Death and dying/terminology

Hospice
Postmortem care
Rigor mortis
Death rattle
Moribund

Stages of grieving as defined by
Kubler-Ross
Denial

Anger

Bargaining

Depression

Acceptance

Emotional and spiritual needs of
terminally ill residents
Contact with loved
ones

Communication

Expression of
emotions ie., guilt,
anger, frustration,
anxiety, depression

Reminiscence

Emotional and spiritual needs of
terminally ill residents #2
Approaches

Respect religious
cultural practices

Provide
physical/emotional/spi
ritual comfort to
resident and family

Accept resident
emotions

The Dying Patient’s Bill of Rights Be treated as a human being Hope Freedom to express feelings/emotions Medical and nursing care .

The Dying Patient’s Bill of Rights #2 Not to die alone Freedom from pain Honesty Help for self/family in accepting death .

The Dying Patient’s Bill of Rights #3 Die in peace and dignity Retain individuality and beliefs Expect respect of body after death Sensitive. knowledgeable care .

Impending signs of death Cold hands and feet Diaphoresis Pale Loss of muscle tone .

irregular pulse or slow pulse Respiration .Impending signs of death #2 Labored respirations “Death Rattle” Weak.

Impending signs of death #3 Blank staring expression Jaw drops Cheyne-Stokes respirations .

Moribund signs No pulse No respiration No blood pressure Pupils fixed and dialated .

Care and comfort measures for the dying resident Pain management Hygiene Oral hygiene Communication/ support .

Care and comfort measures for the dying resident #2 Positioning/turning Provide comfort Attend to phychosocial needs Spiritual support .

Procedures and responsibilities for postmortem care Assist with postmortem care as directed by nurse Follow facility procedures Provide privacy. support and comfort .

.

Vital Signs / Terminology #2 Febrile Metabolism Mucosa Pyrexia .

Vital Signs / Terminology #3 Pulse Apical Brachial Carotid Radial arrhythmia .

Vital Signs / Terminology #4 Bradycardia Tachycardia Bounding Pulse deficit thready .

Vital Signs / Terminology #5 Respiration Apnea Cheyne-Stokes Orthopnea Shallow breathing Kussmaul’s respiration .

Vital Signs / Terminology #6 Hyperventilation Cyanosis Diaphragm dyspnea .

Vital Signs / Terminology #7 Blood pressure Aneroid manometer Diastolic Hypertension Hypotension diaphragm .

Vital Signs / Terminology #8 Sphygmomanometer Stethoscope Systolic bell .

pulse. Vital Signs / Purposes Temperature.respiration and blood pressure Assess functioning of vital organs Signify changes in the body .

Vital Signs / Observations Color and temperature of the skin How is the patient acting What does the patient tell you about the way he/she feels .

Temperature Balance between heat gained and heat lost The hypothalamus is the regulation center .

Heat Production Heat is produced by cellular activity. food metabolism. muscle activity. and some hormones Infection Brain injury External factors .

the lungs in breathing. Heat loss Heat is lost from the body through the skin. and by elimination Sweating Increased respiratory rate Increased flow of blood to skin .

Heat conservation Reducing perspiration Decreasing the flow of blood to the skin Shivering .

Nursing measures to raise the temperature Increase the temperature in the room Add coverings to the body Provide hot liquids to drink Give warm baths or soaks .

Nursing measures to lower the temperature Decrease the temperature in the room Remove coverings from the body Offer cool liquids to drink Provide cool bath or sponging Direct fan toward body .

Major Pulse sites Carotid Apical Brachial Radial Femoral Popliteal Dorasalis pedis .

Factors that increase pulse Exercise Strong emotions Fever Pain Shock Hemorrhage Anemia .

Factors that decrease pulse Rest Depression Drugs Respiratory center depression .

Qualities of pulse Rate Rhythm Strength .

Respiration Respiration is defined as the exchange of oxygen and carbon dioxide in the lungs It is regulated in the brain by the medulla .

Factors that increase respiratory rate Exercise Strong emotion Infection Increased body temperature Increased metabolism .

Factors that decrease respiratory rate Rest / Sleep Depression Respiratory center depression .

Qualities of Respiration Rate Rhythm Depth Effort Discomfort Position Sounds Color .

Abnormal breathing patterns Labored Orthopnea Stertorous Abdominal Shallow Dyspnea Tachypnea Bradypnea .

Blood pressure Pressure exerted against walls of blood vessels Systolic pressure Diastolic pressure Thumping sounds Sounds correspond to numbers First sound heard is systolic pressure Last sound heard is diastolic pressure .

Factors that raise blood pressure Strong emotion Exercise Excitement Pain Decrease of blood vessel size Digestion Cuff that is too narrow or too loose Cuff below heart level .

Factors that lower blood pressure Rest/Sleep Lying down Depression Shock Hemorrhage Cuff that is too wide Cuff above the heart level .

Equipment needed to measure blood pressure Manometer Cuff Stethoscope .

has an intravenous infusion.Guidelines to take blood pressure Is commonly measured at the brachial artery Do not use arm that is injured. or is in a cast Patient should be at rest Apply blood pressure cuff to bare arm Use appropriate sized cuff .

graphic records.. 120/80 Note location.g. thigh . Charting vital signs Report abnormal TPR and blood pressure to nurse Record on hospital flow sheets. e. 150/90.. and nurse assistant notes Write the blood pressure as a fraction: systolic/diastolic e.g.