PRACTICAL 10 CARE OF

TERMINALLY ILL
AND A DYING
PATIENT
Structure

10.0 Objectives

10.1 Introduction

10.2 Terminal Illness and Emotional Stages

10.3 Nurse and Patient's Perception of Death

10.4 Physiological Process of Dying

10.5 Nursing Care Aspects

10.6 Let Us Sum Up

10.7 Key Words

10.8 Answers to Check Your Progress

10.0 OBJECTIVES
After studying this practical, you should be able to:

• recognize individualized needs of a terminally ill patient to keep him or her

physically comfortable and offering realistic hope;

• developing understanding of the physical and emotional aspects of a patient,

nearing death and implication of these to nursing care;

• analyze the dynamics of nurse and patient perception of death, influencing

nursing care needs and nursing interventions; and

• ease discomfort and promote peaceful death.

10.1 INTRODUCTION
All of us are aware of the fact that death is an inevitable certainity. Yet, it
involves considerable channelization of coping mechanism of a dying person
and also the care providers/relatives to face this certainty. Knowledge and
understanding of these are important for giving effective care. This practical
presents some of the basic ideas that you will require to nurse a terminally ill
or a dying patient. While studying this practical it is essential for you to keep
contact with dying or grieving family in order to develop the understanding of
a process of dying. This practical will focus on adoption to the dying process
in which nursing interventions serve vital importance to a peaceful and
98 dignified death.
 Care of Terminally HI
10.2 TERMINAL ILLNESS AND EMOTIONAL and a Dying Patient

STAGES
Patients who have lost hope to get well are termed as terminally ill patients.
You might have experienced while nursing patients in the ward that knowledge
of terminal illness is shocking for some patients and disturbing to every patient.
Patient usually reacts by denial or feeling of anger, envy or resentment.

Denial

As such act as shock absorber. This is a temporary mechanism, which functions

as buffer after shocking news. This in a way gives time to a patient to .
recompose oneself to accept the inevitable to some extent. You will see such
patients to isolate themselves. These require someone to share their loneliness,
respect their feeling and allow them to express their thoughts. This gradually
helps them to accept their prognosis. Nurse, doctor, relative, religious leader,
etc. become important support on which patient can lean.

Anger

Denial feeling in some patient is replaced by anger/envy. This is a difficult

stage. Anger is usually projected on an immediate environment of which nurse,
doctors, usually become targets. Patients usually complain of nurses, doctors not
good, hospital regulations strict, etc. This is also a temporary phase. They may
even try to bargain with God to extend life and allow to fulfil some of the
tasks. Sometimes guilt feeling about the earlier life-style may surface. These
also require expression and support from the nurse, doctor or priest, etc. Studies
have shown that if patient is allowed to express feelings, grief, and the
acceptance of fatal and terminal illness become much easier.

Physical comforts and realistic hope form the basis of nursing care of such
patient. The patient should feel that life is well spent. To do so you need to
have the knowledge of different emotional stages through which such patients
usually go through.

You may also come across such patients or circumstances in which the dying
patient may not move through all the emotional stages or any of the stage may
be interrupted by sudden death in accident, heart attack, etc. which will take
only few minutes or hours to pass all emotional stages. Therefore, it is
important for you as nurse that you should recognize unique nature of
emotional reaction to death in different patients. Some of these reactions you
may recall from your earlier experience with patient approaching death could
be.

Panic

This happens when shock of death become unbearable to a patient. He/she

restores to impulsive, uncontrolled and unrealistic behaviour. The fright and
terror of death compels such patient to escape reality and go in for magic or
faith healing, develop psychosis or may commit suicide. You need to be
observant and understanding of such clues and help patient to see reality and be
with him or her. You might have seen or experienced that inexperienced and
unskilled nurse usually panic in such situations and flees the patient, which
instead of helping patient to understand the reality of death may enforce his
myth. 99
Caring in Medical As reality of terminal illness sets in, the emotion finds outlet as catharsis or it
Surgical Conditions
may turn inward against the self and patient will be in depression. In case
patient is not allowed catharsis he/she is likely to display his/her anger on the
staff/relatives or friends. You might have experienced that many nurses feel
comfortable to nurse cooperative patient and these nurses are likely to stifle
such behaviour. Patient because of his/her own belief may find expression of
negative feelings with self-concept. In such patients when negative feelings find
no outlet, the guilt and likely shame of such feeling, may reach a neurotic
stage. Such patients are to go in a depressive state and become helpless.
Nursing intervention in such situation will be that your patient get support from
you that his reasons for anger is realistic, you are there to help him.

Negotiation

You would have also experienced in hospitals and otherwise the patient tries to
negotiate with self/God about death. In the process he/she is also likely to come
in conflict with self or God and may resolve to leave living with such bargain.
You may recall some of your reaction in such situations, which reinforced
patient's negotiations rather than remaining realistic. Your realistic approach in
this should be directed in understanding patient, respect his decision and help
him to accept reality.

Commitment

This is the phase when realistic hope moves into acceptance, or it may be a
despair ending in resignation. Hope (acceptance) is confirmed in assurance
when patient feels that everything will be all right whereas in resignation the
patient gives into inevitable. Nurse plays important role in building hope in
patients.

C;ompletion

This is the stage when finally death approaches the patient and life either with
a sense of fulfillment or hopelessness. In fulfillment stage patient dies in peace
and dignity and enriches life of those around. Hopelessness stage make patient
to tolerate each pain and welcome death as end to suffering. Nurses in such
situations are prone to get emotionally involved and may find difficulty in
helping family and patient. Therefore, you are in such a situation it is important
for your to express your feelings with fellow nurse, supervisor or even priest.

At least when patient has found some peace and wish to be alone, he/she may
be allowed this. Communication usually is non-verbal. Visitors may be limited
to close relations/friends. The patient at this point may wish to make/alter will
or express gratitude to his close and dear relatives.

Check Your Progress 1

Which three of these diseases are considered terminal: conjunctivitis, peptic

ulcer, AIDS, anaemia, thalassemia, cancer .

................................................................................................... : .
100
 Care of Terminally III
10.3 NURSE AND PATIENT'S PERCEPTION and a Dying Patient

OF DEATH
In this section you will learn about the perception of death by the nurse and the
patient and implication of these in nursing care.

i) Nurse Perception of Death

No matter how skillful a nurse may be in the care of a living patient, but her
approach to dying patient is typical with some feeling of uncertainity,
helplessness, and anxiety.

Uncertainty because of her best effort to comfort has not helped. Helplessness
comes because she is not able to sustain patient's life. Feels anxious how to
communicate this painful matter to patient and relative, etc. All those feelings
become quite taxing for a nurse. She is likely to loose hope of attaining and
maintaining the goal of health. She often tries to disassociate from the death
and patient itself. Unconsciously or consciously tries to indulge in nursing task,
equipment, disease process, and superficial conversation to hide fear of death
and like. Nurse may even avoid contact with dying patient. This behaviour of
nurses in many studies in described as slow response of nurses in answering
terminally ill patient's signals. In the light of these it is important for you to
analyze and understand your own behaviour as nurse that may cause you
discomfort. You should express your discomforting feelings with your senior
nurse and supervisor or doctor to help you to ease these so that you face your
patient confidently and help him purposefully in coping with the inevitable.

ii) Patient Perception of Death

You have seen in hospitals that in addition to patient's physical needs other
issues viz. morale, religious, legal, economic etc. are also associated with death.
Whether death is sudden or gradual, series of defenses, attitudes unique and
specific to death surface. Most common question that arises in nurse's mind or
others mind is should the patient be told truth about the state of his illness?
There are two views expressed in this connection. Each of these has its own
merit. One such view is proponents of informing patient. This maintains that it
is not morally right as silence condemn the patient to die alone with a reality
of which he/she is aware. This approach is likely to deprive the patient of the
empathy of physician, nurse, friend and family when it is most needed. The
supporters of this view feel that the patient should be told truth.

Other view which supports telling truth to a patient about impending death is
inappropriate. Supporters of this view maintain that death in itself is unique
among human fears, normally defended by degree of denial. Envision of this
universal and unique fear if forced can do more harm than good.

Both these views have merits. There are number of examples in which blunt
disclosure of terminal illness has driven patient to despair. Conspiracy of silence
by physician or relatives has condemned the patient to go through the pain of
death alone. In both views such extremes have to be avoided. These approaches
should be selectively chosen after acquainting thoroughly with patient history
and personality. Patient's personal perception of death will affect the morale and
religious attitudes to death. You would have come across people who may be
prepared to die any day as deserved rest or relief from pain or death as
spiritual renewal. There may be others who may deny dying to self and others.
Such patients try to 'protect' self or the family from expressing grief.
101
'aring in Medical You would have observed that terminally ill patients react differently, some may
urgical Conditions like to talk, others may be silent or cry or may show anger, fear, guilt,
stoicism, may like to be left alone or these may fear being left alone.

You have earlier learnt in psychology of dying that patient tend to follow as
general pattern of behaviour. Understanding of this pattern will help you to
meet the individualized nursing care needs of the dying patient.

Check Your Progress 2

Read the following statement carefully and write True (T) or False (F).

a) Nurse while caring for dying patient at time feels helpless because her
best efforts in caring of the patient are not sustaining life. (TIF)

b) Slow response to patient signals indicates that nurse is trying to avoid

contact with a dying patient. (TIF)

c) Issues like morale, religious, legal, economic etc. do not concern

dying patient. (T/F)

d) Disclosure of prognosis to such (dying) patient should be discretory. (T/F)

Activities

I) Talk to a patient who is terminally ill or dying in your ward. List his feelings,
compare those with which you have learnt in this section.

2) List your own feelings while caring for a dying patient. Discuss these with your
supervisor/Doctor. See how you felt thereafter.

10.4 PHYSIOLOGICAL PROCESS OF DYING

You have studied in your GNM programme that death is a progressive failure
of the vital functions, carried out by three vital systems: nervous system,
circulatory system and the respiratory system.

In peripheral circulatory failure general slowing down of the body circulation

takes place. Coldness from lower extremities to upwards sets in and there will
be changes in pulse, respiration and temperature. Pulse will be fast and
irregular. Heart contract even after respiration has ceased. The radial pulse
gradually falls and only apical heart rate can be counted. Patient sweats
profusely and body surface cools. However patient feels warm and restless due
to sensation of heat, patient will have dry mouth and thirst. Respiratory failure
will alter breathing. There will be irregular, noisy, rapid, shallow or abnormally
slow respiration. In many instances breathing is chyne strokes respiration (cycle
of apnea). Elevation of head and shoulders on pillows, oxygen administration
may ease discomfort in breathing. Mental abilities diminish as blood supply to
nervous system (brain) ceases. Mental alertness varies from complete
consciousness to a coma. Eyesight begins to fail, patient instinctively turns
towards the light and can see r-ilv what is near. There will be a confused,
mumbled, laboured speech.

Asphagia gradually sets in, there will be gurgling sound or death rattle. This _
sound comes because of the collection of mucous in the throat and mouth, air
passing through the secretion. Thus turning patient to one side will allow the
gravity drainage of the mouth secretion. Oropharyngeal suction can be used to
02 clear the secretion.
Hearing Care of Terminally III
and a Dying Patient

Hearing is a last sense to leave the dying persons. Peaceful environment, word
spoken to dying patient should be distinct and spoken close to the ears. Any
distressing conversation is to be avoided.

Muscles become flaccid, body assumes a supine position. Patient is unable to

communicate his basic needs. Nurse turns patient frequently and supports his
body parts with pillows.

Peristalsis ceases: Stomach distends with what is swallowed. Anal and bladder
sphincters relax. There will be incontinence of feces and urine. Hence, bed need
to be protected with dry Macintosh and drawsheet. Catheter or candom drainage
and frequent bedpan giving help to keep patient clean and dry and also release
urinary retention, if any.

Face appearance of a dying patient in long and continued illness as a result of

anaemia, loss of muscular tone looks ashy and pale; sunken and glazed eyes;
sharp and pinched nose; prominent chin and cheeks called facies hippocratica.

Check Your Progress 3

Match Column A with Column B:

Column A Column B

a) Death Rattle i) Chyne strokes breathing.

b) Facies hippocratica ii) Air passing through secretion in the throat.

c) Cycle of Apnea iii) Prominent chin and cheeks.

10.5 NURSING CARE ASPECTS

Let us now discuss the nursing care of a dying patient. Maintaining
psychosocial balance of such patient is one of the most urgent needs of dying
patient. To provide for emotional need, it is important for you to assess the
meaning of death to a patient such as acceptance or denial of it; awareness (or
lack of awareness of it and his prognosis. Nursing care of such patient will take
into account the following aspects.

i) Principles Derived from Behavioural Sciences

Principles listed below are derived from behavioural sciences. These will help
you to have meaningful communication with a dying patient. These are:

a) Your knowledge of patient perception of death connected with his

psychological, spiritual and social meaning to him/her will help you to
understand his need for communication with family or a person caring for him.

b) You would have experienced onwards or otherwise that such patient often will
have need to talk to some specific people of hislher family, friends, etc. Social
environment in hospital must provide for such interaction.

c) You have also known that culturally approved roles requires specific social
behaviour. There are chances when such patient may react contrary to these. As
nurse you need to understand the psychosocial dynamic behind the reaction.
Patient may react by denial, bereaved, grief contrary to acceptance. Nurse in 103
Caring in Medical such situation is likely to be hostile instead of compassionate and doctor may
Surgical Conditions become helpless instead of helpful. Reason for patient reaction need to be
understood to give himlher support. Patient may be using disassociation or
denial as to suppress or control emotional reaction. Whereas the expression of
reaction is important for peaceful dying. Though there may be some tense
feeling between both patient and nurse during discussion, but as both unwind
their feelings in the process of discussion gain strength and comfort. Therefore,
as nurse you should provide for expression of patient's emotional reaction.

d) During period of stress and uncertainity our spiritual needs often tend to
increase in intensity. You as nurse should be attentive to such cues from patient
and help the patient in being willing and able to discuss with spiritual leader of
his/her religion.

ii) Sociological Responsibilities

Relative, friends form an integral part of a dying person's milieu or

environment. They also require support to cope with the pending grief.

8---7 +
8
Fig. 10.1: Dying person's environment

Death as we know is a very much family matter. Closeness of these significant

people with patient is important. Understanding of relative's reaction to such
situations is also linked with the nature of a death of any previous family
member. Sometimes, you may kind that during the period of sickness itself a
person is undergoing grief and need help to cope with the ordeal.

At times patient's relatives also pass through the stages of emotion a patient
passes. Their behaviour would become demanding. Nurses need to understand
this. Thus accepting their reaction you would help them to work through their
grief and at the same time assist them in providing support to the patient. You
have seen in your experience whether death is sudden or gradual the family is
never ready for such eventuality. The typical behaviour of the family is difficult
to anticipate. Observance of religious practices, familiar faces and also an
expressive handshake/embracing by a close friend or relative bring comfort. You
need to be sensitive and respectful to religious needs of a patient and be helpful
in procuring such support.

In case patient at this stage wish to change or make will be the hospital
procedure in this regard be followed, you need to communicate such desire of a
patient to your supervisor for desired (;.':.'ti0!l.
•
iii) Nursing Care of the Body After Death

Cessation of breathing and of the heart beat is a general consideration as

evidence of death. Nurse present with the patient record the date and time when
104 patient's heart beat and breathing stopped.
III case a caruiac aueM rue ~avlllg measures ale iusuuneu. nuwevel, YUUas ,-,at 'I[; UI 1'I[;11111114I1J .11

nurse should be aware and selective in choosing resuscitative measures. and a Dying Patient

Resuscitation decision in case of elderly/terminally ill patient you may consult

the family and physician. Physician pronounces the death when breathing
cannot be restored. Record of exact time of death is crucial when dying
patient's organs are to be used for transplantation.

At time nurse or doctor may estimate approximate time of death to inform

family members to be with hirnlher.

Preparation of the body for transfer to the mortury is carried .out by the nurse.

Procedure: Performing Last Offices

a) Purpose: Respectful, aesthetic, safe preparation of dead body.

Follow the correct system of transferring the body to mortuary or to be handed

over to relatives.

b) Points to Remember

• To check that doctor has declared death.

• Nurse should wear plastic apron, mask, and gloves while packing the body.
Follow universal infection control measures.

• Maintaining correct body alignment of the patient.

• Give due respect to the body.

c) Equipment

• Screen

• Death Kit containing shroud wrapping sheet; paper; body tags; tables;
4" x 4" dressing, cotton swabs; large packing forceps, safety pins,
plastic bag.

• Sponge tray/trolley containing sponges (2); towels (2); soap; comb/

brush, paper bag, bucket, basin, water jug (big), broad bandages,
scissorlblade, adhesive tape.

• Plastic apron, mask for nurse.

• Paper sheet, pen.

Steps of a Procedure

i) Screen the bed.

ii) Assemble equipment on a trolley or tray at the bedside of the body.

iii) Flatten the bed or adjust it to working height.

iv) Place body in supine position, eyes closed, denture in place, arms at sides or
across chest and place a pillow under the head.

v) Disconnect oxygen, suction if any attached.

vi) Remove jewellery if any and list personal articles. 105

Caring in Medical vii) Remove patient's clothing. Clean the body and pack orifices.
Surgical Conditions
viii) Comb and arrange hair.

ix) Remove tubes (in no autopsy). Tube remains in if any autopsy is to be

performed. Denture if any may be put in place or sent with dead body.

x) Change dressing if any.

xi) Put on gown or clothes as per hospital procedure. Restrain jaw, wrist, toes,
ankle, with sufficient padding and soft bandage.

xii) Tie identification (labeled) tag on toe/wrist/chest as per hospital procedure.

xiii) Wrap the body in shroud or sheet and attach label.

xiv) In case of infections patient body is wrapped in double bed sheet and
thereafter with plastic sheet/bag to prevent any spilling of body discharge.
The body is labeled as 'biohazard'.

xv) Shift the body on a stretcher maintaining body alignment.

xvi) Secure safety belts or use broad bandage/draw sheets at knees and chest.

xvii) Transfer body to morgue.

xviii) Return to room for stripping and final cleaning.

xix) Hand over patient's valuables, death certificate to relatives as per procedure
and take their signature.

xx) Record the procedure or any unusual observation on the chart and sign.

xxi) Death certificate is filled by the physician. This is to be sent to the health
authorities concerned with birth and death record. Death certificate is also
issues to the relatives before the body is permitted to be taken for burial or
cremation.

xxii) For doing autopsy, signature is to be taken from the relative. This is you may
recall usually done on patient who died of brief illness, unknown cause or in
case of crime/medico-legal etc. The autopsy will show the cause, extent of
condition and effect of treatment. This procedure is like operations. There
should not be unnecessary mutilation of the body. The mortician after
autopsy prepares the body so that there is no visible evidence of post-
mortem while handing over the body to relatives for cremation or burial.

Changes that Follow Death

Body Cooling

Soon after death you will find that body cools very fast. Thereafter, it proceeds
slowly until 24 hours and reaches temperature of the environment.

Rigormortis sets in within few hours of death. It starts from the muscles of the
jaw and passes successively down' the neck, arms, trunk and legs. The arms,
legs, become so stiff that these cannot be bent. This appears in 1 to 6 days.
Though muscles thereafter may become soft, but these never contract again.

Post-mortem hypostasis is a dark, red and bluish discolouration caused by the

settling of the blood. You have learnt that gravity affects the level and
distribution of fluids. Thus raising the head and shoulders on pillows or with
backrest prevent blood settling on the face and discolouring it. Pillows, rests are
106 required to keep body in possible good posture. ,
 Performance Checklist of Dying Patient and Post-mortem Care Care of Terminally III
and a Dying Patient
After you have performed the care of a dying/the last offices, check if you have
done systematically.

i) Did Iknow the principles of behavioural sciences that underlie in caring of a

terminally ill patient?

ii) Did Iknow the social milieu of my patient and its stressful implication on
patient. and family?

iii) Did I provide physical comfort and emotional support to patient and also to
family that helped in dignified and peaceful death?

iv) Did I follow hospital procedure in pronouncing the death?

v) Did I screen the bed and provide privacy to my patient after death?

vi) Did I assemble necessary equipment for preparing dead body at the patient
bedside?

vii) Did I adjust bed to working height, and gave himlher appropriate position and
removed oxygen, suction if any?

viii) Did I remove ornaments or any other valuables from patient and listed these?

ix) Did I wear apron, gloves while cleaning the body?

x) Did I bathe the body properly, packed orifices, changed dressing if any and
dressed the patient in appropriate clothing?

xi) Did I put identification tag as per procedure, wrapped the body in shroud or
sheet and labeled the body?

xii) Did I use correct body alignment while moving body from bed to the
stretcher and secured it for safer transfer to morgue?

xiii) Did I return to the patient bed for its stripping and cleaning, resetting?
I

xiv) Did I hand over valuables to relative or deposited in the offices?

xv) Did I do necessary recording on the patient chart and also wrote on other
register/form etc. as may be the hospital system?

Guidelines for Care of Terminally III and Dying

The details of caring for a terminally ill and dying person may not be different
from those of caring for someone who is ill but may recover but they may,
sometimes, be perceived rather differently. In particular for a terminally ill and
. dying person, the quality of Ii re becomes especially important.

Guidelines for the Care of the Dying and hi, Family

i) Encourage patient to be a decision maker concerning hislher care as long as

condition permits to maintain his dignity and self-worth.

ii) It is the responsibility of the nurse/care giver to see that physical care,
emotional and spiritual support and available to the dying person.

iii) Terminally ill/dying elderly may identify one or two members of hislher family
for discussing hislher inner most feelings. This should be respected.

iv) Encourage family members to express their feelings towards the impending
loss of their loved one. Provide them with additional emotional support.

v) Various cultural and ritualistic practices enabling individual and family to

move through the grief process should be encouraged and respected: 107
Caring in Medical .
Surgical Conditions 10.6 LET US SUM UP
You have learnt that death is viewed from the point of individual and cultural
value system of a. patient. Respecting and assessing the system is of key
important in planning and implementing nursing interventions. Doctors and
nurses are committed to save life and promote well being. Dying aspect conflict
with the primary purpose of the healing professions and feeling of frustration
and failure often occur. These feelings often become part of hospital social
culture. There may be collective professional attitude of withdrawal from death
e.g. avoidance of discussion about death with dying or by isolating the person
from meaningful interaction with others. This prevents him/her to express fear
and face death in positive sense. In such situation dying person somewhat feel
abandoned, depersonalized, lonely, whereas, positive interaction with nurse and
other would add strength and help and patient feel safe and better, able to face
dying with courage and dignity.

Physiological death is a gradual process, which get completed with cessation of

breathing, heartbeat, and brain activity. The care after death is directed to
preserve natural comfortable appearance of the dead and providing comfort and
support to the grieved family as well as completing necessary death formalities.

10.7 KEY WORDS

Catharsis Getting rid of emotion through free expression of
these
Prognosis Foretelling the outcome or course of disease
Shroud Wrapping or sheet for corpse
Stifle Smother
Stoicism Self control

10.8 ANSWERS TO CHECK YOUR

PROGRESS
Check Your Progress 1

Cancer, AIDS, Thalassemia

Check Your Progress 2

a) T

b) T

c) F

d) T

Check Your Progress 3

a) c

b) a

c) b

108
 SELF ACTIVITIES Care of Terminally III
and a Dying Patient
Hams: 150
Marks: lOO
,''''
··;5.
",
Practical Title of the Activity Area Hrs. Marks
. No. No. and
Section

1, Practical 1 Select a patient from the Cardiology 10 10

Sub-section ward in which you are Neurology
1,3 posted and do the Urology
following activities Medical!
• Collect a detail history of Surgical
the patient and document
it using the sample format
No, 1,2.

• List the subjective and

objective data

2, Practical 3 Using the sample format Hospital/ 10 10

sub-section 3,1 for case study, write Rehabilitation
3,2 one case study in any area Unit!
of your choice Community

3, Practical 5 • .Select three patients posted Neuro ward/ 15 10

sub-section for surgery (abdominal, General
5,3,2 chest or neuro-surgery) Surgical
and do the skin preparation Ward/Thoracic
• Draw and describe the Surgery
part preparation in these
surgeries

4, Practical 6 Prepare a health teaching Postoperative 5 5

sub-section plan on diet for a patient Ward
6,3,5 who has undergone
abdominal surgery

5, Practical 9 Select a patient with burns, Burns Ward/ 10 10

sub-section assess the percentage of Surgical/
9,6,9 burns by using Rule of '9' Causality/
Community

6, Practical 9 • List the articles used in Hospital 10 5

sub-section emergency and specify
9.4.2 the purposes of each article

• Prepare a list of drugs 15

used in emergency with
their action

7, Practical 11 Identify the type of vials Hospital 10 10

sub-section used for specific investiga-
11,3.4 tions, follow the guidelines

8. Practical 12 Observe anyone of the Hospital 5 10

sub-section following procedure and check
12,2 the list of equipment and
supplies needed and compare
it what is given in this
practical

1Q9
Caring in Medical
Surgical Conditions S. Practical Title of the Activity Area Hrs. Marks
No No. and
Section

9. Practical 13 Observe a patient undergoing Hospital 15 10

sub-section cardiac catheterization. Write
13.2.3 the indications

10. Practical 16 Select a patient with Hospital 5 5

sub-section diabeties mellitus. Prepare Community
16.3.3 the patient for fasting and
PP blood sugar test

11. Practical 17 Select a patient requiring Hospital 10 5

sub-section pulmonary ventilation Community
17.6

12. Practical 18 Select a patient having a Hospital Med- 10 5

sub-section CVP line. Surg. C
18.3 Record the findings Burns Plastics

13. Practical 19 Prepare the patient for blood Hospital clinic 20 5

sub-section transfusion. Administer OPD causality
19.6 blood and observe the OT
transfusion reactions if any
and record.
,

110
 SUPERVISED ACTIVITIES Care of Terminally III
and a Dying Patient
Hours : 150
Marks: '100

S. Practical Title of the Activity Area Lirs. Marks

No. No. and
Section

1. Practical 1 Select a patient from any Cardiology/ 5 5

sub-section medical surgical area and do Neurology/
1.3.1 the physical examination Nephrology/
Medical-
surgical ward

2. Practical 2 Based on the findings of the Cardiology/ 20 10

sub-section above patient write nursing Neurology/
2.2 care plan applying the Nephrology/
principles of nursing process Medical-
refer sample 1.2 surgical ward

3. Practical 4 Prepare five medication cards Hospital 10 5

sub-section and administer the drugs to
4.3 your assigned patients and
document it.

4. Practical 4 Enter the drugs which you Medical 5 5

sub-section are giving to your patients ward/
4.3 in the drug book. Write the Surgical
action, dose, indications, & ICU/CCU
sideeffects and nursing
responsibilities
5. Practical 5 Select a patient who is Surgical 10 5
sub-section scheduled for abdominal ward
5.3.3 surgery give pre-operative
care and evaluate your care
using pre-operative check list
6. Practical 7 • List the articles needed for Neuro/ 5 5
sub-section Ryle's tube intubation General
7.2.1 • Perform Ryle's tube Ward
feeding

• Make observation of the \

patient during and after

procedure
7. Practical 8 Prepare a surgical dressing Hospital 10 10
sub-section tray and follow the procedure surgical
8.3 step by step and do a ward
minimum of two dressings
Make observation of wounds
you dressed using the per-
formance check list given in
Table No. 8.1.
8. Practical 9 Assess the level of conscious- Neuro/ICU/ 10 5
sub-section ness using Glassgow coma Medical.
9.3.3 scale and record your finding ward

III
Caring in Medical
Surgical Conditions S. Practical Title of the Activity Area Hrs. Marks
No. No. and
Section

9. Practical 14 Select a female patient and Hospital 10 5

Sub-section collect mid-stream urine
11.3 specimen for culture and
sensitivity. Follow the
guidelines given in 11,3
10. Practical 15 Select one patient scheduled Hospital Clinic 10 10
Sub-section for endoscopy. Follow up the
14.2 patient before, during and
after the procedure. Follow
the guidelines.

11. Practical 15 Observe the patient Hospital 15 5

Sub-section undergoing thoracentesis
15.2.15 and record.

12. Practical 17 Select a patient having ICU Med-Sug 10 10

Sub-section ETTITracheostomy tube set up Ward Neuro
17.5 a troley for suctioning and ward ENT
perform suctioning ward

13. Practical 18 Observe the patient in ICU 15 10

Sub-section ICU/CCU having arrythemia/ ICCU
18.4 cardiac arrest. List down the
equipments for defibrillation.
Observe and write the
procedure of defibrilation.

14. Practical 19 Select an oncology patient Hospital 15 10

Sub-section receiving chemotherapy, Chemotherapy
19.7 administer chemotherapy
and list down the precutions
taken during chemotherapy

112
 Post Basic B. Se, Nursing
Programme Study Centres

l. College of Nursing 14. Fort College of Nursing

Bel. Medical College Bangalore-560 002.
New Civil Hospital Campus Karnataka
Ahmedabad-Sfit) 016

2. Institute of Nursing Education 15. College of Nursing

Ll. Group of Hospitals. Campus. Medical College Hospital
Byculla, Bombay-400 608 Trivandrum

3. College of Nursing 16. College of Nursing

ArmedForces Medical College Sri Ramakrishna Institute of Para
Pune-41 I 040 Medical Sciences
395, Sarojini Naidu Street
Coimbatore-641 004

4. College of Nursing 17. College of Nursing,

S.S.K.M. Hospital MKCG Medical College Campus
Calcutta Behrampur, Ganjam-760 004

5. Regional College of Nursing 18. Adhiparashakti College of Nursing

Indrapur Melmaruvathur-603 319
Guwahati-78 I 032 Kanchipurarn, Tamil Nadu

6. College of Nursing 19. BVVSS Institute of Nursing Sciences

CRPLines Bagalkot
Indore-452 00 I Kamataka

7. RAK College of Nursing 20. College of Nursing

Andrews Ganj KLES Institute of-Nursing Sciences
New Delhi-I 10 024 Nehru Nagar
Belgaum-590 010

8. School of Nursing 21. M. A. Chidambaram College of

Safdarjang Hospital Nursing Voluntary Health Services
New Delhi-I 10 029 Aadyar
Chennai-600 113

9. College of Nursing 22. Dayananda Medical College & Hospital

C.M.C. Hospital Civil Lines
Ludhiana-141 008 Ludhiana-141 00 1
Punjab Punjab

10. College of Nursing .13. College of Nursing

Medical College Campus Regional Institute of Paramedical and
Karipur-214879 Nursing (RlPAN)
Uttar Pradesh Aizwal, Mizoram-796 017
11. College of Nursing 24. College of Nursing
Nizam's Instiiute of Medical Sciences Madras Medical College & Research
Punjagutta Institute
Hyderabad-500 082 Chennai-600 003

12. Govt. College of Nursing Oversees

JLN Marg I. Seychelles Polytechnic School of Health
Jaipur-302 0~4, Rajasthan
Studies
13. Narayana Hrudayalaya College of Seychelles Institute of Management
Nursing, 258/A Ma Joie, PO Box-678
Bomrna Sandra Indl. Area Victoria Mahe
Anekal Taluk, Bangalore-562 158 Seychelles
Karnataka