Death and Dying Flashcards
Any disease that cannot be cured and will result in death
Everyone reacts differently to news of a terminal illness
Some react with fear and anxiety
Many fear pain, abandonment, loneliness, and the unknown
They may become anxious about their loved ones, unfinished work, or dreams
Terminal Illness
Helplessness, dependence on others, physical faculties, mutilation by surgery or disease, uncontrollable pain, and being unprepared for death
Emotional and physical reasons people may fear death
Fear of separation from family or home and fear of leaving behind unfinished tasks or responsibilities
Social reasons people may fear death
Identified five stages of grieving that dying patients and their families and friends may experience, they may not be in order and may overlap or repeat a stage at times, others may not experience all stages, and stages include denial, anger, bargaining, depression, and acceptance.
Dr. Elizabeth Kubler-Russ
Usually occurs when the person is first told of the illness, individuals may say, “The tests are wrong”, “this can’t be happening to me”, and “I don’t believe it”, others don’t talk about it, health care workers should listen without confirming or denying it
Denial
This stage occurs when the patient can no longer deny death, the patient may blame themselves, their loved ones, or health care workers for their illness, health care workers must understand this is not a personal attack
Anger
Usually occurs when patient accepts death but wants more time to live, patients turn to religion and spiritual beliefs during this period, they want to see their child graduate, get married, or hold a grandchild, making promised to God to try and obtain more time sometimes occurs
Bargaining
This stage occurs when the patient realizes that death will come soon and they won’t be with their families any longer, they realize that some goals they set will not be met, health care workers need to let the patient know that depression is ok
Depression
This is normally the final stage, the patient understands that they are going to die, may complete unfinished business and try to help those around them deal with death, patients will slowly get farther away from the world and other people, they need emotional support during this stage
Acceptance
talk as needed, avoid superficial answers like “It’s God’s Will” or “It will be OK”, provide religious support as appropriate, stay with the patient as needed, work with the family so they might be strong enough to offer support to the dying person
Interventions to health care professionals
Unable to oxygenate the body enough for adequate gas diffusion. respirations become stridorous or noisy, leading to “death rattle”, Cheyne-Stokes respiration sign of pulmonary system failure (consists of alternate hyperneic and apneic phases
Respiratory System
Heart unable to pump strongly enough to keep blood moving, decreased blood causes decreased circulation to the body, skin becomes cool to the touch (pale), person appears cyanotic, possibly mottled, failure of peripheral circulation frequently results in a drenching sweat cooling the body surface, pulse becomes weak and thready, ultimately irregular, a stronger pulse typically means death is hours away, a weak irregular pulse typically means that death is imminent in the next couple of hours, an apical pulse might be required
Cardiovascular System
Metabolism rates decrease, the person might retain feces or become incontinent, urinary output decreases, dying person may turn toward light as sight diminishes, dying person may hear only what is distinctly spoken, and dying person may remain consciousness or become unconsciousness/comatose, some dying people rally in clarity and consciousness just prior to their death, a person’s eyes might be open if unconscious, dying people might turn toward or speak to someone who is not visible to anyone else in their room, pain might be present, pain medication should not be withheld as person nears death
Other changes
Most people with terminal illness believe that someone with a terminal illness should be allowed to refuse measures that would prolong their life, this is the right to die, respirators, pacemakers, and other medical devices can be withheld and the person can die with dignity, DNR - Do Not Resuscitate Order
Right to Die
This philosophy is to allow the patient to die with dignity and comfort, pain is controlled so that the patient can remain active as long as possible, specially trained volunteers are an important part of many hospice programs
Hospice Care
