Care of terminally ill
4 likes2,036 views
The document discusses signs and symptoms of impending death, including changes to facial appearance, sight, speech, hearing, respiratory, circulatory, gastrointestinal, genitourinary, skin, and central nervous systems. It also discusses care of a dying patient, including psychological support through communication, symptom management, spiritual and social care, and supporting family members by allowing time together and addressing needs.
Care of terminally ill
- 1. SIGNS & SYMPTOMS OF IMPENDING DEATH Ms.Lincy Thomas Tutor St.James’ College of Nursing, Chalakudy
- 2. SIGNS & SYMPTOMS OF APPROACHING DEATH 1.CHANGES IN FACIAL APPEARANCE Facial muscles relax; cheeks become flabby, moving in and out with each breath. Facial structures may change, so the dentures cannot be worn; with the dentures removed ,mouth structure may collapse. lips become sink in; sides of the nose drawn in with each inspiration. Loss of muscle tone and anemia cause “facies hippocratica”, characterised by prominent cheeks and chin, sharp nose, pale ashy skin, sunken glazed eye. 2.CHANGES IN THE SIGHT ,SPEECH & HEARING Sight gradually fails(Blurred vision). The pupils fails to react to light. Eyes are sunken and half closed with a film like appearance over the eyes Speech becomes increasingly difficult, confused, unintelligent and finally impossible Hearing is thought to be retained longer
- 5. 3.RESPIRATORY SYSTEM CHANGES Respiration becomes irregular, rapid and shallow or very slow ; cheyne –stroke respirations; Stertorus or noisy respirations due to the presence of secretions. Mouth breathing leads to dry oral mucous membrane Feeling of “Lack of air” and breathlessness may increase as death approaches “DEATH RATTLE”-A rattling sound heard in throat caused by secretions that the patient cannot cough longer.
- 6. 4.CIRCULATORY SYSTEM CHANGES Circulatory changes cause alterations in the temperature, pulse and respirations. Cardiac output decreases with a corresponding decrease in peripheral & renal perfusion. Pulse rate increases initially and then weakens and becomes irregular. Radial pulse gradually fails/nonpalpable; Once it stops, the apical pulse may continue for some time. Usually the pulsations are seen even after the patient has stopped breathing BP decreases
- 8. 5. CHANGES IN GASTRO INTESTINAL SYSTEM Hiccoughs, Nausea, Vomiting, impaired sense of taste & smell, abdominal distension with flatus The gag reflux disappears; the patient feels an inability to swallow, loss of appetite constipation/retention of feces due to decreased food intake & reduced activity of the gut.
- 10. 6.GENITO URINARY SYSTEM CHANGES Retention of urine, distention of the bladder, incontinence of urine and stool due to loss of sphincter control, fecal impaction
- 11. 7.CHANGES IN SKIN AND MUSCULO SKELETAL SYSTEM The skin may become pale, cool and sweats lot (cold sweats).Ears and nose are cold to touch. Skin is pale & mottled due to congestion of blood in the veins as a result of circulatory failure, Increased perspiration. swelling in the feet and ankles, coolness in the tip of fingers & toes decreased ability to move, beginning in the legs and progressing to arms; body becomes still and joints painful when moved
- 12. 8.CHANGES IN CENTRAL NERVOUS SYSTEM Reflexes and pain are gradually lost. Patient may be restless due to lack of oxygen and due to raised body temperature, although the body surface is cool Mental confusion or disorientation Increased hallucination
- 13. CARE OF A DYING PATIENT (CARE OF A TERMINALLY ILL PATIENT)
- 14. Introduction Nurses has an important & major responsibility to provide care for a dying patient & their family members. Even though death is an inevitable part of everyone’s life, the individual needs care at the time of dying. So we should have to make the long term goals like “ client will die with dignity “. For achieving this goal, the nurses should help in alleviating the patient pain ,fear, anxiety and maintain the basic physiological functions at the end of his life. Care of dying patient include; 1.Psychological support 2.Symptomatic management 3.Pharmacological management 4.Spiritual care 5.Social care & supporting to the family members
- 15. 1.Psychological support The psychological needs of a dying person can be as follows: - Relief from loneliness, fear and depression. - Maintenance of security, self confidence and dignity. - Maintenance of hope. - Maintenance of a comfortable and peaceful environment The dying person who passes through the different stages of grief, so the nurse should be supportive and understandable in these stages Nurse should be truthful but sensible in all their dealings with the patient The nurse should understand the physical & emotional pain that a dying person suffers.
- 16. Nurse should use therapeutic communication with patient and relatives During this period, they may ask many doubts regarding his condition, we should clarify these by using their own words/language. One of the simplest way of providing support by physical contact such as holding hands, a touch on their arms or wrist or a gentle massage or a hug, can make a person feel comfortable. it can be very soothing and may psychologically heal them.
- 17. Being present with the patient and listen the client actively. Show genuine attitude of interest in dealing with his problems. Some health care providers suggest that a low volume music or soft lighting are comforting for a dying patient. It is proven that music therapy is able to improve a patient’s mood by increasing relaxation & reducing their pain. Dying client might believe that, health care members will make their remaining life will be meaningful by using any treatments or comfortable measures and make/allow them to approach a dignified death.
- 18. Problem associated with breathing: The dying person who is restless, apprehensive and short of breath may be given- Oxygen inhalation to remove his discomfort. Elevation of the patient’s head and shoulders may make breathing easier. Keep the room well ventilated and keep the crowds away. Periodic suctioning is necessary in order to maintain patency of airway Change the position frequently at least 2 hourly
- 19. Problem associated with eating and drinking: Anorexia, nausea, and vomiting are commonly seen in dying patient person. They are unable to take any form of food and if they taken, they are unable to retain the food in the mouth The patient is unable to swallow even the sips of water poured in the mouth. Most of them may require I.V fluids. If they can tolerate the oral fluids, sips of water is given with teaspoon. That will help the patient to keep the mouth moist. Give frequent oral hygiene. Apply emollients to the dry lips. The denture are removed and kept safely.
- 22. Problem associated with rest and sleep: Patients may have distressing symptoms, so the patient should not be disturbed while sleeping. The visitors should be instructed not to disturbed the patient during he is resting. Maintain calm and quiet environment. Problem associated with cleanliness and grooming: Cleanliness and appearance are important until the end. Cleanliness of the skin, hair, mouth, and cloth has to be maintained.
- 24. SPIRITUAL CARE Religion is a prime source of strength to many people when they are dealing with death. So meet the spiritual needs of the client according to their religious customs. Some patients may not wish to access such support & these wishes should be respected It is a good practice to check with the patient what they would like or to family members if the patient is not able. Since an unconscious patient is still able to hear, nurses may suggest that family members invite religious person/s to come & perform certain prayers as it will help the patient to meet their spiritual needs.
- 25. SOCIAL CARE & SUPPORTING TO THE FAMILY MEMBERS Dying persons want to maintain relationships with the special people in their lives. They may be concerned about their roles within the family, in the work place &in community. The family members also passes through the same stages of emotion as the patient is nearing death. So the nurses attitude towards the relatives should be sympathetic, considerate and meaningful. Allow the relatives to see the patient & give enough time to be with the dying person Nurses can encourage the family members to share their memories of good times with the patient.
- 26. Nurses see that the family members have a place to take rest & to have their meals. Whenever possible, communicate the news of a patient’s declining condition or impending death when they are together. So they can provide support to one another The dying person may be shifted to private room or privacy is maintained by putting the screen, so that other patients may not be disturbed by the unpleasant sight, the cries and other disturbances. Assist the client & family members in decision making at the end of the client’s life, because they may not have enough knowledge or prior experience.