Answer questions
Edith Johnson
NursingCareattheendoflife.pptxNursing Care at the end of life
Dr. Stephanie Jeffers
Death
How do YOU feel about Death?
I am very much afraid to die
It doesn’t make me nervous when people talk about death
I am not at all afraid to die
I fear dying a painful death
The sight of a dead body is horrifying to me
Death
“…cessation of integrated tissue and organ function, manifested by lack of heartbeat, absence of spontaneous respirations, or irreversible brain dysfunction.”
Ignatavicius & Workman, 2013, p. 107
Leading Causes of Death
Heart Disease
Cancer
Accidents
COPD
Stroke
Diabetes
Alzheimers
Diabetes
Flu and pneumonia
Kidney Disease
Suicide
2 million deaths per year in the US
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Assessment at End of Life
How do you know if your patient is dying?
What signs do you look for?
How does the nurse intervene to promote a peaceful death with dignity and comfort?
How does the nurse support the family?
End-of-Life Nursing Care
Caring for a dying patient and their family is a privilege and an honor.
Caring for a dying patient requires more time and energy from the nurse.
Assessment: Final Hours
Cool extremities
Increased sleeping, progressive decrease in LOC
Restlessness, disorientation
Decreased oral intake
Breathing pattern changes
Congestion and gurgling
Incontinence
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Psychosocial Assessment
Find out about social/familial support
What is your belief about death?
What is the meaning of life?
How do you want to die?
Life Review
Observe nonverbal behavior
Observe interactions with others
Nursing Diagnoses
Compromised Family Coping
Death Anxiety
Fear
Pain
Grieving
Hopelessness
Spiritual Distress
Nursing Interventions
PAIN MANAGEMENT
Pain is the most feared symptom at the end of life
Opioids
Massage
Guided Imagery
Heat
Distraction
Music therapy
Nursing Interventions
NUTRITION
Provide frequent oral care
Offer sips or ice chips
Do not force oral intake
Dehydration is part of the natural process
Avoid IV fluid replacement
Monitor for dysphagia
Crush oral meds or switch to liquid
Nursing Interventions
RESPIRATORY
Opioids – Morphine
Oxygen therapy
Corticosteroids
Diuretics
Anticholinergics for “death rattle”
Fan
Nursing Interventions
GASTROINTESTINAL
Patient may experience nausea, vomiting or constipation
Antiemetics
Stool softeners
Enema
Laxative
Nursing Interventions
RESTLESSNESS/AGITATION
Quiet room
Dim lights
Decrease stimulation
Identify cause – discontinue medications
Haldol PRN
Ativan PRN
Psychosocial Interventions
Nursing Interventions; Psychosocial
Be PRESENT
Educate the family
Advocate for the patient’s wishes
Understand the patient and family will be grieving
Respect cultural preferences
Encourage reminiscence – listen to stories
Promote spirituality
Collaborate with palliative care team
Spirituality
Conduct a spiritual assessment
Identify any spiritual needs
Consult with chaplain or other religious figures
Foster hope, but remain realistic
Be PRESENT
The patient has passed…
First, identify that the patient has expired
Listen for heartbeat, assess lungs
If no heartbeat or respirations, call physician to declare death
Notify nursing supervisor
Call Gift of Life
Support the patient’s family, allow time with the patient
Postmortem Care
If family is not immediately present, cleanse the patient
If patient is NOT a trauma, discontinue IV, Foley, etc
Comb the patient’s hair
Close the patient’s eyelids
If patient wore dentures, place them in patient’s mouth
Straighten the patient in bed
Postmortem Care
Bag all of patient’s belongings
Call family or if they are present, allow time for closure
Family may wish to perform religious or cultural customs
Once family has left, place tag on patient’s toe and belongings
Place patient in the shroud, attach tag to zipper
Call for transport to morgue
Documentation
Time and date of death
Persons notified
Whether tubes, drains left in or removed
Take Care of Yourself!
Caring for dying patients can be difficult, even for experienced nurses
Talk about your feelings
Write down your feelings
Do something fun!
Accept Death as a Part of Life
Now….
…..how do you feel about caring for a dying patient?
