Chapter 23: Caring for People who are Dying Nursing Assistant III Chapter 23: Caring for People who are Dying

Usually we consider a person “dead” when the heart stops beating and cannot be started again A physician can also declare a person dead when there has been a permanent loss of brain function To be declared “brain dead” a person must show no brain activity for a specified amount of time by law (usually 24 hours or more) Death and dying

Physical signs of impending death Many people die suddenly With so-called “natural death” there are many physical signs as the body begins to shut down Signs may appear over the course of a few hours or a few days, or even as fast as a few minutes Physical signs of impending death

Physical signs of impending death Circulation Fails BP drops Pulse becomes rapid and weak Skin feels cool and clammy Body temperature rises Person may perspire heavily Skin appears mottled, pale, and cyanotic Person will not need to be heavily covered Physical signs of impending death

Physical signs of impending death Respiratory Pattern Person may take rapid, irregular, shallow breaths Cheyne-Stokes Respiration Fluid and mucus collects in air passages “Death Rattle” Physical signs of impending death

Physical signs of impending death Digestive System Slows down Nausea Vomiting Abdominal swelling Fecal impaction Bowel incontinence May not want food or water Oral care Physical signs of impending death

Physical signs of impending death Urinary system Kidneys respond to lack of blood flow Physical signs of impending death

Physical signs of impending death Nervous System Decrease muscle tone Decreased sensation Muscles relax May loose ability to speak Vision becomes blurred People may turn towards light Hearing remains normal until time of death Physical signs of impending death

Physical signs of impending death Consciousness Some loose consciousness and become comatose Some remain oriented until moment of death Common for a person who has drifted in and out of a comatose state to become alert and oriented right before they die Physical signs of impending death

Physical signs of impending death When caring for a person who is dying, take note of any physical changes, report them to the nurse, and document appropriately Physical signs of impending death

Caring for a dying person A holistic approach is taken to care for a dying person Have the same needs as everyone else Needs may change dramatically as death approaches Many nurses and nursing assistants compromise care they give to a dying person Especially new ones Usually not fully aware This is not a good thing Caring for a dying person

Caring for a dying person Examples: May not check on the person as often Provide only the necessary care because they are afraid in engaging the patient in a conversation about death May be overly cheerful Other avoidance behaviors Fear Caring for a dying person

Meeting a dying person’s physical needs Care of the Skin More frequent skin care and linen changes needed Care of the Mucous Membranes Frequent oral care Eye care Nasal care Meeting a dying person’s physical needs

Meeting a dying person’s physical needs Positioning Person may not be able to reposition themselves Comfort breathing Meeting a dying person’s physical needs

Meeting a dying person’s physical needs Other Comfort Measures Back massage Soft music Being read to Enemas Managing airway secretions Suction Atropine Keep room well ventilated Meeting a dying person’s physical needs

Meeting a dying person’s physical needs Remember as death approaches person’s vision may become blurry Keep room well lit Introduce yourself when entering room Encourage family members to do the same Let person know you are leaving room Meeting a dying person’s physical needs

Meeting a dying person’s physical needs Speaking may become difficult for the person so speak Ask simple yes or no questions Meeting a dying person’s physical needs

Meeting a dying person’s physical needs Hearing remains quite sharp Always talk to the person as if they are able to hear you Explain procedures to the person, even if they are unresponsive Remind family members that the person can still here Meeting a dying person’s physical needs

Meeting a dying person’s physical needs Family members may wish to assist in physical care Let them help Meeting a dying person’s physical needs