CARE OF THE DYING
process, including the benefits and burdens of
STANDARDS FOR HEALTHCARE IN PROVIDING END-OF-
LIFE CARE
1.Providing appropriate treatment for any primary and
secondary symptom, according to the wishes of the patient
and surrogate decision maker
2. Managing pain aggressively and effectively.
3. Sensitively addressing issues such as autopsy and organ
donation
4. Respecting the patient’s values, religion, and philosophy.
5. Involving the patient and the family in every aspect of
care.
6. Responding to the psychological, social, emotional,
spiritual and cultural concerns of the patient and family.
CARE OF THE DYING:
BENEFITS OF GOOD NURSING CARE SO PATIENT DIE
WITH DIGNITY AND COMFORTABLY
 Attention to pain and symptom control
 Relief of psychological distress
 Coordinated care across setting with high quality
communication between health care providers
 Preparation of the patient and family for death
 Clarification and communication of goals of treatment
and values
 Support and education during the decision-making
treatment
PALLIATIVE CARE
 GOAL: to prevent and relieve sufferings and to
support the best possible quality of life for
patients their families
 both a philosophy of care and an organized
highly structured system delivery of care
 provided to older patients who have:
- acute, serious, life-threatening illness (stroke,
trauma,MI,cancer)
- progressive chronic illness (end stage dementia,CHF,
renal or liver failure)
 may take place in the hospitals, in outpatient clinics, in
long term care facilities or in home
HOSPICE CARE
 The support and care for persons in the last
phase of an incurable disease so that they may
live as fully and comfortably as possible
 Medicare hospice benefit was designed to support
dying patients with less than 6months to live
 focuses on the whole person by caring for the
body, mind and spirit
 hospice care nurse assesses the patients and family’s
coping mechanisms, the available resources to care for
 the patient, the patient’s wishes and the support
system in place
ALTERNATIVE CARE
 traditional medicine may share spotlight with
acupuncture, massage therapy, chiropractors
and herbal medicines
 National Institutes of Health initiated the National
Center for Complementary and Alternative Medicine
(NCCAM) – is dedicated to explore complementary and
alternative medicine.
COMMON FEARS AND CONCERN OF THE DYING
 Death itself
 Thought of a long and painful death
 Facing death alone
 Dying in the nursing home, hospital, or rest home
 Loss of body control, such as bladder or bowel
incontinence
 Not being able to make decisions concerning care
 Loss of consciousness
 Financial costs and becoming burden on others
 Dying before having a chance to put personal affairs in
order
NURSE’S ROLE
 Will assume the role of a clinician (expert clinician)
 The nurse will carry out a complete physical,
psychological, social, and spiritual assessment and
design a plan of care (in collaboration with the patient,
family & interdisciplinary team) to meet the needs of
the older patient.
PAIN RELIEF AT THE END OF LIFE
 providing the initial and ongoing assessment of levels
of pain, administration of pain meds, and evaluation of
the effectiveness of the pain mgt plan
 PAIN the 5th vital sign – must be routinely carried
out when other v/s such as the temp, pulse, RR, BP are
assessed.
 Pain hasten death and is associated with needless
suffering at the end of life
 the provision of culturally sensitive care is a necessary
component of effective and comprehensive end-of-life
care
 pain is a subjective experience.
Self report is the gold standard for measuring pain.
If the patient can’t speak or cognitively impaired,
nurse shld carefully observed for:
 moaning, groaning at rest or with movement
 failure to eat,drink
 grimacing or strained facial expression
 guarding or not moving body parts
 resisting care or noncooperation with therapeutic
interventions
  rapid heartbeat, diaphoresis or change in V/S
EFFECT OF PAIN DURING THE DYING PROCESS
 increasing physiological stress, potentially diminishing
immunocompetency
 decreasing mobility: worsening risk of pneumonia and
thromboembolism
 increasing the work of breathing and myocardial
oxygen requirements
 unrelieved pain at the end of life can cause
psychological distress to the patient and family and
associated with negative outcomes such as sufferings
and spiritual distress
PHARMACOLOGICAL APPROACH
 Non-opioids - acetaminophen and NSAIDS.
- Effective for mild to moderate pain.
 Opioids –Codeine, MOSO4, methadone
– block the receptor of the CNS
 Adjuvant drugs – muscle relaxants, corticosteroids,
anticonvulsant, antidepressants and topical meds –
enhance the effectiveness of other classes of drugs
NURSING CARE AT THE END OF LIFE
 Personal hygiene (top priority)
oral is crucial – oral swabs, soothing ointment or
petroleum jelly
 Eye care – provided to promote comfort.
Artificial tears or ophthalmic saline solutions to prevent
drying of the eyes
 Anorexia and DHN- a benefit of DHN is decreased lung
congestion, which prevents noisy or labored
respirations
 Skin integrity should be monitored carefully to
prevent complications.
Lotions, repositioning patient, avoid shearing forces, use of
lift sheets
 Bowel and bladder incontinence
– protective pads to prevent decubitus ulcer
- Avoid use of catheter because of UTI.
- Constipation should be treated with stool softeners
 Visual or auditory hallucinations – family
members maybe upset
 It is believed that the sense of hearing is intact
in comatose patient.
- Encourage family members to “let go” and give
the terminal patient permission to die.
- Appropriate affection should be encouraged and
privacy provided.
 read a poem, tell a joke, listen to past story sing
a song, provide a hug.
PREPARING FOR DEATH
  Watching the patient decline and the body itself
starting to shutdown life process can bring
helplessness and anxiety.
 Nurse must help alleviate the fears and anxiety of the
patient and family
 Questions of an afterlife, unresolved emotional or
social issues, acceptance of death and financial
matters are common.
 If possible before death occurs the limbs should be
straightened and the head placed on a pillow.
 If autopsy is to be done, the body should be left
undisturbed
 Do not secure or tie any body parts as this cause
indentations, body tags.
 Place a clean gown, insert dentures.

Nurse must support themselves thru this difficult period and
recognize and accept feelings
 Older patients need reaasurance from their relatives
that all is well and it is OK to let go
 Prepare the necessary papers, charting
 Call morgue, funeral home or other personnel for the
removal of the body from the facility.

POST MORTEM

 When respirations cease, manually check breath

sounds and heartsounds

 check the eyes for pupillary light reflex

 note the time of the occurrence of death and

chart

 notify the physician, family members and

express condolences

 notification comes a shock and needs to be

handled gently and with empathy, allow relative
sufficient time to spend with the deceased

 actual post mortem care

 needs to be done promptly, quietly, efficiently and

with dignity.