Exam 3: Death and Dying Content

Hospice Vs Palliative Differences

Hospice (terminal disease)

• prognosis less than 6 months

• NO curative treatments → comfort care only

• Services are limited by time and illness

• Insurance will not cover any “treatment med”.

• Focus on peaceful death

Palliative (Chronic disease)

• provided regardless of life expectancy

• client can receive curative treatments

• services are unrestricted by time and can last yearsfor for years

• focuses on organizing care for chronic and curable illnesses

• gives clients tools to live fully with an INCURABLE condition and avoid suffering

Hospice Vs Palliative Similarities

• holistic approach addressing physical, spiritual, emotion, and psychological needs

• Interprofessional team: nurses, social workers, providers, ect

• symptom management: prioritize management of symptoms and comfort

• Advance planning: facilitate decision making and advance direction planning

• provide resources and education

What sense is the last sense to leave?

hearing, keep talking to patients

Can MOLST be done over the phone?

NO! has to be signed by provider

Clinical VS Biological/Brain death

• clinical → heart and lungs have stopped but brain is viable, brain damage happens after 4 minutes without oxygen, death within 4-6 minutes

• biological → lack of brain activity, life support

organ donation

• client must be brain dead

• all organs can be used

Normal findings of dying (generalized changes)

• increased weakness

• fatigue

• increase sleeping

• weight loss

• muscle mass loss

• decreased ADL abilities

• increased lethargy

neurological changes of death

• hallucinations

• Confusion

• terminal agitation → wanting to move but cant

• anxiety

• fear

• comatose state

Cardiovascular changes

• mottling

• edema

• peripheral cyanosis

• cool extremities

• weak or absent pulses → late stage

• hypotension

• tachycardia

Respiratory changes

• apnea → periods without breathing

• Cheyenne respirations → shallow and rapid breathing with periods of apnea

• Death Rattle → gurgling caused by respiratory secretions

• labored breathing

• tachypnea

• weak or absent cough

Bowels and Urinary

• dehydration

• anoerzia → decrease appetite, do not force feed

• weakness

• consiption → often persents has agitation

• diarrhea

• dysphgia → trouble swallowing dysphagia

• incotenece

• decreased dark urine

How often should you provide oral care?

every 2 hours! keep lips moist

Rally day

• terminal lucidity

• surge of energy

• occurs 24-48 hours before death

• encourage family to enjoy it, but tell them this does not mean they are cured

Imminent death

• decreased LOC and muscle tone

• labored breathing → death rattle

• Cheyenne stokes respiration

• diminished senses

• incipience

• mottling

• cool extremities, with clamy skin, decreased BP and increased HR

Repositioning

• client can die during this due to fluid shift but you still do it

Pyrexia

• fever

• can be a normal finding during active dying

• only treat if patient is uncomfortable

• educate families on too much clothes or blankets

How to assess pain on dying patient?

• FACES, FLACC

How to know if patient is deceased?

• cyanotic

• no RR

• LISTEN to apical pulse for 1 full minute → check with another nurse

• no response to tactile or verbal stimuli

• YOU cannot pronounce client dead, only a provider can

Post-Mortem Care Considerations

• Pronouncement: time and date of death by the provider

• Question: Was death planned? Is an autopsy needed? Are they an organ donor?

• Ask family if they want aid in the process, religious beliefs

Preparing body for viewing

• supine with pillow under head to avoid discoloration, close eyes, place dentures in mouth, brush hair

• remove all tubes, drains, and lines → UNLESS autopsy, medical examiners, or donations

• bath patient, fresh linens, and clean gown, pads underneath (client will leak)

• Dim lights keep room cool

Autopsy considertions

• law can require that if death was due to homicide, suicide, accident, or within 24 hours of hospital admission, during restraint, or 24 hours after

• foul play is suspected

• DOCUMENT EVERYTHING! belongings, tubes, tags, time, and date body left

Where to place tags?

• big toe

• on bag itself