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For this session…
Discuss the clinical trajectory of care for dying patients
Learn the goals of care for dying patients
Know how to relieve the dying person’spain, keeping him comfortable, and have apeaceful death
Recognize the signs and symptoms of adying person
Learn about palliative and hospice careClinical Trajectory of Care for Dying Patients
Death and Dying
Death is unique to each person. It may beexpected if a person has certain diseasesthat can no longer be cured.
It may happen suddenly or unexpectedly ina certain way or place, and may occur within a few seconds or minutes.
Persons may suffer for months then slowlydie in a short period of time.
Goals of Care for the Dying Patient
When it is not possible to prevent a patientdying, and medical care is no longer possible or useful, provide supportive careto the patient and family. The main goalsare to:
keep the patient comfortable and free of pain
make the patient's final days as good aspossible for both patient and family, with aslittle suffering as possible
help the patient to die peacefully
provide comfort to the family
Relieve the dying person's pain
Always trust what patients say about their pain. Never just make your own decisionabout how much pain they are suffering.
Many patients fear that they will die in agony.Be kind when people express or show fear.Comfort them and tell them that you can takecare of the pain and that they do not need tofear.
Give doses of pain medication that give themost pain control with the least side-effects.
Give pain medication all through the day andnight to make sure that the patient hasenough pain relief 
The best pain medication for the dying ismorphine.
Giving some drugs together (in combination)increases their effectiveness.
Use the simplest route to give medicine.
Use other ways to control pain, includingmassage, music, and comfortable positioningof the patient.
Addiction to medication is never important for dying patients.
Reduced breathing (respiratory depression)is not important for dying patients.
Keep the patient comfortable
The patient may suffer other discomfort,partly as a result of pain medication.
If the patient is constipated, a laxative maybe helpful.
Encourage the patient to drink fruit juices.
As much as possible, give the patient a high-calorie, high-vitamin diet.
Do not force the patient to eat. The patientshould eat only what foods he or she wishesto eat.
Encourage the patient to drink fluids.
Keep the patient clean; give frequent baths,give mouth care if the mouth is dry, andclean the eyelids if secretions collect.
Help the patient to get out of bed and sit in achair if he or she is able. If not, change theposition every two hours and try to keep thepatient in whatever positions are mostcomfortable.
 Trans Com: Surname1, Surname2, Surname3, Surname4
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SAN BEDA COLLEGE OF MEDICINE
Batch 2011
Care of the Dying Patient: The Journey’s EndFCM ILecturer:
Mek Villafuerte-Solana, MD, CFP
January 2008
Diagnosis of dyingOngoing careDeathCare after deathRecovery
 
If the patient has trouble breathing, havehim or her to sit up a little.
If the airway is obstructed, you may needto suction the patient’s throat.
If the patient feels short of breath or gaspsfor air, give oxygen.
Even when patients are close to death,they can hear, so do not speak in awhisper. Speak clearly. The patient willalso still feel your touch
How to help the patient to a peaceful death
It is important to ask the patient and familywhether the patient would prefer to stay inthe hospital or to go home for the last days.
If the patient wants to go home, teach thefamily how to care for him or her.
Show the family how to give medication for pain.
If the patient stays in the hospital, try, asmuch as possible, to do what he or sheand the family want. It is important toprovide physical comfort.
It is also important to make the patient feelsecure to calm any fears, and give him or her hope.
Make the person feel safe and secure byshowing that he or she will be taken careof, and will not be left alone.
Calm any fears by assuring the patient thathe or she will not suffer or die alone.
Give hope. Do not give false reassurances.Talk about the future of the patient’s family
If the patient has unfinished business, givehelp with what he or she needs to do. Thepatient might need help with arrangementsfor his or her children or house.
Provide spiritual care if the patient wishes,or speak to the family about having thepriest or pastor or other religious leader visit.
Above all, respect the patient's decisions.Accept the patient’s feelings.
Listen and allow the person to talk abouthow he or she feels. Make it easy for thefamily to stay with the patient as much asthey want.
Keep the family informed about how thepatient is. When death is near, let themknow so that they can be with the patient atthe time of death if they wish.
What are the signs and symptoms of a dyingperson?
Activity:
He may stop talking or responding, and begin sleeping more andmore. He may also have body pain,weakness, or fatigue
Body temperature:
His ears, nose, hands,arms, feet, and legs, may become cool totouch. This happens because of thedecreasing blood circulation in his body
Breathing patterns:
Troubled or irregular breathing patterns often change as the bodycontinues to stop working.
Confusion or disorientation:
Thesechanges may be caused by decreasedamount of oxygen in the brain. These mayalso be due to the chemical changes in thebody or effects of his medicines.
Eating or drinking habits:
Little or nointerest in eating or drinking as his bodyshuts down. He may also have troubleswallowing or taking his medicines.
Skin color:
Poor blood flow to the skin maycause it to look dull or darker. Sometimes,the skin may become mottled (blue andblotchy).
Coma:
May lasts from minutes to hoursbefore death occurs.
What care should be given to a dying person?
Physical care:
Pain and other symptomsthat cause discomfort or distress may beeased by giving medicines. Personal careneeds, such as bathing and getting dressed,are also given.
Emotional and psychological care:
Counseling and emotional support for thepatient and those close to the patient may begiven.
Social care:
Social workers and other caregivers arrange to find answers toquestions about practical, financial, or other concerns.
Spiritual and cultural care:
Depending onthe patient's and family's spiritual needs andreligious beliefs. Memorial services andfuneral arrangements may be made basedon the patient's last wishes.
Others:
Equipment, such as an electric bed,a special mattress or a wheelchair may beprovided as well as oxygen, bandages,catheters, etc
What are advance directives?
Spoken or written legal and medical careinstructions (directions) made by the patient.
Decisions made beforehand in casesomething happens and the patient becomesunable to decide for himself.
Examples of advance directives includeliving will, organ donation, andcardiopulmonary resuscitation (CPR)attempts.
What are the signs that death has occurred?
Body is very cold when touched.
Breathing is absent.
Eyelids may remain open and do not blink.Pupils become fixed and dilated (enlarged).
Heart stops beating.
Jaws may remain slightly open.
 Trans Com: Surname1, Surname2, Surname3, Surname4
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