NURM-101 Stress, Coping, Comfort and Spirituality Exam Review

Death

Individual with either irreversible cessation of all circulatory and respiratory functions or irreversible cessation of all brain function (including brainstem)

Medical criteria for death

Cessation of breathing, lack of response to deep and painful stimuli, lack of reflexes and spontaneous movement, flat encephalogram

• 2 readings at 2 different times to indicate no brain activity

• Hospice nurses/nursing home/subacute area nurses can pronounce someone as deceased

Clinical Signs of Impending Death

• Restlessness and/or agitation

• Nausea, flatus, abdominal distention

• Difficulty talking or swallowing

• Weak/slow/irregular pulse

• Decreasing bp

• Decreasing body temp, with cold or clammy skin

• Cooling, mottling, cyanosis of extremities or dependent areas

• Loss of movement, sensation and reflexes

• Urinary and/or bowel incontinence/constipation

• Cheyne-Stokes respiration

• You should call the patient’s family to notify them so they come in time

Cheyne-Stokes respiration

Noisy, irregular breathing

• Difficulty and gasping for air, layman’s term is the death rattle 

Flatus

Fart

Good death components

• Symptom control

• Preparation for death

• Opportunity for sense of completion

• Good relationship with health care professionals

Symptoms of approaching death

• Drowsiness

  • Fluctuating state of consciousness

• Difficulty eating/drinking

• Reduced pee

• Different breathing patterns

  • Labored, rapid

  • Lung secretions make death rattle noise

Palliative Services

Best QoL WITH aggressive symptom management

• Not extending life just making it comfortable and a lil longer 

• Can be received alongside curative treatment

  • Can be received at any stage of illness

Hospice

Under 6 month life expectancy 

• NOT curing

• Focus on needs of the dying

  • Hospice can INCLUDE palliative care

    • End of life comfort

Factors Affecting Grief Dying

• Developmental considerations

  • They may regress developmentally 

• Family

  • Older members may avoid grieving to stay strong

• Socioeconomic factors

  • Is the dying patient the breadwinner of the family?

  • Is there life insurance?

• Cultural, gender and religious influences

• Cause of death

  • Terminal illness = Anticipatory grief

Dying pt’s PHYSIOlogical needs

Physical needs like hygiene, pain control, nutritional needs

Dying pt’s PSYCHOlogical needs

Needs control over fear of unknown, pain, separation, leaving loved ones, loss of dignity and control, unfinished business, and isolation

Dying pt’s INTIMACY needs

Needs ways to be physically intimate that helps BOTH partners

Dying pt’s SPIRITUAL needs

Needs means of purpose, love and relatedness, forgiveness and hope

Nurse-Patient Relationship for death and dying

• Explain patient condition and treatment

• Teach self-care and promote self-esteem

• Teach family members to assist in care 

• Meet needs of dying patient and family

Postmortem Care

• Care of body and family

  • Making the body presentable for when family arrives

  • Everything comes out if patient is not having an autopsy

  • Tubes stay in if patient IS having an autopsy 

• Discharging legal responsibilities

• Death certificate issued and signed

• Labeling body

• Reviewing any organ donation arrangements

• Care of other patients 

  • Try to get other patients in the room out just for intimacy’s sake

Can the nurse always pronounce a pt dead?

Nuh uh

The nurse must facilitate…

• Family and viewing

  • Provide uninterrupted time 

• Coordination with the funeral home

  • Have info ready

• Legal requirements

  • Autopsy case/organ and tissue donation

Nurse procedure for dead pt

• Hand hygiene

• Gloves

• Raise bed

• Supine position

• Put dentures in if patient had them

• Close eyelids

  • If they don't close, put moistened cotton ball

• Folded towel under chin to close mouth

• Remove all equipment

• Remove lines, tubes, drains and wires UNLESS an autopsy is ordered by Medical Examiner 

  • Cover with bandages if removing

• Replace soiled dressings

• Change bed linens 

• Cover client up to chin with clean linens

• ID client with hospital policy

When does the nurse NOT remove tubes inside a dead pt?

If an autopsy is ordered

Nurse’s post-procedure for dead pt

• Remove gloves

• Hand hygiene

• Gather client belongings with ID tag 

• Hand hygiene again

• Document

Spirituality

• Anything in someone’s life pertaining to a non-material life force/higher power

• Some refer to God while others refer to universal energy

Three Spiritual Needs

1. Need for meaning and purpose

2. Need for love and relatedness

3. Need for forgiveness

Meeting pt’s spiritual needs

• Offer compassionate presence

  • Even if you’re not physically present, you should connect with their spiritual needs

• Assisting in struggle to find meaning in face of suffering and illness

• Fostering relationships that nurture the spirit 

  • Attaining peace promotes wellness by calming down 

• Facilitating patient expression of religious or spiritual beliefs and practices

Religion

Organized system of beliefs about a higher power including set forms of worship, spiritual practice and codes of conduct

Hope

Ingredient in life responsible for positive outlook

Love

Connectedness with others

Spiritual health and healing

Spiritual needs met

Spirituality and everyday living

Felt in health and illness

O’Brien’s Spiritual Well-Being SUPPORTERS

• Personal faith

  • God is real

  • Confidence in it and trust

• Spiritual contentment

  • Satisfaction and peace from what we believe

• Religious practice

  • Supports our faith, like going to church on Sunday

O’Brien’s Spiritual Well-Being CHALLENGERS

Should be MEDIATED

• Stressful life events

• Social support

Religious beliefs

• Guide to daily life habits

  • From a set of rules, like lifestyle and dietary

• Source of support

  • Compassionate presence but also educate so they fully understand their options

  • Religion AND community serve to support

• Source of strength, healing AND conflict

Morality

Matters of truth in moral life that shape character formation in relation to fellow human beings

• Principles concerning distinction between right and wrong or good and bad behavior

• Particular system of values and principles of conduct, especially one held by a specified person or society

• Extent to which an action is right or wrong 

• Set of personal or social standards for good or bad behavior and character

Spiritual distress

Impaired ability to experience and integrate connectedness with what they believe in

• Pain, guilt, anger, loss, despair

Implementing spiritual care

• Offering supportive presence

• Facilitating patient religious practice

• Nurturing spirituality

• Praying with and for a patient

  • WITH patient’s permission if praying for them

• Spiritual counseling

• Contacting spiritual counselor

• Resolving conflicts between treatment and spiritual activities

Facilitating Religious Practice

• Familiarize patient with religious services within institutions

• Respect the patient’s need for privacy during prayer

• Assist patient to obtain devotional objects and protect them from loss or damage

• Arrange for sacraments to be received

• Attempt to meet dietary restrictions

• Arrange for priest, minister or rabbi visit if patient wishes