Death and Dying
Leading Causes of Death in the U.S.
•Heart disease
•Cancer (malignant neoplasms)
•Accidents (unintentional injuries)
•Chronic lower respiratory diseases
•Cerebrovascular diseases
•Alzheimer’s disease
•Diabetes mellitus
•Influenza and pneumonia
•Kidney disease (nephritis, nephrotic syndrome, and nephrosis)
•Suicide (intentional self-harm)
What does (DNAR) stand for?
Do-not-attempt-to-resuscitate
H-
Sources of hope and strength
Managing Pain
Pain is the symptom that dying patients fear most • Opioid and non-opioid analgesics are used • Medical Marijuana (cannabis) –Cannabinoid-based medicines (CBMs) –Recommended only for refractory cancer pain as adjunct to other prescribed analgesics –Reported to address fatigue, anorexia, sleep problems, anxiety, nausea, vomiting –Be aware of state-specific laws • Complementary and Integrative Health –Massage –Music therapy –Therapeutic touch –Guided imagery –Aromatherapy and essential oils— lavender
Active euthanasia
Not supported by most health professional organizations in the U.S.
What is a Living Will (LW)?
what one wants, does not want, if near death; healthcare only
What is Palliative Care?
Philosophy of care for people with life-threatening disease
Goal is to improve quality of life for patient and family
O-
Organized religion (if any) and role that it plays in one's life
Managing weakness:
May be advised to stay in bed to avoid falls, injuries – Foley catheter may be used as a comfort measure – Put aspiration precautions in place for inability to swallow – Provide mouth care; apply emollient to lips— dry mucous membranes
Physician-assisted death (PAD)
Legalized in some European countries • Legally approved in some states in the U.S. • Nurses must be aware of legislation • Withdrawing or withholding life-sustaining therapy • Withdrawal of the intervention does not directly cause the patient’s death
What is a durable power of attorney for healthcare (DPOAHC)?
someone assigned to talk on your behalf when you can’t talk for yourself
What is Hospice and what is their life expectancy?
life expectancy of 6 months or less
Model for quality, compassionate care for people facing life-limiting illness or injury
Often provided to those with terminal cancer, dementia, end-stage COPD, cardiac disease, neurologic disease
Hospice can be at home with pain management, medical supplies
P-
Personal spirituality, rituals, and practices
Managing breathlessness/ Dyspnea:
Can occur for multiple reasons • Perform full assessment of dyspnea • Provide pharmacologic interventions early during dyspnea • Opioids (morphine sulfate) are standard treatment • Some patients may benefit from oxygen • Other medications used— bronchodilators, sometimes diuretics, and anticholinergics for secretions • Nonpharmacologic interventions: breathing exercises
What does (VSED) stand for?
Voluntary stopping of eating and drinking
Overview of Death, Dying, and End-of-life:
–Part of the normal life cycle –Nurses can have a great impact on an adult’s experience with death –Preventing death without dignity –Promoting a peaceful, meaningful death –Helping patient remain free from distress –Minimizing suffering for patient and families –Observe patients’ and families’ wishes –Observe clinical practice standards
What to Assess with hospice and/or palliative care?
weakness, sleepiness, anorexia, changes in cardiovascular, respiratory, and elimination; lethargy, leading to unresponsive state, and then coma.
Decrease in BP, and sometimes increased in HR from pain then decrease, rapid and shallow respirations with period of apnea,
E-
Effects of religion and spirituality on care and end-of-life decisions
Managing nausea and vomitting:
Biphosphate enema (if constipation is causing nausea and vomiting) and mineral oil and gentle disimpaction— for constipation • Antiemetic agents (like ondansetron or metoclopramide) • Remove source of odors • Aromatherapy
Postmortem Care
–If death was unexpected, medical examiner is notified –Check agency policy for who pronounces death, and completes death certificate –Allow family and caregivers to spend time with the patient if they desire –Determine if autopsy is needed or permitted –Follow agency procedure for preparing the body for transfer
Pathophysiology of Dying:
Cessation of integrated tissue and organ function
Lack of heartbeat, absence of spontaneous respirations, or irreversible brain dysfunction
Psychosoical Assessment of someone in hospice
Assess: if the patient’s family feels as if they are in discomfort, treat the discomfort
Spirituality and culture should be assessed
Assess patient and family for expectations of the death experience
Provide with information— like s/s pain
Offer bereavement counselor of clergy
Encourage “saying goodbye”
Free Space
Free Space
Managing Agitation and Delirium:
Assess for pain, urinary retention, constipation, other reversible cause • If other causes of agitation are ruled out, delirium is suspected • Hyperactive delirium— agitation, restlessness, and sometimes aggressiveness • Hypoactive delirium— slower speech and appear to be sedated • Antipsychotic agents for delirium • Music therapy and aromatherapy may help
Managing Refractory Symptoms of Distress
Nurse’s ethical responsibility is to follow guidelines for drug use • Palliative sedation may be needed to decrease suffering • Promotes comfort • Does not hasten death • Is different from euthanasia