Death and Dying

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Death and Dying

• Gerontology Nursing 202
• Tasha Pfenning

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Definition

• Slowing and cessation of body processes
• Multiple causes
• Orderly and undramatic progressive series of
  physical changes
• Non medical emergencies
• Comfort-enhancing measures
• Hospice definition

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Physiologic Changes

• Sensory
• Neurological
• Cardiac
• Pulmonary

• Integumentary
• Gastro-intestinal
• Genitourinary
• Musculoskeletal

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Sensory Changes

• Eyes
• Sight fails
• Turns toward light
• May not close
• Pupils react slowly to light
• Hearing is last sense to go

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Sensory ChangesNursing Interventions

• What can I do as a nurse for this patient?

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Neurological changes

• Mental status changes
• Lethargy or apathy
• Restless and/or confused
• Reflexes decrease
• Perception of pain decreases
• Converses with loved ones who have died
• Surge of energy may occur 1-2 days prior to death

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NeurologicalNursing Interventions

• What can I do for this patient?

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Cardiopulmonary collapse(Cardiac)

• BP and ventricular filling during hyperneic
  phases may cause CHF
• Insufficient perfusion, ischemia, cell
  death
• If CHF occurs slowly, may compensate
• Decomposition myocardial ischemia, liver
  congestion and pulmonary congestion

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Cardiopulmonary collapse s/s(Cardiac)

• BP decreases
• Pulse weak, thready, rapid irregular
• Pulse may continue after respirations cease

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Cardiopulmonary CollapseNursing interventions

• What can I do for the patient with failing
  cardiac system?

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Cardiopulmonary collapse Pulmonary

• Cheyenne-Stokes
• Hyperpnea decreased PCO2 triggers
  brain decrease respiration apnea
  increased PCO2 hyperpnea

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Cardiopulmonary collapse Pulmonary (s/s)

• Rapid shallow breathing
• Stridorous respiration
• secretions, unable to cough up
• Relaxation of tongue and soft palate
• Jaw may droop

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Pulmonary collapseNursing Interventions

• What can I do for the patient in respiratory
  distress?
• What if theyre a do not resuscitate?

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Integumentary (s/s)

• Skin cool
• Flushed if fever
• Pale or cyanotic
• Bluish discoloration
• Nail beds, hands or feet are pale or bluish
• Profuse diaphoresis

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Integumentary Nursing Interventions

• What can I do for the patient suffering from a
  failing integumentary system?

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Gastro-intestinal changes

• Nausea/emesis
• Hiccoughs
• Incontinence
• Abdominal distention
• Cessation of peristalsis
• Impactions

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Gastro-intestinalNursing Interventions

• What can I do as a nurse for a patient with
  failing gastro-intestinal system?
• Are there differences between a code and a do not
  resuscitate patient?

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Genitourinary System

• Incontinence
• Bladder distention
• Decreased output
• Concentrated urine

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Genitourinary SystemNursing Interventions

• How can I care for a patient with a failing
  genitourinary system?

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Musculoskeletal changes

• Muscles relax
• Lose ability to move
• After death, muscles become rigid and fixed

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MusculoskeletalNursing Interventions

• What can I do for the patient with
  musculoskeletal changes?

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Effects of Age-Related Changes

• Pressure ulcers
• Pneumonia
• Constipation
• Sensory deprivation
• Relocation stress
• Pharmacokinetics

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Definitions

• Clinical death
• Cessation of blood flow and/or respiratory arrest
• Implies loss of consciousness which is reversible
• Biological Death
• Irreversible destruction of brain tissue
  ischemia

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Predicting Time of Death

• Strong, easily found peripheral pulse
• Weak, irregular pulse
• Extremities cold, cyanotic, breathing is irregular

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Classic S/S of Death

• Absence of pulse, respirations, and heart beat
• Pupils fixed, non-reactive
• Absence of reflexes

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Nursing Interventions for Imminent Death

• What can I do for the patient who is experiencing
  imminent death?
• What can I do for the family of the dying
  patient?

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Determining Death

• Check with a stethoscope
• Occasional gasping breaths
• Pulse may still occur after respirations cease

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Post Mortem Care

• Exact time
• Pronounce the death

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Notify

• Family
• Chaplain
• Attending and consulting physicians
• Patient care unit
• Nursing administrative supervisor
• Coroner, if death due to a homicide, suicide, or
  accident

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Care of the Body

• How do I care for the body if an autopsy is
  ordered?
• How do I care for the body if an autopsy is not
  ordered?

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Autopsy

• Determine cause of death
• Determine legal information
• Nursing must obtain written permission
• Must be indicated on Notice of Death form

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Family Grieving

• What can I do to assist
• the family when grieving?
• What can I do when the family wants to view the
  patient?

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Charting

• Specific details
• Who notified
• Time
• Where body sent
• What did the family take
• What was sent with the patient

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Culture Perspective

• Frightening thing
• 80 of American deaths now occur in the hospital
• As nurses, we must respect cultural differences
  regarding death.
• Seek to understand

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Healthcare Perspective

• Emphasis on care
• Emotionally draining
• Influences attitudes and abilities
• Take care of yourself

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Psychological Support

• Kubler-Ross
• Nursing interventions
• What can I do for coworkers, myself, family or
  friends when a death occurs?

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The End