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Death
Death is a irreversible cessation of circulatory, respiratory function or the
irreversible cessation of all functions of the entire brain, including the
brainstem.
Signs of Dying
This includes the following changes:
Loss of appetite
Decreased oral fluid intake and decreased thirst.
Increasing weakness and/or fatique
Decreasing blood perfusion, including decreased urine output, peripheral
cyanosis and cool extremities.
Neurologic dysfunction, including delirium, lethargy and coma and
changes in respiratory patterns.
Loss of ability to close eyes.
Noisy breathing as pharyngeal muscle relax.
In particular, neurologic dysfunction can sometimes result in terminal
delirium. Which can include a mounting syndrome of confusion,
hallucinations, delirium, myocardial jerks and seizures prior to death.
Pitting edema develops, especially of the extremities and sacrum
Movement and sensation are gradually lost.
Temperature elevation will be there, but the skin feels cold and clammy.
Pulse becomes irregular, weak and fast.
BP falls as the peripheral circulation decreases.
The skin cyanosed as circulation decreases.
Respiration become noisy
Reflexes disappear
Urine decreases
Pain usually subsides
Mental alertness varies
Jaw and facial muscles relax with the expression becoming peaceful.
Stages of Dying
According to Kubler- Ross, the five stages of dying are:
1. Denial. On being told that one is dying, there is an initial reaction of shock.
The patient may appear dazed at first and may then refuse to believe the
diagnosis or deny that anything is wrong. Some patients never pass
beyond this stage and may go from doctor to doctor until they find one
who supports their position.
2. Anger. Patients become frustrated, irritable and angry that they are sick. A
common response is “Why me? ” They may become angry at God, their
fate, a friend, or a family member. The anger may be displaced onto the
hospital staff or the doctors who are blamed for the illness.
3. Bargaining. The patient may attempt to negotiate with physicians, friends
or even God, that in return for a cure, the person will fulfill one or many
promises, such as giving to charity or reaffirm an earlier faith in God.
4. Depression. The patient shows clinical signs of depression- withdrawal,
psychomotor retardation, sleep disturbances, hopelessness and possibly
suicidal ideation. The depression may be a reaction to the effects of the
illness on his or her life or it may be in anticipation of the approaching
death.
5. Acceptance. The patient realizes that death is inevitable and accepts the
universality of the experience. Under ideal circumstances, the patient is
courageous and is able to talk about his or her death as he or she faces
the unknown.
Physical Signs of Dying
Confusion – about time, place, and identity of loved ones; visions of
people and places that are not present
A decreased need for food and drink, as well as loss of appetite – this
may be caused by the body’s need to conserve energy and its decreasing
ability to use foods properly
Drowsiness – an increased need for sleep and unresponsiveness
Withdrawal and decreased socialization – can be caused by mentally
preparing for dying, decreased oxygen to the brain and decreased blood
flow
Loss of bowel or bladder control – caused by relaxing muscles in the
pelvic area
Skin becomes cool to the touch – especially in the hands and feet, skin
may become bluish in color caused by decreased circulation to the
extremities
Rattling or gurgling sounds while breathing or breathing that is irregular
and shallow, decreased number of breaths per minute, or breathing that
switches between rapid and slow
Involuntary movements (called myoclonus), changes in heart rate, and
loss of reflexes in the legs and arms also mean that the end of life is near .
Management of Dying Patient
Cassen (1991) suggests seven essential features in the management of the
dying patient:
A patient in the terminal stages of a disease, is given all the nursing care
possible to ensure the most comfort and freedom from pain. Physical
comfort is important as well as emotional and spiritual comfort.
Meeting nutritional need:
Patients suffer discomfort due to decreased gastrointestinal activity.
Nutrients and fluids are given intravenously when they are not tolerated
orally.
Sips of water is given as long the swallowing reflex is present.
When there is a problem gauze soaked with water may be placed in the
patient’s mouth for him to suck and moisten the mouth.
Meeting special needs:
I. Purpose