DEATH

AND DYING
Presented by Dr. Judith Sugay
Learning Objectives
After
30 minutes of competing the module, the
students will be able to:

Discuss death and related terminologies

Identify the signs and symptoms of
grieving
Discuss the types of death
Apply nursing interventions that help
client cope with loss
Explain the nursing care needed in
meeting the needs of the client related to
death and dying, and grieving.
Definition of Terms
Loss:  an actual or potential situation in which something that is valued is
changed, no longer available, or gone.
Grief: the total response to the emotional experience related to loss. It is
manifested in thoughts feelings, and behaviors as associated with
 overwhelming distress or sorrow.
Bereavement: is the subjective response experienced by the surviving loved
ones after death of a person of a person with whom they have shared
significant relationship.
Death: a fundamental loss, both for the dying person and for those who
survive.
Types of Loss
ACTUAL LOSS
can be recognized by others.

PERCIEVED LOSS
experienced by one person but cannot be
verified by others.
ANTICIPATORY LOSS

experienced before the loss actually

happens.
Types of Loss
SITUATIONAL LOSS

the loss of one’s job, death of a child, or

the loss of functional ability because of
acute illness or injury.

DEVELOPMENTAL LOSS

losses that occur in the  process of normal

development.
Symptoms of
Grief
Repeated somatic disorders (anxiety,
weight loss, headaches, dizziness,
vomiting)
Depression
Weight loss
Difficulties in swallowing
Intense subjective distress
 Allow to tell their story

Nursing Recognize and accept varied emotion

that they express in relation to

Management significant loss

Allow to express difficulty, anger and
sadness
Include children in the grieving process
Encourage bereave to maintain and
establish relationship Acknowledge
usefulness of mutual help group
Encourage self-care
Acknowledge the usefulness of
counseling in difficult problems
 THE LIBRARY

DENIAL ANGER BARGAINING DEPRESSION ACCEPTANCE

Refuses to Client or family Seeks to Grieves over Comes to

believe that loss may direct bargain to what has terms with loss.
is happening. avoid loss. May
anger at nurse happened and May have
Unready to deal
or staff about express what cannot decreased
with practical
matters that feelings of guilt be. May talk interest in
problems, such
as prosthesis normally would or fear of freely, or may surroundings
after loss of leg. not bother punishment for withdraw. and support
May assume them. past sins, real, people.
artificial or imagined.
cheerfulness to
prolong denial.
Nursing Intervention
Verbally support the client, but do not reinforce denial.
Deal with needs underlying angry reaction.
Provide structure and continuity to promote feelings of security.
Listen attentively, and encourage client to talk to relieve guilt and
irrational fear.
Encourage client to socialize/participate.
 DEFINITON & SIGNS OF DEATH

Loss of Muscle Tone Slowing Circulation

Relaxation of facial muscles ( jaw Decrease sensation
lag) Mottling/cyanosis of extremities
Difficulty in speaking Cold skin, first feet, hands , ears
Difficulty in swallowing/ gradual and nose
Loss of gag reflex
Decrease activity of the GIT
Possibility of rectal and urinary
incontinence
Diminished body movement
 DEFINITON & SIGNS OF DEATH

Change in Vital Sign Sensory Impairment

Decrease or weaker pulse Blurred vision
Decrease Blood pressure Impaired sense of taste and
Rapid shallow, irregular smell
respiration ( Cheyne stoke
respiration)
Noisy breathing
Mouth breathing
 Indication
TOTAL LACK OF RESPONSE TO
of Death
EXTERNAL STIMULI

NO MUSCULAR MOVEMENT
NO REFLEXES

FLAT ECG- MOST ACCURATE

INDICATION
 Changes in
the Body After
Death
 RIGOR MORTIS
The stiffening of the body that occurs
about 2 to 4 hours after death.
It results from a lack
of adenosine triphosphate (ATP) which causes the
muscles to contract, in turn
immobilizes joint.

ALGOR MORTIS
The gradual decrease of the body’s
temperature after death.
When blood circulation terminates and
the
hypothalamus ceases to function, body
temperature falls about 1C (1.8F) per
hour until it reaches room temperature.
 LIVOR MORTIS
This is when discoloration due to
breakdown of red blood cells happen. This
appears in the lowermost or dependent
parts of the body.
 INFANCY - 5 YEARS OLD

Not yet understand death

Concept Death is reversible, temporary departure,

of Death for
sleep

Each Age 5-9 YEARS OLD

Understand death is final

Group Accept and associate death with

aggression and violence

9-12 YEARS OLD

Death is final
Death is inevitable and end of life
 12-18 YEARS OLD

Fear of lingering death

Concept Fantasized death be defiled, getting out in

defiance thru reckless behaviour
of Death for 18-45 YEARS OLD

Each Age Attitudes towards death is influence by

Group
religion and cultural belief

45-65 YEARS OLD

Accepts own mortality

65 AND ABOVE
Fear prolong illness
 Post
Mortem
All equipment, soiled linens, and supplies
should be removed from the bedside.
Normally, the body is placed in a supine
position with arms either at the sides, Care
palms down, or across the abdomen.
One pillow is placed under the head to
and shoulders to prevent blood from
discoloring the face settling in it.
The eyelids closed.
Dentures  are usually inserted to help give
the face a natural appearance.
The mouth is then closed.
 1
Assist client to achieve
dignified and peaceful
death

Care of the provide  relief for loneliness, fear and 

Terminal Ill
depression
maintain client’s sense of security, self

Patients and confidence, dignity, self confidence and self –

worth

their Families
2 Help client
accept his/her losses

Provide physical support

Identify personal feelings about death
 3
Provide physiological
and psychological
support

Care of the Personal hygiene

Terminal Ill
Pain control measures ( highest priority)
Relief of respiratory difficulty

Patients and Assistance in movement, nutrition, hydration

and elimination

their Families
THANK YOU!