23 death and dying define the following term: terminal illness a disease or condition that will...
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Define the following term:
Terminal illnessa disease or condition that will eventually cause death.
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1. Discuss the stages of grief
REMEMBER:Not every resident goes through all of the stages of grief, nor do they necessarily go through them in this order.
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Transparency 23-1: Stages of Grief
• Denial: refusal to believe they are dying • Anger: “Why me?” • Bargaining: “Yes me, but…” • Depression: need to mourn and review their lives • Acceptance: preparing for death
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2. Describe the grief process
These are seven common reactions to the death of a loved one. • Shock: especially at our own feelings • Denial: usually lasts a short time • Anger: at God, the doctors, even at the person who died
• Guilt: that we are still alive • Regret: for what we did or did not do • Sadness: depression, headaches, or insomnia • Loneliness: missing the person and painful memories
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23Death and Dying3. Discuss how feelings and attitudes about death differ
The following factors may influence feelings and attitudes about death: • Experience with death • Personality type • Religious beliefs • Cultural background
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23Death and Dying3. Discuss how feelings and attitudes about death differ
Think about this question:How have your background and experiences affected your attitudes about death?
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4. Discuss how to care for a dying resident
Remember these guidelines when caring for a dying resident: • Be aware of diminished senses and help keep resident comfortable
• Provide attentive care of mouth and nose • Provide good skin care • Physical comfort is very important - observe carefully for signs of pain
• Help make the environment soothing and pleasant• Remember that emotional and spiritual support are essential at this time
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4. Discuss how to care for a dying resident
Think about these questions: • How can you treat residents with dignity when they are approaching death?
• Which of the residents’ rights may apply when a resident is close to death?
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4. Discuss how to care for a dying resident
REMEMBER:Advance directives must be honored and the residents’ decisions regarding advance directives must be respected.
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23Death and Dying5. Describe ways to treat dying residents and their families with dignity and honor their rights
REMEMBER:You can treat residents with dignity as they are approaching death by respecting their rights and their preferences (see Handout 23-1, “The Dying Person’s Bill of Rights”).
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Transparency 23-2: Rights to Remember When Caring for the Terminally Ill
1. The right to refuse treatment.2. The right to have visitors.3. The right to privacy.
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Transparency 23-3: Ways to Treat Dying People and their Families with Dignity
• Respect their wishes in all ways possible. • Do not isolate or avoid a resident who is dying.• Do not make promises that cannot or should not be kept.
• Continue to involve the dying person in facility activities.
• Listen if they want to talk. • Do not babble, or be especially cheerful or sad. • Keep the resident comfortable. • Assure privacy when they want it. • Respect the privacy of the family and other visitors.
• Help with the family’s physical comfort.
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Define the following term:
Palliative care care that focuses on the comfort and dignity of the person rather than on curing him or her.
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6. Define the goals of a hospice program
Hospice care and palliative care have the following goals: • Comfort of resident • Dignity of resident
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6. Define the goals of a hospice program
Think about this question:Hospice works to meet the resident’s physical, emotional, social, and spiritual needs. Why is the focus not on wellness or recovery?
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6. Define the goals of a hospice program
The following skills and attitudes are useful in a hospice setting: • Be a good listener. • Respect privacy and independence. • Be sensitive to individual needs. • Be aware of your own feelings. • Recognize the stress. • Take good care of yourself. • Take a break when you need to.
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6. Define the goals of a hospice program
Think about these questions:• Are the skills and attitudes listed on the previous slide any different than those required when caring for other residents?
• How can NAs deal with their own feelings when doing hospice work? Would a hospice NA support group be a good idea?
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Define the following term:
Cheyne-Stokes respirationsslow, irregular respirations or rapid, shallow respirations.
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7. Explain common signs of approaching death
REMEMBER:Death can be sudden or gradual, but physical signs often occur that can indicate approaching death.
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Transparency 23-4: Signs of Approaching Death
• Blurred vision that gradually fails • Unfocused eyes • Impaired speech • Diminished sense of touch • Loss of movement, muscle tone, and feeling • Rising body temperature or below normal temperature
• Decreasing blood pressure • Weak pulse that is abnormally slow or rapid • Slow, irregular respirations or rapid, shallow respirations
• “Rattling” or “gurgling” sound when breathing • Cold, pale skin • Mottling, spotting, or blotching of skin caused by poor circulation
• Perspiration • Incontinence • Disorientation or confusion
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Define the following term:
Rigor mortisthe Latin term for the temporary condition after death in which the muscles in the body become stiff and rigid.
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23Death and Dying8. List changes that may occur in the human body after death
The following changes occur in the body after death: • No heartbeat, pulse, respiration, or blood pressure • Rigor mortis• Eyelids partially open; eyes in fixed stare• Mouth may remain open • Incontinence
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23Death and Dying8. List changes that may occur in the human body after death
REMEMBER: Although these changes are a normal part of death, it is also normal to find them frightening. Tell the nurse immediately to help confirm the death.
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Define the following term:
Postmortem care care of the body after death.
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9. Describe postmortem care
Remember these postmortem care guidelines: • Rigor mortis may make body difficult to move. Talk to the nurse if you need assistance.
• Bathe the body gently.• Place drainage pads. • Do not remove tubes or other equipment. • Put in dentures if instructed by the nurse.
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9. Describe postmortem care
Postmortem care guidelines (cont’d.): • Close eyes. • Position body. Put a small pillow under head. • Follow facility policy on personal items. • Strip the bed after body is gone. • Open windows to air the room. Straighten room. • Respect wishes of family and friends. • Document procedure.
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9. Describe postmortem care
REMEMBER:Facilities may have special policies on postmortem care. Know and follow your facility’s policy.
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9. Describe postmortem care
Think about these questions:• How do you think you will feel about providing postmortem care? Do you think you find it difficult to touch a dead body?
• How can they show emotional support to the resident who is dying? To family members after the death?
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9. Describe postmortem care
REMEMBER:In home care it is important to ask the family members of a client who has died what you can to do help. You may answer the phone, make coffee or a meal, supervise children or keep family members company.