Chapter 15- Death and Dying

grief

outward expression of pain or loss
ex: crying or anger

Bereavement

being left behind, the process of grieving, the experience of being deprived of another's presence

brain dead

no higher function to the brain, these are people who are usually resuscitated after a few minutes

DNR

No not resuscitate using CPR

Advance Directive

documents that describe what a person wants for end of life care/life-prolonging methods of treatment.
Do it while elder is still mentally capable

Living will

state medical treatments that are not to be used in specific instances, a type of advance directive along with power of attorney

POLST Paradigm

Physician Orders for Life Sustaining Treatment, a doctor's order for end of life care- the doctor and patient talk and he writes a note that specifies what treatment they want for end of life care

Passive euthanasia

withholding treatment that would prolong life or natural death

Active euthanasia

a person actively ends their life, it is deliberate and usually with medications

Palliative care

compassionate care to help you be comfortable at the end of life without treating you

Persistent vegetative state

irreversible unconsciousness, they can't move or think on their own anymore, it is permanent

terminal sedation

when you take a high opiate dose from a prescription to die

What will you observe when a person is dying?

Person is anxious, resigned to their fate
Seen more death at the end of their life, they may want an end to pain
Physically their skin is cold and their breathing is raspy or they may stop breathing for periods of time
Don't want to eat or drink
Withdraw from everyone
Appear restless in bed
Don't urinate very often
Sleep most of the time
Confused if awake
Even when they are asleep they can hear

Stages of dying

Denial
Anger
bargaining
depression
acceptance

Denial

when a person doesn't think they are dying or want to believe it

anger

they are upset about their situation, know their life is ending and they are upset about it

bargaining

when you bargain with a higher power for more time

depression

accepted death and very sad about it

acceptance

accepted death and are at peace about it

What are the advantages and disadvantages of using this model as a professional?

People are constantly changing which state they are in, it isn't in order. Every person is very different in how they grieve.
It helps you understand better where the person is at. If you can see where they are at in their grieving then you can better know how to talk to them.

What are the pros and cons of advance directives

You know what you want for end of life care and what you don't want. cons are that they aren't frequently followed because there are changes in medical practice from when the document was originally drafted. It may not be what they actually want as time goes on.

What services are offered in hospice?

offer palliative care They don't try to treat the patient, only comfort them and the family as family is in last 6 months of life. They offer physical, emotional, medical services, respite care, grief counseling for family.

Tranquilizers and sedatives are effective and are recommended to reduce grief among the bereaved.

False

Voluntary motor function is lost when the body is without oxygen for six minutes.

True

In most states, paramedics called to a residence are required to provide CPR if the heart has stopped beating, even if the victim has signed an advance directive.

False

Several states have enacted a "death with dignity" law which permits physicians to administer a fetal dose of a drug to hasten death in a terminally ill patient. (only 2 states)

true

Which of the following is part of the current law regarding physical restraints?
A. Restraints are not allowed to be used in nursing homes.
B. Restraints can be used but must be regularly monitored
C. Restraints are allowable if families request restraints
D. Restrains are allowable for those with high fall risk

B and D- only a physician can prescribe a restraint

Which of the following is not a type of advance directive?
A. Choosing a proxy
B. Becoming an organ donor
C. DNR
D. Living Will
E. All of the above

E

Which states allow assisted suicide?

Oregon and Washington

Although assisted suicide is illegal in most states, what must health professionals honor according to the Supreme Court?
A. Advance directive
B. Need for palliative care
C. Wishes of the patient and family
D. Religious beliefs regarding death
E. All of the above

E

The most commonly accepted definition of when death occurs is:
A. When the heart stops
B. When breathing ceases
C. When higher brain waves cease
D. When body functions stop
E. None of the above

E. Death is the loss of ALL brain function

Te federal Uniform Determination of Death Act of 1981

states define death as the absence of brain function

Durable power of attorney

names an individual who can make decisions

Less formal ways to set up an advance directive

life prolonging procedures declaration
Organ/tissue donation

Assisted suicide

a physician helps a seriously ill person to end his/her life
(Dr. Jack Kevorkian)

3 ways of dying

1. short and quick decline
2. long-term disability with unpredictable timing of death
3. inability to care for one's self and slow journey to death- "The dwindles"

What do the dying fear the most?

pain

Rights of the dying

open communication about death
painless death as possible
presence of concerned others
as much control over the environment
all treatments fully explained and the right to refuse

Tasks of the dying

completing unfinished business
dealing with medical care needs
allocating time and energy resources
arranging for death
life review

SUPPORT survey tell us many things about dying:

don't want pain
healthcare people didn't know what they wanted at the end of their life

Who provides the vast majority of care for the terminally ill?

The family, the person also fears being alone

Health professionals and working with dying

burnout is quick
don't want to work with death
not adequately trained