Bell Work 11/5 and 11/6 Why is being willing to learn important in late adulthood? Show fewer signs of decreased mental ability Which life stage is frequently the most productive life stage? Early adulthood – marriage, childbearing, family, career,

Emotional and Physiologic Elements of Death and Dying

ELISABETH KUBLER-ROSS Landmark work entitled On Death and Dying Identified five emotional stages experienced by dying individuals

FIVE EMOTIONAL STAGES Denial - or “no not me” Anger - or “why me?” Bargaining - or “Yes, but. . .” Depression - or “It’s me!” (realize death will come soon) Acceptance - or “It’s part of life. I have to get my life in order.”

Results of Kubler-Ross’ Research Most medical personnel now believe patient should be informed of approaching death Patient should be left with some hope and know they will not be left alone Staff need to know extent of information known by patient

DEATH CAN INVOLVE FEARS THAT ARE PHYSICAL, SOCIAL, AND EMOTIONAL PHYSICAL - Helplessness, dependence, loss of physical faculties, mutilation, pain SOCIAL - Separation from family, leaving behind unfinished business EMOTIONAL - Being unprepared for death and what happens after death

INTERVENTIONS FOR FEARS Talk as needed Avoid superficial answers, i.e. “It’s God’s will Provide religious support as appropriate Stay with the patient as needed Work with families to strengthen and support

PHYSIOLOGY OF DYING Somatic death or death of the body Causes of death varies

BASIC CHANGES RESULTING IN THE DEATH OF VITAL BODY SYSTEMS PULMONARY: Unable to oxygenate the body Assess for poor oxygenation-skin pale, cyanotic, mottled, cool in dark skinned - assess mucous membranes, palms of hands, soles of feet (capillary refill time) https://www.youtube.com/watch?v=3KGiVw9sOcA https://www.youtube.com/watch?v=3KGiVw9sOcA

CARDIOVASCULAR Large load on heart when lungs fail Heart not getting needed oxygen Heart may not be strong enough to circulate blood Blood backs up causing failure Leads to pulmonary and liver congestion

Cont… Decreased, as heart less able to pump May have a “drenching sweat” as death approaches Pulse becomes weak and irregular If pulse relatively strong, death is hours away If pulse is weak and irregular, death may be imminent

COMBINATION OF THESE EVENTS LEADS TO CELL & SYSTEM DEATH As pulmonary and cardiovascular systems fail, other body systems begin to fail, also

FAILING METABOLISM Metabolic rate decreases, almost stopping Feces might be retained or incontinence might be present

FAILING URINARY SYSTEM Urinary output decreases Blood pressure too low for kidney filtration Further load on cardiovascular system due to increase circulating volume

FAILING NERVOUS SYSTEM Decrease oxygen to the brain, means decreasing brain function Sensation and power lost in legs, first, then arms May remain conscious, semi-conscious, or comatose

SPECIFIC SENSORY DECLINE Dying person turns toward light - sees only what is near, may have slow or weakly responsive pupils Can only hear what is distinctly spoken Touch is diminished - response to pressure last to leave Dying person might turn toward or speak to someone not visible to anyone else Eyes may remain open even if unconscious Person might rally just before dying

FURTHER NEUROLOGIC DECLINE AT DEATH Pain might be significant Assess for pain if person is unable to talk, restless, tight muscles, facial expressions, frowns Provide pain medication as needed

Caring for the Dying Patient Very challenging, but rewarding work Supportive care Health care worker must have self-awareness Common to want to avoid feelings by avoiding dying patient

Hospice Care Palliative care only Often in patient’s home Philosophy: allow patient to die with dignity and comfort Personal care Volunteers After death contact and services

Right to Die Health care workers must understand this issue Ethical issues must be addressed Allowing patients to die can cause conflict Specific actions to end life cannot be taken Laws allowing “right to die”

Summary Death is a part of life Health care workers will deal with death and dying patients Must understand death and dying process and think about needs of dying patients Then health care workers will be able to provide the special care these individuals need

Bell work Nov 2, 3 What stage in the process of death and dying does the person understand and accept the fact they are going to die? Acceptance What stage in the process of death and dying does the dying person try to make deals with a higher power? Bargaining