END OF LIFE CARE

Pre test
15marks
1. What does END OF LIFE CARE mean? 1mark
2. What are the signs of end of life? 2mark

3. Mention 4 Nursing needs of the patient 2 mark

4. Mention 4 needs of the family 1 mark

5. What is pallative care? 1 mark

6. How to ensure comfort of the patient? 2 mark

7. List down distressing signs and symptoms during end of life 2mark

8. What is DNR ? As per law is it followed in our hospital? 1mark

9. In MLC cases Embalming is done. True or false? 1mark

10. How is death care given? 2 marks

 meaning
• END OF LIFE CARE refers to health care
for a person with a terminal condition
that has become advanced progressive,
and /or incurable.
 PURPOSE
• To establish & maintain standardized
procedures for “End of life Care” & post
death procedures in an ethical,
dignified manner & to ensure its in line
with the legal requirements of the State
 scope
The policy of “End of Life
Care” covers all critically ill
patients on life support & / or
without life support.
 RESPONSIBILITY
• Medical Superintendent
• Consultants/Intensivists
• Head of Nursing Services
• Security Officers
• Nursing Staff
 Sign of death
• No Response
• No Pulse
• No Breathing
• Relaxed Muscles
• Fixed Eyes:- Pupils not reacting to light
• A Bowel or Bladder Release
• Partially Shut Eyelids
Management for End Of Life care
• Providing care to terminally ill patients
• Administer appropriate pain & palliative care
according to the wishes of the patient & his/her
relatives.
• Keeping the relatives informed about the
condition from time to time
• Goals of treatment
• Needs of the patients.
• Needs of the family.
 Nursing Needs of the patients

• Receiving adequate pain &

symptom management.
• Strengthening relationships with
loved ones.
• Understanding patients cultural &
spiritual belief.
 Needs of patients
Patients who are deteriorating :
• Relatives should be informed politely & clearly
• Next of Kin will be allowed to be with the
patient.
• Upon death relatives will be given time to
spend with the (deceased) body
• All jewellery will be removed if any
• All invasive tubes, lines will be removed
• MLC if any will be explained to the relative
 Needs of patients
• D.C will be prepared
• Body care will be given
• Due respect to the body when handling
• The body will be dressed as per the
request of the relative
• The body will be sent to the Mortuary
after Identification tags
 Needs of the family
• To be comforted & to be assured that their
decisions were right
• To ventilate their emotions
• To find meaning in the dying of their loved
ones,( private time with the pt, hold hands
etc)
• To be fed hydrated & rested.
• All members of the family are allowed to see
the patient during the last hours
 Palliative care
• Palliative Care is a specialized medical care
given for making life as easy as possible for
patients and families living with serious illness.
 Conti…
• Palliative care is treatment of the discomfort, symptoms,
and stress of serious illness. It provides relief from
distressing symptoms including
• Pain
• Shortness of breath
• Fatigue
• Constipation
• Nausea
• Loss of appetite
• Problems with sleep
 Ensuring comfort of patient
• Assessment of pain
•GCS
• Administering of opioids
• Physical needs
• Nutritional needs
• Elimination needs
 d.n.r

• As per the law not

practiced in our hospital.
 Preparation of body after death
• Lay the patient on his/her back
• Remove all mechanical aides ( ventilator etc)
• Support the jaw either with sand bag or tie.
• Wash/ bathe the patients, place dentures
insitu.
• Brush and comb the hair
• The eye lids are closed for few seconds so
they remain in place
 Conti…

• Remove all ornaments

• Place absorbent pads under the buttocks
( Muscle sphincter relaxation)
• All the orifices should be closed
• Dress the patient unless MLC.
• Ensure 3 ID tags are present.
• Wrap body in sheet, making sure that all limbs
are covered & secure.
• DO COMPLETE DOCUMENTATION IN THE
NURSES NOTES
 Medico legal Cases

• Incase of MLC cases, inform

the police, clean the body, but
do not remove any evidence
from the body. No embalming
to be done.
 Organ donation.
• Donation of organs will be done as per
the wishes of the dying person &/ or the
relatives.
• Proper informed consent will be done.
• After the consent only then will the
organs be harvested
• Legal & statutory requirements should be
adhered to
 What is “End of life Care”?
• Position comfortable for patient -consider mattress for pressure area care
• No bowel problems
• Appropriate psychological and social support given to:
• I) patient
• Ii) family
• Appropriate religious and spiritual support given to:
• I) patient
• Ii) family
• Needs of the family addressed
• Family with level of involvement in care
• Aware of patient’s condition
• Pain assessment
• Nutrition & hydration
• Counseling
• Optimizing fluid balance/alternate routes
• Respiratory secretion
• Education/counseling
 Post test

15marks
1. What does END OF LIFE CARE mean? 1mark
2. What are the signs of end of life? 2mark

3. Mention 4 Nursing needs of the patient 2 mark

4. Mention 4 needs of the family 1 mark

5. What is pallative care? 1 mark

6. How to ensure comfort of the patient? 2 mark

7. List down distressing signs and symptoms during end of life 2mark

8. What is DNR ? As per law is it followed in our hospital? 1mark

9. In MLC cases Embalming is done. True or false? 1mark

10. How is death care given? 2 marks

 THANK YOU
Presented by : Sr. Alexandria Rebello