Death and Dying. Shelley Westwood, RN, BSN Bullitt Central High School

Transcription

1 Death and Dying Shelley Westwood, RN, BSN Bullitt Central High School

2 Objectives The student will: Explain the stages of death and dying including the philosophy of hospice care

3 Contents Stages of Death and Dying Right to Life Issues Advance Directives Living Will Medical Power of Attorney

4 Terminal Illness Any disease that cannot be cured and will result in death. Everyone reacts differently to news of a terminal illness. Some react with fear and anxiety. Many fear pain, abandonment, loneliness, and the unknown. They may become anxious about their loved ones, unfinished work, or dreams.

5 Emotional and Physical Reasons People May Fear Death. Helplessness Dependence on others Physical faculties Mutilation by surgery or disease Uncontrollable pain Being unprepared for death

6 Social Reasons People May Fear Death Fear of separation from family or home Fear of leaving behind unfinished tasks or responsibilities

7 Stages of Grief Dr. Elizabeth Kubler-Ross has established five stages of grieving. Many terminally ill patients and their family members experience these stages of grief as they cope with a terminal illness. People may not experience all the stages, they may experience them out of order, or they may cycle through them or some of them several times.

8 Denial Denial is often the immediate reaction to being told of a terminal illness. A person in denial will reject the idea that they are dying, or insist that the doctor has made a mistake. Individual s may say, The tests are wrong. This can t be happening to me. I don t believe it. *Health care workers who deal with terminally ill patients who are in denial should allow the patient to speak and provide comfort without confirming or denying the situation.

9 Anger Anger often follows denial, specifically when the patient is no longer able to deny the truth. Patients can become hostile and direct it towards anyone with whom they come in contact. Patient may blame themselves, their loved ones, or health care workers for their illness. Health care workers must provide support and understanding during this time.

10 Bargaining Once patients accept death, they often desire more time to live. The will to live is strong and they set goals for themselves that they want to meet. To achieve these goals, many patients turn to religion and make bargains or promises in hopes of having more time to live. Health care workers should be sensitive and attentive to patients in this stage.

11 Depression Depression can occur when a patient realizes that death is will come soon and they won t be with their families any longer. Depression can take the form of quiet withdrawal, spoken regrets, or great sadness. Health care workers should be particularly sensitive during this time and allow patients to express their grief.

12 Acceptance The final stage of grief is acceptance. During this stage, patients accept the fact that they are going to die. They may spend the rest of their days settling unfinished business and helping family and friends cope. Patients will slowly get farther away from the world and other people. They need emotional support during this stage. Health care workers should be sure to continue to provide emotional support and gentle touches of reassurance.

13 Interventions for Health Care Professionals Talk as needed Avoid superficial answers, i.e. It s God s will. or It will be OK. Provide religious support as appropriate Stay with the patient as needed Work with the family so they might be strong enough to offer support to the dying person.

14 Physical Changes Of Impending Death

15 Respiratory System 1.Unable to oxygenate the body enough for adequate gas diffusion 2.Respirations become stridorous or noisy, leading to death rattle 3. Cheyne-Stokes respiration sign of pulmonary system failure a. Consists of alternate hyperpneic and apneic phases

16 Cardiovascular System Heart unable to pump strongly enough to keep blood moving Decreased blood causes decreased circulation to the body Skin becomes cool to the touch, pale Person appears cyanotic, possibly mottled Failure of peripheral circulation frequently results in a drenching sweat cooling the body surface. Pulse becomes weak and thready, ultimately irregular A stronger pulse typically means death is hours away A weak, irregular pulse typically means that death is imminent in the next couple of hours. An apical pulse might be required.

17 Other Changes Metabolism rates decrease. The person might retain feces or become incontinent. Urinary output decreases. Dying person may turn toward light as sight diminishes. Dying person may hear only what is distinctly spoken. Dying person may remain consciousness or become unconscious/comatose

18 Other Changes Some dying people rally in clarity and consciousness just prior to their death A person s eyes might be open even if unconscious Dying people might turn toward or speak to someone who is not visible to anyone else in room Pain might be present Pain medication should not be withheld as person nears death.

19 Right to Die Most people with terminal illness believe that someone with a terminal illness should be allowed to refuse measures that would prolong their life. This is the right to die. Respirators, pacemakers, and other medical devices can be withheld and the person can die with dignity. DNR Do Not Resuscitate Order

20 DNR Do Not Resuscitate Order

21 Hospice Care This philosophy is to allow the patient to die with dignity and comfort. Offers palliative care: care that provides support and comfort. Pain is controlled so that the patient can remain active as long as possible. Comforts may include: Providing hospital equipment such as beds, wheelchairs, and bedside commodes Offering psychological, spiritual, social, and financial counseling Providing free or less expensive pain medication

22 Hospice Care Care can be offered in hospitals, medical centers, and special facilities. Most frequently it is offered in patient s home Specially trained volunteers are an important part of many hospice programs. When time for death arrives, patient is allowed to die with dignity and in peace After death, hospice personnel often maintain contact with the family during the initial period of mourning

23 Advance Directives A general term that describes two types of legal documents. Living Will Healthcare (Medical) Power of Attorney

24 Living Will Allows a person their wishes about medical treatments for the end of life in writing in the event that they cannot communicate those wishes directly. Different states may use different names.

25 Healthcare Power of Attorney Also know as a healthcare proxy, appointment of a healthcare agent, or durable power of attorney for healthcare. The person you appoint will be authorized to deal with all medical situations when you cannot speak for yourself.