaggerated –Masked

KUBLER-ROSS GRIEF AND DEATH REACTIONS Denial Anger Bargaining Depression Acceptance

Death (Definition)  Cessation of respiratory and heart beat caused by physiologic dysfunction generally related to an illness or trauma  Clinical Death - short interval after cessation of heart beat and breathing when no evidence of brain function is present - CPR

Goals for End of Life Care  Control symptoms  Identify client needs  Promote meaningful interactions between the client and their significant others  Facilitate a peaceful death

SIGNS OF IMPENDING DEATH CCoolness of extremities - skin mottled or discolored IIncreased sleeping r/t decreased metabolism FFluid and food intake decreases r/t decreased or slowed metabolism IIncontinence

 Breathing pattern change r/t slowed circulation to the brain  Congestion, dyspnea, and gurgling  Disorientation  Restlessness - terminal agitation  Pain  Nausea/vomiting

Impending Death Con’t  Psychological (Emotional signs) –Withdrawal –Letting go –Vision-like experiences –Saying goodbye

END-OF-LIFE ISSUES AND CONCERNS  Advance directives –Living Will –Durable Power of Attorney  Quality of life/Life support  Terminal Weaning  Do Not Resuscitate/Intubate orders (DNR/DNI)

 Physician Assisted Suicide  Active vs. Passive Euthanasia

IMPORTANT DEATH TOPICS  Palliative Care Hospice  Cultural practices Spiritual practices  Organ donation  Coroner notification  Autopsy

POST MORTEM CARE DDeath certificate FFamily participation RRemoval of tubes and lines CClose eyes RReplace dentures PPositioning PPillow under head

 Clean client’s room  Bathing as needed  Family viewing  Religious notification as requested  Shroud and ID tags  Documentation

TERMS  Rigor Mortis - the rigid stiffening of the skeletal and cardiac muscles after death  Algor Mortis - reduction in body temp. and accompanying loss of skin elasticity that occur after death  Livor Mortis - purple discoloration of skin in dependent positions following death r/t blood cell destruction

PUT YOUR BOOKS AWAY AND LET’S TALK SSHARE YOUR EXPERIENCES