practical nursing

1. CARE FOR THE DYING
ASSESSING THE NEEDS OF LIFE CARE

2. OBJECTIVES:
 To make initial assessment to identify actual and potential needs.
 To make assessment based on physical and mental changes
 To assess patient/client’s condition in order to determine individualized
responses to impending death.
 To make assessment as baseline data for providing care and referral

3. The health care industry in which you must operate is client centered.
This means that the client/patient is central in everything that you
do regardless of the care setting

4. Care setting may include:
 Residential ( client’s home)
 Hospital
 Long term facilities
 hospices

5. At the time of admission, you as the health
care Assistant are expected to conduct an
initial assessment of the client’s/patient
health status before any care can be
planned. This is one of four types of
assessment, which are:
Initial
Problem focused
Emergence
Time Elapsed Reassessment

6. You should ensure that the area in which this assessment is
carried out is private, quite and relaxing. Unless the client
is unable to communicate clearly or wants to have family
members present, you should assess him/her alone. There.
exceptions to this, such as when your client client/patient
is a child or an older adult, a parent/guardian has to be
present.

7. The initial assessment of a client is used to
create a nursing history. This includes:
 Biographic data ( name, age, marital status)
 Chief complaint/Reason for visit
 History of present illness
 Past history (Childhood disease)
 Family history of illness
 Lifestyle (dietary needs, personal habits)
 Social data (religious preferences, beliefs, support system, economic status)
 Psychological data (stressors, coping pattern, communi8cation style)
 Patterns of health care(usual source of medical care)
 Expressed wishes for post mortem care

8. SOURCE OF DATA
 You can gather this information from a number of sources such as:
 Client
 Relatives
 Records
 Health care professionals
 Health care literature

9. MAKE ASSESSMENT BASED ON PHYSICAL
AND MENTAL CHANGES.
 Obtain information about the patient’s function abilities
 Obtain data that will help you determine the response required and plan the care
 Make clinical judgements on the health status and the need to refer
The physical and mental conditions of a dying person vary according to the client’s
general health condition, medication being used to treat the symptoms and other
significant factors, You may observe all the changes, some or no changes in the
patient/client. You may find that some persons respond to impending death based on
their life experiences, some may be very angry and others may remain calm and
peaceful.
The first thing that you must do is record your general impressions f the client’s
overall appearance and health status such as:

10. Assessment based on physical and
mental chances:
The first thing that you must do is record your general impressions f the client’s
overall appearance and health status such as:
 Body size
 Mental state
 Nutritional status
 Level of activity
 Speech
 Appetite
 Breathing rate

11. Physical changes that you noticed ay
include the following:
 Activity decreases i.e. less movement, less interest in the environment
 Interest in food and water diminishes
 Body temperature lowers by a degree or more
 Blood pressure begins to fall gradually
 Circulation to the extremities diminished so that the hands and feet begin to feel cool compared to the rest of the body
 Skin colour becomes dull or a greyish blue
 The fingernail beds become bluish rather than the normal pink
 Communication decreases, i.e. the person ceases to respond to questioning and no longer speaks spontaneously
 Coma ensues and may lasts from minutes to hours before death occurs. Persons in a coma may still hear what is said even
though they no longer seem to respond to verbal or even painful stimuli
 Pulse may change in regularity from rapid to slow
 Blood pressure may fall
 Fluid may accumulate in the lungs causing the “roll and rattle”
 Breathing changes from a normal rate to an abnormal rate

12. MENTAL CHANGES THAT YOU MAY NOTICE
INCLUDE THE FOLLOWING:
 Denial, guilt, despair, feelings of worthlessness, crying and inability to
concentrate
 Thoughts of suicide
 Delusions and hallucination
 Increased respirations, dry mouth, anorexia, difficulty sleeping and
nightmares
 Helplessness – may say, “I will never get over this”
 Apathy, permission and inability to make decisions
 Loss of control – may be manifested by anger, violence, acting out or
depression and passive behaviour
You should note any unusual behaviour demonstrated.

13. SUPPORT DYING PERSON/RELATIVES
 Obtain information about patient/relatives regarding beliefs, values and preferences
 Secure necessary resource and provide emotional and spiritual support to maintain
client’s/relatives beliefs
 Demonstrate respect for patient‘s/relatives
 Use knowledge regarding death and dying to support client/relatives
 Allow relatives to spend time with dying client
 Respect clients rights to privacy
 Communicate client’s/relatives’ request for visit of clergy/spiritual leader to nurse in charge
 Facilitate the visit of the clergy/spiritual leader/resource personnel
 Keep client’s room well lit, ventilated and pleasant
 Arrange pictures, flowers, religious objects and other significant items within view and reach
of client.

14. Information that you need to provide the
required support to the patient/relative is:
 Religious/cultural affiliation
 Who makes the decisions regarding the persons care
 How treatment is to be administered
 What treatment will be refused
 How patient expresses emotion, feelings, spirituality and religious beliefs
 How dying, death and grieving are expressed in a culturally appropriate
manner

15. Gathering information about your patient’s
values, beliefs and preferences will enable
you to:
 Provide service/care with request for the dying person’s dignity and
uniqueness
 Give direction and meaning to life and guide the person’s behaviour
 Recognize that the values, beliefs and preferences of the patient and his/her
relatives must precedence when they conflict with those of health care
providers
Values are often taken for granted, but it is important for you to know that they
influence the patient/relatives’ decisions and actions. For e.g
 value placed on dying
 Your patient’s place in the family
 Value placed on being informed
 Value placed on the type of care

16. People need personal values to have a sense of individuality, and beliefs to
have a sense of family. I some religions/cultures, persons value treatment
by a folk healer over that by a physician. If you know this then you can
plan, care and ensure that your patient knows that you understand
him/her.
Beliefs and attitudes about death vary. You should determine the
client’s/relatives’ attitudes towards death, illness and health care
providers, then care based on what they expect.
You should be aware of your own beliefs/values and preferences and be
clear on your ability to interact supportively with the patient/relatives.
You should not impose

17. POST MORTEM CARE

18. Provide post mortem care
Provide post mortem care
 Preparation of body is done after doctor’s written declaration of death.
 The deceased person is carefully cleaned and groomed consistent with
policy related to infectious diseases.
 Caregiver is appropriately attired according to established procedures for
minimizing risks of infections.
 Cleaning and preparation of deceased person is carried out in a manner
that shows sensitivity to the feelings of the deceased person, relatives and
friends.

19. POST MORTEM CARE
 The immediate environment is prepared in a manner that respects the
cultural and religious beliefs of the deceased and relatives.
 Valuables that are to remain with the deceased person are reported and
recorded accurately, legibly and completely.
 Where visible identification is used, it is complete and accurate.

20. POST MORTEM CARE
 Disposal of body is done in a timely manner.
 Environment is appropriately cleaned after removal of body.
 Universal precautions are applied.

21. Care for relatives of the deceased
 Impacting situations relating to the deceased person are explained
sensitively in a manner and at a level, appropriate to those concerned.
 Viewing of body is confirmed with relatives and friends.
 Action is taken to prepare and dispose of body according to relatives
expressed wishes.
 Family is supported through the grief process.

22. CARE FOR THE DECEASED CONT’D
Individuals include:
 older adults and relatives regardless of
 religious/cultural beliefs
 children
 adults
Care includes:
 monitoring dying process
 Cleaning
 rooming
 tagging of body

23. CARE CONT’D
Settings may include:
 those dying at home
 hospital
 long-term facilities
 hospices
Health and safety measures relating to:
 Infectious and contagious diseases
 drainage tubes etc

24. Work activities include:
 verify that the person has been certified dead by a physician
Impacting situations include:
 cases under jurisdiction of the coroner
 financial obligations


25. Personal Protective Equipment may include:
 gloves
 protective clothing
 face mask
Other equipment may include:
 tags
 body bag

26. Legislation, policies and regulatory bodies may include:
 Ministry of Health
 National regulations regarding death and dying
 Guidelines governing scope of practice
 Policies and protocols outlined by facility
 Universal precautions guidelines

27. Care of relatives may include:
 Provision for emotional and spiritual needs
 Support of beliefs etc.
 Adherence of wishes regarding the disposal of body

28. THANK YOU
Done by: Ms FOSTER