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end of life care

27 Mar 2023
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end of life care

  1. KING GEORGE’S MEDICAL UNIVERSITY KING GEORGE’S ,COLLEGE OF NURSING SEMINAR ON END OF LIFE CARE SUBMITTED TO: SUBMITTED BY: MRS. PRIYANKA SINGH DIVYA PAL CLINICAL INSTRUCTOR M.SC. N. 1ST YEAR K.G.M.U. COLLEGE OF NURSING K.G.M.U. COLLEGE OF NURSING 1
  2. OUTLINES • Introduction • Definition of end of life care • Terminologies • Types of grief • Theories of grief • Indications of death • Psychosocial manifestation of approaching death • Physical manifestation of approaching death • Care of the body after death 2
  3. INTRODUCTION End –of -life care includes physical, emotional, social and spiritual support for patients and their families. The goal of end -of -life care is to control pain and other symptoms so the patient can be as comfortable as possible. 3
  4. DEFINITION “End-of –life care refers to health care, not only of patients in the final hours or days of their lives, but more broadly care of all those with a terminal illness or terminal disease condition that has become advanced ,progressive and incurable.” 4
  5. TERMINOLOGIES Loss:- an aspect of self no longer available to a person. Death:- cessation of life. Grief:- pattern of physical and emotional responses to bereavement. End of life:- final phase of a patient’s illness when death is imminent. Death rattle:- a sound that is something heard coming from a dying person’s throat or chest. Palliative care:- making life as easy as possible for patients and families living with serious illness. 5
  6. Hospice care:- Hospice care is given when there is life expectancy of 6 months or less. 6
  7. DEFINITION OF GRIEF Grief is a strong sometime overwhelming emotion for people, regardless of whether their sadness stems from the loss of a loved one or from a terminal diagnosis they or someone they love have received. 7
  8. TYPES OF GRIEF Normal grief:- Complex emotional, social, physical, behavioural and spiritual responses to loss and death. Anticipatory grief:- Associated with the normal grief response before the loss actually occurs. Delayed or inhibited grief:- Absence of evidence of grief when it ordinarily would be expected. Distorted grief:- Symptoms associated with normal grieving are exaggerated. 8
  9. Chronic or prolonged grief:- Maintaining personal possessions aimed at keeping a lost loved one alive. Disenfranchised grief:- When relationship to the decreased person is not socially sactioned. 9
  10. Ambiguous loss:- The lost person is physically present but not psychologically available. Complicated grief:- Prolonged or significantly difficult time moving forward after a loss. Masked grief:- Disruptive behaviour due to loss and ineffective grief resolutions. 10
  11. KUBLER-ROSS THEORY 5 STAGES OF GRIEVING(1969):- The five stages of grief model or the kubler ross model is popularly known as a model that describes a series of emotions experienced by people who are grieving:- DENIAL ANGER BARGAINING DEPRESSION ACCEPTANCE 11
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  13. BOWLBY 4 PHASES OF MOURNING (1980) Bowlby and markes (1980) identify four phases of mourning :-  Numbing  Yearning and searching  Disorganization and despair  Reorganization NUMBING:- feeling “stunned” or “unreal” can be interrupted by periods of intense emotion. 13
  14. YEARNING AND SEARCHING:- Full effects of emotional outbursts and uncontrollable crying. DISORGANIZATION AND DESPAIR:- Evaluation of loss, may become angry at perceived person at fault. REORGANIZATION:- Person begins to move forward with life, roles , skills and relationships. 14
  15. WORDEN’S FOUR TASKS OF MOURNING WORDEN’S FOUR TASKS OF MOURNING(1991):- Task 1:- To accept the reality of the loss. Task 2:- To work through the pain and grief. Task 3:- To adjust to the environment in which the decreased is missing. Task 4:- To emotionally relocate the decreased and move on with life. 15
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  17. INDICATIONS OF DEATH Relaxed muscles No pulse No breathing Fixed eyes Total lack of response to external stimuli. No muscular movement , especially breathing. No reflexes A bowel or bladder release No response 17
  18. PSYCHOSOCIAL MANIFESTATIONS OF APPROACHING DEATH Altered decision making Anxiety Helplessness Life review Peacefulness Unfinished business 18
  19. Restlessness Saying goodbyes Decreased socialization Fear of loneliness Fear of meaninglessness Unusual communication of one’s life Fear of pain Vision like experience 19
  20. PHYSICAL MANIFESTATION OF APPROACHING DEATH Sensory:- decreased sensation , perception, blurring of vision, siking and glazing of eyes, blink reflex absent, eyelids remain half open. Integumentary:-mottling on hands ,feet, arms and legs , cold, clammy skin, cyanosis on nose, nail beds, knees , wax like skin when very near to death. Respiratory:- increased respiratory rate , chyne-stokes respiration , inability to cough or clear respiration , secretions resulting in grunting , gurgling. 20
  21. Urinary:- decreased urine output , urinary incontinence, unable to urinate. Gastrointestinal :-accumulation of gas, distension, nausea , loss of sphincter control. Musculoskeletal :- inability to move, sagging of jaw , difficulty in swallowing , difficulty in maintaining posture and alignment , loss of gag reflex, jerking. Cardiovascular:- increased heart rate, slower and weakening pulse, irregular rhythm . decreased in blood pressure , delayed absorption of drugs. 21
  22. CARE OF BODY AFTER DEATH PROCEDURAL GUIDELINES:- EQUIPMENTS:- Bath towels, wash clothes, wash basin, scissors, shroud kit with name tags, bed linen , room deodorizer, documentation forms. 22
  23. NURSES:-  Make arrangements for staff, spiritual advisor or other to stay with the family while the body is prepared for viewing. Prepare the death care tray. 23
  24. Cleanse body thoroughly, apply clean sheets. Brush and comb clients hair. Encourage family to say good bye through both touch and talk. 24
  25. Do not rush good bye process. Remove all equipments and ornaments. Clarify the personal belongingness to handover the personal objects and body. Do not discard items found after the family is gone, tell them what is found. 25
  26. Apply name tags. Cover the body while shifting on the death trolly. Complete documentation Follow all protocols and policies to meet all legal requirements in caring for the body. 26
  27. APPROPRIATE DOCUMENTATION Time of death and actions taken to prevent or cardiac arrest record if applicable. Name of the person that pronounced the client’s death. Make special preparation and type of donation , including time, staff, company. 27
  28. The name of the family member or friend who was called and who came to the hospital- donor organization, morgue, funeral home, chaplain. Time of discharge and destination of the body , location of the name tags on the body, special requests .  Made by the family ,any other statements that might be needed to clarify the situation. 28
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