1. Death and Dying
Fundamentals Unit 6

2. Death and Dying Terms to be familiar with…and tissues…
How does each age group look at death?
Infants and toddlers-very little perception of people or permanence
Preschool and young school age- “anything is possible”
Late childhood- perception of permanence of death
Adolescents- “death defying”
Young adults- life is potential
Middle aged adults- life is doing
Older adults- fear od losing those around them

3. Death and Dying The steps of the grieving process are…
Denial-”No, not me”
Anger- at ones self and family members
Bargaining- “Let’s make a deal”
Depression- realization time
Acceptance- making peace with it
Decathexis- gradual separation from the world

4. Death and Dying What are some S and Sx of impending death?
Skin-cyanosis, diaphoretic, skin feels cool
Central nervous system- LOC decreases
Special senses- loss of visual acuity, eyes remain open
Respiratory- irregular
Circulatory- cardiac output decreases
Gastrointestinal- decrease in peristalsis
Urinary- decreased output
Musculoskeletal- relaxation of muscles

5. Death and Dying
What are some basic nursing measures I can use during the dying process regarding…
Comfort
Loss of reflexes
Senses
Vital Signs
Intake
Oral care
Skin
Pain
Touch and emotions
Family time

6. Death and Dying
Legal and ethical problems that are related to the dying process are…
Technology- allows for prolonging life
Euthanasia
Active- steps taken to bring about death
Passive- “NO CODE” or DNR
Physician assisted suicide- knowingly or intentionally providing person with means to commit suicide
Suicide-taking actions to cause death
Organ donation- personal choice

7. Death and Dying What are ethics committees?
Interdisciplinary committee appointed by the hospital who’s purpose is:

8. Death and Dying What is the Patient Self Determination Act
Effective in December 1991
Requires hospitals, nursing homes, etc. to advise patients about their patient rights and their right to execute an advanced directive.
Done on admission

9. Death and Dying Advanced Directives
The Living Will- patient indicates life sustaining treatments they do or do NOT want administered to keep them alive.
The Durable Power of Attorney-written document naming someone to make treatment choices for a patient, should they lose decision making abilities.
Financial vs. Medical
Therapeutic Support Levels

10. Death and Dying-Post Mortem Care
How is the care done?
Obtain equipment
Wash hands, don gloves
Place body supine
Close eyes if open
Replace dentures if out
Place rolled towel under chin to keep mouth closed if necessary
Remove or cut tubes per policy
Remove all jewelry (give to family)
Cleanse body in order of bed bath
Place protective pads
Replace dressings
Put clean gown on patient
Place the ID tag, check for accuracy
Place arms next to body
Move body to stretcher
Gather valuables, label
Transport
Document

11. Death and Dying What is a Medical Examiner’s case?
Charting is important.
Time no blood pressure is obtainable
Time no respirations are observed
Time no apical pulse is present
Times Dr. is notified of any changes in condition
Times family is notified, and who that was
Disposition of belongings
Result of tissue donation discussion
Time MTS is notified
Time ME office is notified, if applicable
Time pastoral care is notified, and their arrival
Disposition of the body
Whether or not an autopsy is required, and the time a permit is obtained

12. Death and Dying Legal consent… Attorney in Fact Spouse
Adult child over 18
Parent
Adult sibling
Legal guardian
Other

13. Death and Dying Hospice Care
Hospice- a facility or program of care specifically designed to provide emotional and physical support to terminally ill patients and their families
Respite- a period of relief from the responsibilities of caring for a patient

14. Death and Dying Criteria for Hospice Admission
Provider must certify that the patient’s illness is terminal and has less than a 6 month prognosis
Must have 2 providers verify patient has less than 6 months to live for Medicare or Medicaid to pay
The patient must want the services
The patient and caregivers must agree that hospice staff will plan care according to comfort rather than curative measures
The patient and the caregivers must be willing to participate in the planning of care

15. Death and Dying Who are the team members?
OT – PT – Volunteers – Clergy – Dr. – Bereavement Coordinator
Nurses – Social Workers – Dieticians – Pharmacists – Aides
What makes a hospice program?
What is bereavement care?
Our nursing skills in hospice care are important.