MS 8F PART 2- DISCHARGE CARE AND REHABILITATION

death

an irreversible cessation of circulatory, respiratory function or the irreversible cessation of all functions of the entire brain, including the brainstem.

death

A common mode of discharge

clinical death

CLINICAL OR BIOLOGICAL DEATH

(0-4 minutes)

REVERSIBLE

clinical death

CLINICAL OR BIOLOGICAL DEATH

occurs from the time the person stops breathing and the heart stops pumping.

biological death

CLINICAL OR BIOLOGICAL DEATH

(4 minutes onwards)

"HIGHER BRAIN DEATH"

dying

• Process of death

• On the point of death

infancy-5 years

AGE RANGE FOR THE DEVELOPMENT OF THE CONCEPT OF DEATH

No understanding

• reversible-temporary departure/ sleep

• Immobility and inactivity as death attributes

5 - 9 YEARS

AGE RANGE FOR THE DEVELOPMENT OF THE CONCEPT OF DEATH

• "Final" • Assoc. with aggression and violence

9 - 12 YEARS

AGE RANGE FOR THE DEVELOPMENT OF THE CONCEPT OF DEATH

• Begins to understand own mortality • Interest of afterlife/ fear of death

12 - 18 YEARS

AGE RANGE FOR THE DEVELOPMENT OF THE CONCEPT OF DEATH

• Fantasize that death can be defied • Reckless behaviors-dangerous driving, substance abuse, etc.

18 - 45 YEARS

AGE RANGE FOR THE DEVELOPMENT OF THE CONCEPT OF DEATH

• Influenced by religious and cultural beliefs

45 - 65 YEARS

AGE RANGE FOR THE DEVELOPMENT OF THE CONCEPT OF DEATH

• Accepts own mortality • Experiences peak of death anxiety

65 YEARS & UP

AGE RANGE FOR THE DEVELOPMENT OF THE CONCEPT OF DEATH

• Death having multiple meanings

Buddhist

RELIGIOUS PRACTICES & RITUALS

belief in rebirth/reborn

and

Nirvana=perfect peace

Buddhist

RELIGIOUS PRACTICES & RITUALS-

at the time: Respect spirit= happy state

funeral: Coffin-surrounded by significant objects

Buddhist

RELIGIOUS PRACTICES & RITUALS-

after: Giving offerings to monks in memory of the dead

Roman Catholic

RELIGIOUS PRACTICES & RITUALS-

belief in "Eternal life with God" and Heaven / Purgatory/ Hell

Roman Catholic

RELIGIOUS PRACTICES & RITUALS-

at the time: Sacraments of Reconciliation/ Holy Communion

funeral: Vigils & Requiem mass

Roman Catholic

RELIGIOUS PRACTICES & RITUALS-

after: Death Anniversaries, flower offerings at gravesite, etc.

hinduism

RELIGIOUS PRACTICES & RITUALS

belief in Reincarnation Many gods & godesses

hinduism

RELIGIOUS PRACTICES & RITUALS-

at the time: Sprinkling of Ganges water, etc.

funeral: Bathed & dressed in white traditional clothing

Red- if woman dies before husband

Head mourner-male/ eldest son

hinduism

RELIGIOUS PRACTICES & RITUALS

after: Home purified with spices and incense

Shradh- one month

Jewish

RELIGIOUS PRACTICES & RITUALS

belief that death- part of God's plan

Olam HaEmet-world of truth

Jewish

RELIGIOUS PRACTICES & RITUALS

in preparing Rabbi- reads Psalm 23 & recites Shema prayer

Jewish

RELIGIOUS PRACTICES & RITUALS

at the time Body laid on floor with lit candles

Being around dead body= uncleanliness

Jewish

RELIGIOUS PRACTICES & RITUALS

funeral: White Shroud

Tearing clothes-express grief

Jewish

RELIGIOUS PRACTICES & RITUALS

during burial Throwing a handful of earth to casket

Jewish

RELIGIOUS PRACTICES & RITUALS

Shivah- 7 days (candle is lit)

muslim

RELIGIOUS PRACTICES & RITUALS

belief that Death is Allah's will

Heaven / Hell

muslim

RELIGIOUS PRACTICES & RITUALS

Koran recitation

Eyes closed, arms across chest

Body should face Mecca

muslim

RELIGIOUS PRACTICES & RITUALS

Buried within 24 hours

No women allowed during burial

muslim

RELIGIOUS PRACTICES & RITUALS

NO cremation

3 days - mourning

40 days - prayers (No women on gravesite)

-loss of muscle tone

-slowing signs of circulation

-changes in respirations

-sensory impairment

CHARACTERISTIC CHANGES OF IMPENDING CLINICAL DEATH

RIGOR MORTIS

PHYSIOLOGICAL CHANGES IN DEATH

hardening of body muscles after death.

• 2-4 hours after death • From lack of ATP

ALGOR MORTIS

PHYSIOLOGICAL CHANGES IN DEATH

Body cooling

A decrease of body heat until room temp. is reached • About 1.5 to 1.8 degrees Celsius/ hour

LIVOR MORTIS

PHYSIOLOGICAL CHANGES IN DEATH

hypostasis of the blood following death that causes a purplish red discoloration of the skin—called also "dependent lividity"

embalming

how is livor mortis prevented?

withdrawal

SIGNS OF IMPENDING EMOTIONAL DEATH

person is preparing to "let go" from surroundings and relationships

vision-like experience

SIGNS OF IMPENDING EMOTIONAL DEATH

may talk to people you cannot see or hear and see objects and places not visible to you

letting-go

SIGNS OF IMPENDING EMOTIONAL DEATH

becomes agitated or continues to perform repetitive tasks

saying goodbye

SIGNS OF IMPENDING EMOTIONAL DEATH

words like "goodbye", "thank you", I'll be missing you", etc.

ADVANCE HEALTH CARE DIRECTIVES

legal documents that allow persons to specify aspects of care they wish to receive should they become unable to make or communicate their preferences.

LIVING WILL - NATURAL DEATH ACTS

TYPES OF ADVANCE DIRECTIVES

provides specific instructions about what medical treatment that client chooses to omit or refuse (eg. Ventilator support) in the event that the client is unable to make decisions.

HEALTH CARE PROXY - DURABLE POWER OF ATTORNEY

TYPES OF ADVANCE DIRECTIVES

Is a notarized or witnessed statement appointing someone else to manage health care treatment decisions

Do Not Resuscitate- DNR

TYPES OF ADVANCE DIRECTIVES

- ALLOW NATURAL DEATH/NO CODE ORDERS - when a client or proxy has expressed the wish for no Resuscitation in the event of a respiratory or a cardiac arrest.

ORGAN DONATION

TYPES OF ADVANCE DIRECTIVES

18 years old and of sound mind take the gift of an organ donation for the purpose.

autopsy

"Post-mortem examination"

examination of the body after death-either partial or complete

partial autopsy

consist of an examination of the organ of interest to determine the cause.

complete autopsy

complete examination of the body organs and the brain

CERTIFICATION OF DEATH

formal announcement of death must be performed by a doctor, nurse or coroner.

euthanasia

" Mercy Killing"

The act of painlessly putting to death persons suffering from incurable or distressing disease.

inquest

a legal inquiry into the cause or manner of death under the jurisdiction of a CORONER or a MEDICAL EXAMINER.

inquest

- done to know who is at blame - In cases of sudden, suspicious or unnatural death

hospice care

designed to give supportive care to people in the final phase of a terminal illness

Goal: to enable patients to be COMFORTABLE and FREE of PAIN

home care

A type of care for the terminally ill, is founded on the concept of allowing individuals to die with dignity and be surrounded by those who love them.

Rehabilitation

health-oriented process that helps people with disabilities to ACHIEVE GREATEST POSSIBLE LEVEL OF FUNCTIONING

Rehabilitation

Process of restoring people to their previous level of health.

impairment

loss or abnormality of psychological, physiological and anatomic structure and function

DISABILITY

restriction or lack of ability to perform activities in a normal manner

HANDICAP

is the total adjustment to impairment and disability that limits functioning at a normal level

the problem they face in society because of that disability

impairment- disability- handicap

phases of rehabilitation

impairment

any loss or abnormality of pyschological or physiological function

ex. cataract, delayed speech

disability

any restriction or lack of ability to perform an activity in the manner within the range considered normal

ex. inability to read, inability to speak

handicap

disadvantage for a given individual that limits or prevents the fulfillment of a role that is normal

ex. exclusion from school, defective communication

rehabilitative care

a process of restoring a person's highest level of possible wellness and returning the person's ability to live and work as normally as possible.

Outpatient settings

REHABILITATION SETTINGS

With minimal impacts on functional ability

Home setting or day treatment

REHABILITATION SETTINGS

more complex impairment; can be done in a home care

Acute rehabilitation

REHABILITATION SETTINGS

impairments that affect multiple functional abilities • may provide in free standing rehabilitation hospitals or dedicated units within the hospitals.

Sub-acute rehabilitation

REHABILITATION SETTINGS

• Long-term care facilities • clear admission and discharge to assist in determining the most appropriate care