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CARE OF TERMINALLY

CARE OF TERMINALLY ILL


ILL

INTRODUCTION

DEFINITION
Terminally illness is a state in which an
individual faces/medical conditions that will
end in death within limited period. KUBBLER
ROSS
OR
Terminally ill people are those with
active&progressive disease for which curative
treatment is not possible/not appropriate
&from which death can reasonably be
expected within. NATIONAL HOSPICE
ASSOCIATION

SIGNIFICANCE
*Increasing no of terminally ill
*Imroves quality of life
*Acess& avaiability of services.
Symptom control & pain relief
Proper use of resources.

Who needs?

IMPACT OF TERMINAL
ILLNESS
TERMINAL ILLNESS

ON PATIENT

ON FAMILY

GRIEF
PHYSICAL REACTIONS
*Anorexia
*weight loss
*chest pain
*fatigue
*GI disorders
*Hair loss
*Headache
*Immunondeficiency
*Agitation
*crying

PSYCHOLOGICAL REACTIONS
*Anger
*Anxiety
*Apathy
*Denial
*Depression
*Disbelief
*Guilt
*Hallucinationof the deceaseds presence
*Helplessness
*Irritability

COMPONENTS OF TERMINAL
CARE
1)Palliative care
2)Hospice care
3)Home care

PALLIATIVE CARE

It is the total care of patients &their families


by a multi professional team at a time when
the patients disease is no longer responsive
to curative treatment

PRINCIPLES
Provides relief from pain
Regards dying as a normal process
Neither hastens nor postpones death
Support system
Enhance quality of life
Team approach

Components of Palliative
care
Symptom relief
Psychosocial support
Team work

HOSPICE CARE
Hospice provides palliative care services to
the terminal patients &care for dying
patients.
DEFINTION
Hospice is an inter disciplinary concept for
providing comprehensive care to terminally ill
patients.

characterstics
Centrally administered
Autonomous programme
Symptom controll
Team work
Services extended to families

HOME CARE

It includes arrangements of health related


services provided to people in their place of
residence.

ADVANTAGES
Less expensive
More comfortable
Continous care
Clients prefer to die at home

STANDARDS OF CARE OF TERMINALLY ILL

Control of symptoms &family support


Comfortable
Goals redefined
Modification of management
Review
Effective communication
Clients assured of their comfort
Avoid unnecessary interventions

DOMAINS OF CARE OF
TERMINALLY ILL

PHYSICAL ASPECTS
1)Pulmonary impairement
Cough
Dyspnea
Death rattle
Stridor
2)Cardaic dysfunction
Heart failure
Peripheral circulation changes

3)Central nervous system alterations


Delirium
Terminal anguish
Terminal restlessness
Hiccoughs
4) Renal impairement
Frequency
Incontinence

5)GI Disturbances
Anorexia
Dehydration
Nausea& vomiting
Constipation
Diarrhoea
6)Musculo skeletal changes
7)Integumentary
Pressure ulcer

PSYCHOLOGICAL ASPECTS
Depression
Denial
Anger
Anxiety
Fear of death/dependence
Suicide

SPIRITUAL ASPECTS

SOCIAL ASPECTS

DEATH & DYING


Death is an invitable part of glory of life
Cessation of all physical&chemical process
that invariably occurs in all organisms.Miller keene.

SIGNS &SYMPTOMS OF
APPROACHING DEATH
Decreased level of consciosness
Decreased desire for food &liquids
Decreased urine output
Incontinance
Skin dry
Noisy breathing

AT POINT OF DEATH
Breathing,heart beat ,&pulse stop entirely
Person is unresponsive to shaking/ shouting
Pupils dilated &fixed
Loss of urine &bowel control

RIGHTS OF DYING PATIENT

LOSS &GRIEF

KUBLER ROSS STAGES OF


GRIEF
Denial
Anger
Bargaining
Depression
Acceptance

ETHICAL &LEGAL ASPECTS OF CARE


Euthanasia
Advance directives
Living will
DNR
Power of attorney
Health care surrogate
Terminal weaning
Organ donation
autopsy

Kubler rosss stages of


grief