Chapter 41 End of Life Care

1. Chapter 41End of Life Care

2. Definitions of Death • United Nations Vital Statistics: death is the permanent disappearance of every vital sign. • Brain Death: the death of brain cells determined by a flat electroencephalogram [EEG]. • Somatic Death: determined by the absence of cardiac and pulmonary functions. • Molecular Death: determined by the cessation of cellular function.

3. Family Experiences with Death • Past • Most births and deaths occurred in the home and were viewed as a natural process. • Dying individuals could be surrounded by and cared for by loved ones in the comfort of their homes. • Present • Lowered mortality rates and mobile nuclear families have reduced family experience with death and end of life care.

4. Family Experiences with Death (cont.) • Most deaths occur in hospital and institutional settings, not the home. • The separation of individuals from their loved ones during the dying process can be stressful.

5. Goals of Hospice Care • Pain relief • Symptom control • Coordinated home care and institutional care • Bereavement follow-up and counseling

6. Kubler-Ross Stages of Dying • Denial • Anger • Bargaining • Depression • Acceptance

7. Physical Care Needs of the Dying Patient • Pain relief • Respiratory distress • Constipation • Poor nutritional intake

8. Pain Management for the Dying Patient • Assess pattern and severity of pain. • Recommend patient takes analgesic on regular basis. • Assess patient’s understanding of the analgesic. • Consider the impact of psychological factors on physical pain. • Use nonpharmacologic pain relief measures.

9. Clues to the Presence of Pain • Sleep disturbances • Reduced activity • Diaphoresis • Pallor • Poor appetite • Grimacing • Withdrawal

10. Alternative to Pain Medications • Guided imagery • Hypnosis • Relaxation exercises • Massage • Acupressure • Acupuncture

11. Alternative to Pain Medications (cont.) • Therapeutic touch • Diversion • Application of heat or cold, even

12. Interventions for Respiratory Distress • Elevating the head of the bed • Administering oxygen • Administering atropine or furosemide • Using narcotics

13. Measures to Promote Nutritional Intake • Assisting with oral hygiene • Offering a clean and pleasant environment for dining • Providing pleasant company during mealtime • Assisting with feeding as necessary

14. Questions to Assess for Spiritual Needs • What gives you the strength to face life’s challenges? • Do you feel a connection with a higher being or spirit? • What gives your life meaning?

15. Signs of Imminent Death • Decline in blood pressure • Rapid, weak pulse • Dyspnea and periods of apnea • Slower or no pupil response to light • Profuse perspiration • Cold extremities

16. Signs of Imminent Death (cont.) • Bladder and bowel incontinence • Pallor and mottling of skin • Loss of hearing and vision

17. Stages of Family Acceptance of Death of Loved One • Denial • Anger • Bargaining • Depression • Acceptance

18. Edwin Schneidman: Working with Family of Deceased • Total care of a dying person includes contact and rapport with the survivors-to-be. • It is best to begin work with survivors as soon as possible after the tragedy. • Remarkably little resistance is met from survivor-victims. • The role of negative emotions toward the deceased needs to be explored, but not at the beginning. • The professional plays the important role of reality tester. • Medical evaluation of the survivors is crucial.

19. Source • Eliopoulos, C. (2005).  Gerontological Nursing, (6th ed.).  Philadelphia: Lippincott, Williams & Wilkins (ISBN 0-7817-4428-8).