Death and dying/terminology

1. Death and dying/terminology • Hospice • Postmortem care • Rigor mortis • Death rattle • Moribund

2. Stages of grieving as defined by Kubler-Ross • Denial • Anger • Bargaining • Depression • Acceptance

3. Emotional and spiritual needs of terminally ill residents • Contact with loved ones • Communication • Expression of emotions ie., guilt, anger, frustration, anxiety, depression • Reminiscence

4. Emotional and spiritual needs of terminally ill residents #2 Approaches • Respect religious cultural practices • Provide physical/emotional/spiritual comfort to resident and family • Accept resident emotions

5. The Dying Patient’s Bill of Rights • Be treated as a human being • Hope • Freedom to express feelings/emotions • Medical and nursing care

6. The Dying Patient’s Bill of Rights #2 • Not to die alone • Freedom from pain • Honesty • Help for self/family in accepting death

7. The Dying Patient’s Bill of Rights #3 • Die in peace and dignity • Retain individuality and beliefs • Expect respect of body after death • Sensitive, knowledgeable care

8. Impending signs of death • Cold hands and feet • Diaphoresis • Pale • Loss of muscle tone

9. Impending signs of death #2 • Labored respirations • “Death Rattle” • Weak, irregular pulse or slow pulse • Respiration

10. Impending signs of death #3 • Blank staring expression • Jaw drops • Cheyne-Stokes respirations

11. Moribund signs • No pulse • No respiration • No blood pressure • Pupils fixed and dialated

12. Care and comfort measures for the dying resident • Pain management • Hygiene • Oral hygiene • Communication/ support

13. Care and comfort measures for the dying resident #2 • Positioning/turning • Provide comfort • Attend to phychosocial needs • Spiritual support

14. Procedures and responsibilities for postmortem care • Assist with postmortem care as directed by nurse • Follow facility procedures • Provide privacy, support and comfort

16. Vital Signs / Terminology #2 • Febrile • Metabolism • Mucosa • Pyrexia

17. Vital Signs / Terminology #3 • Pulse • Apical • Brachial • Carotid • Radial • arrhythmia

18. Vital Signs / Terminology #4 • Bradycardia • Tachycardia • Bounding • Pulse deficit • thready

19. Vital Signs / Terminology #5 • Respiration • Apnea • Cheyne-Stokes • Orthopnea • Shallow breathing • Kussmaul’s respiration

20. Vital Signs / Terminology #6 • Hyperventilation • Cyanosis • Diaphragm • dyspnea

21. Vital Signs / Terminology #7 • Blood pressure • Aneroid manometer • Diastolic • Hypertension • Hypotension • diaphragm

22. Vital Signs / Terminology #8 • Sphygmomanometer • Stethoscope • Systolic • bell

23. Vital Signs / Purposes • Temperature,pulse,respiration and blood pressure • Assess functioning of vital organs • Signify changes in the body

24. Vital Signs / Observations • Color and temperature of the skin • How is the patient acting • What does the patient tell you about the way he/she feels

25. Temperature • Balance between heat gained and heat lost • The hypothalamus is the regulation center

26. Heat Production • Heat is produced by cellular activity, food metabolism, muscle activity, and some hormones • Infection • Brain injury • External factors

27. Heat loss • Heat is lost from the body through the skin, the lungs in breathing, and by elimination • Sweating • Increased respiratory rate • Increased flow of blood to skin

28. Heat conservation • Reducing perspiration • Decreasing the flow of blood to the skin • Shivering

29. Nursing measures to raise the temperature • Increase the temperature in the room • Add coverings to the body • Provide hot liquids to drink • Give warm baths or soaks

30. Nursing measures to lower the temperature • Decrease the temperature in the room • Remove coverings from the body • Offer cool liquids to drink • Provide cool bath or sponging • Direct fan toward body

31. Major Pulse sites • Carotid • Apical • Brachial • Radial • Femoral • Popliteal • Dorasalis pedis

32. Factors that increase pulse • Exercise • Strong emotions • Fever • Pain • Shock • Hemorrhage • Anemia

33. Factors that decrease pulse • Rest • Depression • Drugs • Respiratory center depression

34. Qualities of pulse • Rate • Rhythm • Strength

35. Respiration • Respiration is defined as the exchange of oxygen and carbon dioxide in the lungs • It is regulated in the brain by the medulla

36. Factors that increase respiratory rate • Exercise • Strong emotion • Infection • Increased body temperature • Increased metabolism

37. Factors that decrease respiratory rate • Rest / Sleep • Depression • Respiratory center depression

38. Qualities of Respiration • Rate • Rhythm • Depth • Effort • Discomfort • Position • Sounds • Color

39. Abnormal breathing patterns • Labored • Orthopnea • Stertorous • Abdominal • Shallow • Dyspnea • Tachypnea • Bradypnea

40. Blood pressure • Pressure exerted against walls of blood vessels • Systolic pressure • Diastolic pressure • Thumping sounds • Sounds correspond to numbers • First sound heard is systolic pressure • Last sound heard is diastolic pressure

41. Factors that raise blood pressure • Strong emotion • Exercise • Excitement • Pain • Decrease of blood vessel size • Digestion • Cuff that is too narrow or too loose • Cuff below heart level

42. Factors that lower blood pressure • Rest/Sleep • Lying down • Depression • Shock • Hemorrhage • Cuff that is too wide • Cuff above the heart level

43. Equipment needed to measure blood pressure • Manometer • Cuff • Stethoscope

44. Guidelines to take blood pressure • Is commonly measured at the brachial artery • Do not use arm that is injured, has an intravenous infusion, or is in a cast • Patient should be at rest • Apply blood pressure cuff to bare arm • Use appropriate sized cuff

45. Charting vital signs • Report abnormal TPR and blood pressure to nurse • Record on hospital flow sheets, graphic records, and nurse assistant notes • Write the blood pressure as a fraction: systolic/diastolic e.g., 120/80 • Note location, e.g., 150/90, thigh