Death and Dying

1. Death and Dying Teresa Rogers Butler County ATC Summer 2010

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. Dr. Elizabeth Kubler-Russ • Identified five stages of grieving that dying patients and their families and friends may experience. • They may not be in order and may overlap or repeat a stage at times. • Others may not experience all stages. • Stages include denial, anger, bargaining, depression, and acceptance.

8. Denial • Usually occurs when the person is first told of the illness. • Individual’s may say, • “The tests are wrong.” • “This can’t be happening to me.” • “I don’t believe it.” • Others don’t talk about it. • Health care workers should listen without confirming or denying it.

9. Anger • This stage occurs when the patient can no longer deny death. • The patient may blame themselves, their loved ones, or health care workers for their illness. • Health care workers must understand this is not a personal attack.

10. Bargaining • Usually occurs when patient accepts death but wants more time to live. • Patients turn to religion and spiritual beliefs during this period. • They want to see their child gradate, get married, or hold a grandchild. • Making promises to God to try and obtain more time sometimes occurs.

11. Depression • This stage occurs when the patient realizes that death will come soon and they won’t be with their families any longer. • They realize that some goals they set will not be met. • Health care workers need to let the patient know that depression is “OK”.

12. Acceptance • This is normally the final stage. • The patient understands that they are going to die. • May complete unfinished business and try to help those around them deal with death. • Patients will slowly get farther away from the world and other people. • They need emotional support during this stage.

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 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. • Pain is controlled so that the patient can remain active as long as possible. • Specially trained volunteers are an important part of many hospice programs.

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

23. 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.

24. 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.