Nursing Care of Clients with Problems in Oxygenation, Fluid and Electrolyte, Infectious,
Inflammatory and Immunologic Response, Cellular Aberration, Acute and Chronic
Module 1: Nursing Care Management of Clients with Cellular Aberration (Cancer)
Clinical Instructor: Racquel C. Cruz RN, MSN
1st Semester | S.Y. 2022-2023
HOSPICE PALLIATIVE CARE
A. Principles of Palliative Care:
1. Affirms life and regards dying as a normal process
2. Neither hastens nor postpones death
3. Provides relief from pain and other distressing
symptoms
4. Integrates the psychological, ethical, legal, and
spiritual aspects of care
5. Offers a support system to help patients live as
actively as possible until death
6. Offers a support system to help patient’s families
cope during the patient’s illness and in their own
bereavement
B. Essential Components of Palliative Care
1. Symptom control
2. Effective communication
3. Rehabilitation
4. Continuity of care
5. Terminal care
6. Support in bereavement
7. Education
8. Research
Nurses Role
a. Providing direct care
b. Advocate
c. Counselor
d. Collaborative Role
END-OF-LIFE (EOL) CARE
CONCEPT OF HOSPICE-PALLIATIVE CARE,
LOSS, GRIEVING, DYING, AND DEATH
“To everything there is a season and a time to every
purpose under the heaven, a time to be born and a time
to die.” – Ecclesiastes 3:1-2
HOSPICE – PALLIATIVE CARE
Hospice
 A coordinated program of interdisciplinary care
and services provided primarily in the home to
terminally ill patients and their families.
Palliative Care
 Comprehensive care for patients whose
disease is not responsive to cure
 Common S/Sx: Pain, Dyspnea, Anorexia,
Cachexia, Delirium, and depression
1. Relieve the dying person's pain
 Always trust what patients say about their pain.
Never just make your own decision about 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 take
care of the pain and that they do not need to
fear.
 Give doses of pain medication that give the
most pain control with the least side-effects.
 Give pain medication all through the day and
night to make sure that the patient has enough
pain relief.
 Use the simplest route to give medicine. Give it
by mouth, if the person can swallow.
 Use other ways to control pain, including
massage, music, and comfortable positioning
of the patient. Sometimes a hot pad or hot
water bottle is helpful with pain.
 Addiction to medication is never important for
dying patients
2. Keep the patient comfortable
 If the patient is constipated, a laxative may be
helpful. Also 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 patient should eat only what
foods he or she wishes to eat.
 Keep the patient clean; give frequent baths,
give mouth care if the mouth is dry, and clean
the eyelids if secretions collect
 Help the patient to get out of bed and sit in a
chair if he or she is able. If not, change the
position every two hours and try to keep the
patient in whatever positions are most
comfortable.
 If the patient has trouble breathing, help him or
her to sit up a little
 If the airway is obstructed, you may need to
suction the patient’s throat.
 If the patient feels short of breath or gasps for
air, give oxygen.
 Even when patients are close to death, they
can hear, so do not speak in a whisper. Speak
clearly. The patient will also still feel your touch
LOSS, GRIEVING, DYING, AND DEATH
Terminal illness
 Progressive, irreversible illness that despite-
cure focused medical treatment will result in
patient’s death.
 Needs of a terminally ill → (1) Spiritual, (2)
Emotional, (3) Physical
Advance Directives
 Written documents that allow the individual of
sound mind to document preferences
regarding end-of-life care that SHOULD BE
FOLLOWED when the SIGNER (patient
himself) is terminally ill and unable to verbally
communicate his/her wishes.
 The documents are generally completed in
advance of serious illness but may be
completed after a diagnosis of serious illness if
the signer is still of sound mind.
 Two types:
1. Durable power of attorney for Health Care
• aka: health care power of attorney or
Proxy directive
• A legal document through which the
signer appoints and authorizes another
individual to make medical decisions on
his/her behalf when he/she is no longer
able to speak for him/herself.
• Notarized, read twice before signing.
 Nursing Care of Clients with Problems in Oxygenation, Fluid and Electrolyte, Infectious, Inflammatory and Immunologic Response,
Cellular Aberration, Acute and Chronic
Module 1: Nursing Care Management of Clients with Cellular Aberration (Cancer)

Clinical Instructor: Racquel C. Cruz RN, MSN

1st Semester | S.Y. 2022-2023

CHANGES IN THE BODY AFTER DEATH

2. Living will 1. Rigor Mortis
 Is the stiffening of the body that occurs
▪ aka: medical directive or treatment about 2 – 4 hours after death
directive  Most noticeable 48 – 96 hours after
▪ Provides specific instructions for care death
should the signer becomes terminally ill  Rapid (Physically active); gradual
and not able to communicate his/her (bedridden)
wishes directly and often is accompanied  Starts on the muscles of the Head and
by durable power of attorney for health Neck → Trunk → Lower extremities
care.  it is therefore advisable to perform Last
▪ Accept / refuse medical care Offices (aka: post-mortem care) prior to
this occurring, as movement and
Factors Affecting Response to Loss positioning will otherwise be impossible
FACTORS EXAMPLES  Position the body properly, place
1. Emotional Family or acquaintance dentures in the mouth and close the
Involvement eyes and mouth before rigor mortis
2. Nature of Acute or chronic sets in.
Death 2. Algor Mortis
3. Characteristic Adult VS. Children  Is the gradual decrease of body’s
of survivor temperature after death.
4. Social and Rural VS. Urban  When the blood circulation terminates
Cultural milieu and the hypothalamus ceases
5. Nature of Relatives and Friends functions, body temperature falls about
support 1°C per hour until reaches room
network temperature.
3. Livor Mortis
SIGNS OF IMPENDING / IMMINENT DEATH  Discoloration of the skin after death
A. Loss of Muscle Tone after circulation has ceased.
a. Relaxation of the facial muscles (jaw  The RBC breakdown, releasing
may sag) hemoglobin which discolor the
b. Difficulty in speaking surrounding tissues.
c. Dysphagia with gradual loss of gag 4. Skin indentation
reflex  Due to loss of turgor and elasticity
d. Decreased in the activity of the GIT 5. Autolysis
e. Possible urinary and bowel  Digestion of tissues from enzymes and
incontinence lysosomes.
f. Diminished body movement  Organs swell and are spongy
6. Putrefaction
B. Slowing of Circulation  Invasion of the body by
a. Diminished sensation microorganisms
b. Mottling and cyanosis of the  Produces greenish discoloration of the
extremities skin, production of gases, and causes
c. Cold skin, first on the feet and later in foamy and spongy organs.
the hands, ears, and nose.
POST-MORTEM CARE
C. Changes in Vital Signs -care of the body after death
a. Decelerated and weaker pulse Purposes:
b. Decreased in blood pressure a. To keep the body clean and odor free.
c. Rapid, shallow, irregular or abnormally b. To prepare the body for discharge from the
slow respirations (Cheyne-Stoke’s health facility.
Respiration); noisy breathing (Death c. To make the dead presentable for viewing by
Rattle), labored breathing the SO.
d. Fixed dilated pupils Steps:
1. Ensure that death has been verified by a doctor
D. Sensory Impairment
a. Blurred vision 2. Familiarize yourself with the client’s/ relatives’
b. Impaired sense of taste and smell wishes and cultural and religious needs before
c. Note: Hearing → the last sense lost touching the deceased, as procedures vary
depending on religious beliefs
POSITIVE SIGNS OF DEATH
3. Wear disposable gloves and other personal
1. Total lack of response to external stimuli protective equipment (PPE) as necessary
2. No muscular movement
3. No reflexes 4. Make the environment as clean and as pleasant
4. Absence of brain activity as evidenced by Flat as possible.
electroencephalogram (EEG). → the most
accurate indicator of death. 5. Make the body appear natural and comfortable
 Nursing Care of Clients with Problems in Oxygenation, Fluid and Electrolyte, Infectious, Inflammatory and Immunologic Response,
Cellular Aberration, Acute and Chronic
Module 1: Nursing Care Management of Clients with Cellular Aberration (Cancer)

Clinical Instructor: Racquel C. Cruz RN, MSN

1st Semester | S.Y. 2022-2023

6. Remove all equipment and supplies from the

bedside.

7. Remove soiled linen, so the room is free from

odors.

8. Place the body in supine position, arms on the

side and palms down.

9. Place one pillow under the head and shoulders

to prevent blood from discoloring the skin.

10. Close the eyelids, insert dentures, and close

the mouth.

11. Wash soiled areas of the body.

12. Place absorbent pads under the buttocks to

take up any feces and urine released because
of relaxation of the sphincter muscles.

13. Provide clean gown, brush / comb the hair.

14. Remove all jewelries. All the client’s valuables

are listed and placed in a safe storage area for
the family to take away.

15. Provide an environment conducive to viewing

by:
 ensuring privacy and dignity
 covering the deceased with clean,
fresh linen
 controlling room temperature
 ensuring good ventilation
 speaking quietly and avoiding
unnecessary/inappropriate
conversation in the vicinity of the
bereaved
 offering to stay with the relatives if
required
 reducing environmental noise such as
telephones, alarms, machinery,
banging doors, and movement of
equipment
 making sure there is adequate seating
for the bereaved

16. Allow the family to view the patient’s body.

17. Apply identification tags, one on the ankle and

one on the wrist.
If the body will be brought to the morgue:
a. Wrap the body in shroud; apply another
identification tag to the outside of the
shroud.
b. Bring the body to the morgue for
cooling.

18. Ensure that the bereaved have some form of

transport home (To demonstrate compassion
and ensure safety)

19. Clean the bed following hospital policy and

remake it before drawing back the curtains
around the deceased’s bed area

20. Inform other clients and provide an opportunity

to express their thoughts and feelings, as they
are often very distressed by such an event