Care of Dying Patient

 

Objective Care of Dying Patient

General objective:

1. The student will be able to know about care of dying patient.

Specific objective:

At the end of session student will be able1. To define dying patient.

1. To know the sign of approaching death.
2. To know the causes of death.
3. To sign of clinical death.
4. To know the dying person’s bill of right.
5. To know the symptomatic treatment.
6. To explain the nursing care of dying patient.
7. To know the spiritual need.
8. To explain the procedure of care of dying patient.

Care of dying patient

Definition of dying patient:

A medical/nursing intervention define as promotion of physical comfort and psychological space in the final space of life.

Signs of approaching death

Circulatory system:

Circulation slow gradually. So there is an alteration in temperature, pulse and respiration.

Skin:

Skin becomes cold and clammy

Central nervous system:

Reflexes gradually disappear . Sign of anxiety may be shown by restlessness .

Gastro-intestinal system:

Vomiting and abdominal distention are seen . The patient is unstable to swallow.

Respiratory system:

Respiration becomes irregular , pulse becomes week and fast.

Sight , Speech and Hearing:

Eye have sunken appearance . Speech becomes mumbled and confused . Hearing becomes delled.

Genito-urinary system:

Retention of urine . Incontinence of urine and stool ton loss of control are seen.

Causes of death

The most common causes of death are :

1. Organ failure
2. Cardic arrest
3. Infection
4. Haemorrhage

Sign of clinical death

1. Sensation and power of motion as well as reflexes are loss first in legs and then gradually arms.
2. Absence of pulse , heart rate and respiration.
3. Pupils becomes dilated and fixed.
4. Pulse stop.
5. Respiration stop.
6. Heart stop working.
7. Absence of brain wave.

The Dying Person’s Bill of Rights

1. He has right of treated as a living human beings until he dies .
2. He has right to maintain a sense of hopefulness.
3. He has right to express his feelings and emotions about his death.
4. He has right to take decisions concerning his care.
5. He has right to medical and nursing care till his death.
6. He has right not do die when he along.
7. He has right to be free from pain.
8. He has right to get his questions answer.
9. He has right to get religious assistance .
10. He has right to respect from his body after death.

Symptomatic Treatment

Problem associated with breathing:

Oxygen inhalation for restlessness and irregular breathing patient to reduce discomfort.

Problem associated with elimination:

Report to doctor for retention of urine and incontinence of urine and stool. Proper skin and perineal care is given. Patient should keep dry.

Problem associated with rest and sleep:

Medication should be given as ordered by doctor to relieve pain and restlessness.

Problem associated with eating and drinking:

The patient is unable to take any from of food , small amount of water may be given if he can sallow.

Patient associated with immobility:

Patient position should change every 2 hourly.

Nursing Care of Dying Patient

1. The nursing care of the dying patient is symptomatic and it’s aims is making the patient as comfort as possible.
2. Nurse should be sympathetic .
3. Deal with mental anguish and fear of death.
4. Try to response appropriately to patient’s need by listening the complain
5. Privacy must be maintain by using screen.
6. To give care for possible reduce care.
7. The dying patient may be shifted to a special room and room should be quiet.

Evaluating the control of symptoms periodically.

The Spiritual needs

A nurse should give the opportunity to the patient to die gracefully. The presence of religious priests and pray for the patient.

Procedure of care of dying patient

After doctor pronounce the patient dead responsibilities of nurse of care of death body:

1. Screen the patient.
2. Explain and console the relatives.
3. Take out I/V drip, oxygen tube and other tube from the body.
4. Close the eye and mouth.
5. Straighten the hands and legs and keeps the body flat with pillow.
6. Close the orifices with cotton.
7. Clear the wound, if any and cover with dressing.
8. Changes patient’s clothes if dirty.
9. Cover the patient’s with a bed shit.
10. A level should be put on the body with name and address.
11. Get the patient’s relatives to sign in the chart before hand over the body to them.
12. If is a police case, inform the police.
13. The death certificate must be filled in and signed by the doctor.

Reference

1. Text book:” Fundamental of nursing: Concepts , Process and practice/ Barbara

Kozier— [ et al ]- updated 5^th ed- USA : Addison, 1998

1. Text book : fundamental of Nursing / Patricia A potter , Anne Griffin perry – 6^th ed.- New Delhi : Mosby , 2005.