The Concept of Death and Dying

Dying

Much more then biological approach the dying process is one of the most social experiences one can have-all human bodies exist within a social and cultural context (Warner in Dickinson, 1990) Dying is a personal & private even involves physical, psychological, behavioral, social & spiritual problems (Potter & Perry, 2004) Four main characteristic changes are loss of muscle tone, slowing of the circulation, changes in vital signs, and sensory impairment (Kozier et al, 1999)

Sign of Impending Clinical Death

Loss of Muscle tone - Relaxation of the facial muscles - Difficulty speaking - Difficulty swallowing & gradual loss of the gag reflex - Decreased activity of the GI tract, with subsequent nausea, accumulation of flatus, abdominal distention, and retention of feces (t.u narcotics/transquilizers administration) - Possible urinary and rectal incontinence due to decreased sphincter control

Slowing of circulation - Diminished sensation - Mottling and cyanosis of the extremities - Cold skin (feet-hands-ears-nose)
Changes in vital signs - Decelerated and weaker pulse - Decreased blood pressure - Rapid, shallow, irregular or abnormally slow respirations; Cheyne-Stokes respirations Sensory impairment - Blurred vision - Impaired sense of sense and smell

Physiologic Needs of Dying People

The needs related to slowing of body processes and to homeostatic imbalance

Interventions include : personal hygiene measures, pain control, relief of respiratory difficulties, assistance with movement, nutrition, hydration, and elimination; and measures with related to sensory changes

Physiologic needs of dying people

Problem Ineffective airway clearance Nursing Intervention Fowlers position : conscious Throat susctioning : conscious O2 therapy as needed Frequent bath & linen changes encourage wearing daytime cloth Change position periodically, elevate leg to prevent pooling of the blood High calorie-protein intake, vitamin semisolid, soft or liquid food Laxative treatment Urinary catheterization, skin care Reduce noisy, prefer light room, touch is diminished

Potential self-care deficit: bathing hygiene Impaired physical ability Altered nutrition: less than require Fluid volume deficit Constipation Altered pattern of urinary elimination Sensory/perceptual alteration : visual tactile

Spiritual Support

Important in dealing with dead not all clients identify with a specific religion faith or belief The spiritual needs of the dying as follows (Conrad, 1985) : - search for meaning - sense of forgiveness - need for love - need for hope

Goals of Care for Dying People

Gaining and maintaining comfort Maintaining independence in daily activities Maintaining hope Achieving spiritual comfort Gaining relief from loneliness and isolation

END OF LIFE

PALLIATIVE CARE

The Dying Persons Bill of Rights

I have right the right to be treated as a living human being until I die I have the right to maintain a sense of hopefulness, however, changing its focus may be I have the right to be care for by those who can maintain a sense of hopefulness, however, changing might be I have the right to express my feelings and emotions about my approaching death in my own way I have the right to participate in decisions concerning my care I have the right to expect continuing medical and nursing interventions eventhough cure goals must be changed to comfort goals I have the right not to die alone I have the right to free from pain I have the right to have my questions answered honestly I have the right not to be deceived I have the right to have help from & for my family in accepting my death I have the right to retain my individuality and not be judged for my decisions which may be contrary to beliefs of others I have the right to discuss and enlarge my religious and/or spiritual experiences, whatever these may mean to others I have the right to be cared for by caring, sensitive, knowledgeable people who will attempt to understand my needs and will be able to gain some satisfaction in helping me face my death

End of Life Care

Helping clients die with dignity Salter (1982) stated three stages of living fully until death : - Developing & growing assisted for doing interests & pleasurable moments - Lying fallow breathing and passive exercise, help to relax & enhance self-esteem - Letting go and becoming dependant meeting both physical and psychological needs

Hospice and home care - based on palliative care approach special care for those in chronic/terminal condition, with focus on quality of life maintenance and prepare for good death - goals of hospice care/palliative care are : control & relief of pain & symptom of illness provision of physical comfort for the terminally ill provision of social, emotional, and spiritual comfort for the client, family and friends throughout the final stage of illness, at the time of death, and during the bereavement periode of the survivors - Needs multidisciplinary team with professional and nonprofessional member

Death

Social death Gradual withdrawal & represents the symbolic death of the person in relation to the world they have known Psychological death - Refers to the death of aspects of the dying persons personality medication & illness brings biochemical reactions to the body personalitys change, isolation, relationships change - In essence, others know that person, dies (Rando, 1984) Biological death The death in which the organism as a human entity no longer exists Physiological death The complete cessation of all vital organs (Sudnow, 1967)

Common Term

Traditional clinical signs of death were cessation of the apical pulse, respirations, and blood pressure World Medical Assembly in 1968 adopted guidilines as indication pf death : - total lack of response of external stimuli - No muscular movement, especially breathing - No reflexes - Flat Encephalogram at least 24 hours

Care body after death

Post-mortem care care after somatic death occurs - remove all the medical appliances from the body as soon as the death time is noted rigor mortis (2-4 hours after death) - Eyes are closed and gentle pressure applied to eyelids for about 30 seconds - Wounds are covered with by simple dressing - Washing the body Rigor Mortis - begins 2-4 hours after death involuntary muscles of hearth, bladder, GI tract and arteries head & neck trunk & lower extremities full intensity is 48 hours, and complete of exhaustion chemical activity & the rigor passes is 96 hour

Algor mortis post mortem cooling - after circulation stop hypothalamus ceases functioning internal body temperature begins to fall at 1C per hour continues untill reach room temperature - Cooling of the brain tissues occurs at a slightly faster rate Post mortem decomposition - accompanied by skin discoloritation - red blood cells breakdown Hb is released and stain the vessel walls & tissues bruising and is most evident the dependent parts of the body due to gravitational movement of the blood Post-mortem digestion - tissue soften and then are liquefied due to fermenatition from saprophytic bacteria occurs rapidly in hot weather and can create a bacterial hazard for those handling the body