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CARE OF DYING PATIENT

Rohini Pandey1st Year M.Sc Nursing KGMU Institute of Nursing

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CONTENTS

• Introduction• Definition• Signs of approaching death• Symptomatic management• Signs of clinical death • Summarization• Conclusion

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INTRODUCTION

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DEFINITION

A medical/nursing intervention defined

as promotion of physical comfort and

psychological peace in the final phase of

life.

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STAGES OF LOSS & GRIEF

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SIGNS OF APPROACHING DEATH

Facial appearance.Changes in sight, speech, and hearing.Respiratory system.Circulatory system.Gastro intestinal system.Genito urinary system.Skin and musculo skeletal system.Central nervous system.

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FACIAL APPEARANCE

CHANGES IN

SIGHT, SPEECH& HEARING

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RESPIRATORY SYSTEM

CIRCULATORY SYSTEM

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GASTRO INTESTINAL SYSTEM

“DEATH RATTLE”

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GENITO URINARY SYSTEM

SKIN & MUSCULO SKELETAL SYSTEM

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CENTRAL NERVOUS SYSTEM

Reflexes and pain are gradually lost. Patient may be restless due to lack of oxygen and due to raised body temperature, although the body surface is cool.

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CARE OF THE DYING PATIENT

Psychological support Advance Planning For Imminent Death Financial Concerns Legal and Ethical Concern Helping the Patient Transition Pain Management The Patient's Right to Information Symptomatic Management

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SYMPTOMATIC MANAGEMENT

Problem associated with breathing:Oxygen inhalation to remove his discomfort. Elevation of the patient’s head and

shoulders may make breathing easier. Keep the room well ventilated and keep

crowed away.Periodic suctioning is necessary.

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Problem associated with eating and drinking:

Anorexia, nausea, and vomiting are commonly seen in dying patient. They are unable to take any form of food and if they taken, they are unable to retain the food.

I.V fluids. Sips of water is given with teaspoon. Give frequent oral hygiene.Apply emollients to the dry lips.The denture are removed and kept safely.

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Problem associated with sense organ:Since the patient loses sight, before given any

care to the patient, the nurse should touch the patient and say what she is going to do.

Since the hearing is retained longer, speak only what is appropriate.

Avoid whispering any thing in patient room.Speak distinctly so that patient may

understand what is done for him.Since the eyes are opened, protect the eyes

from corneal ulceration with protective ointment.

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Problem associated with cleanliness and grooming:

Cleanliness and appearance are important until the end.

Cleanliness of the skin, hair, mouth, and cloth has to be maintained.

Problem associated with communicationConfusionWithdrawal

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Problem associated with rest and sleep:Patient should not be disturbed while

sleeping.The visitors should be instructed not to

disturbed the patient during his resting.Maintain calm and quit environment. Pharmacological managementAnti-pyreticAnalgesic Anti-emeticLifesaving drug if required

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SIGNS OF CLINICAL DEATHAbsence of pulse, heart beat and respirationsPupil becoming fixed and not reacting to light Absence of all reflex.Rigor mortis: Stiffing of the body after death. The

arms & legs cannot be bent or straightened while rigor mortis is present unless the tendons are torn.

POSTMORTEM HYPOSTASIS- It is a dark red or bluish discoloration due to the settling of the blood.

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NURSING MANAGEMENT

A. Role of Nurse

B. AssessmentI. History takingII. Physical Examination

C. Nursing Diagnosis

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SUMMARIZATION

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