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Flashcards in End of life Deck (22):

Describe the ethical and legal issues of advanced directives with a healthcare surrogate



Discuss the nursing management of the dying patient

-Promoting health
-Preventing illness
-Restoring health
-Facilitating coping with illness, disease, death


Providing fluids and nourishment during terminal illness is often controversial. Discuss the key
issues in this controversy



Discuss how pain is identified and managed in the unresponsive terminal patient



Discuss the rationale for use of medications such as morphine, haloperidol, glycopyrrolate, and
lorazepam in the treatment of the terminal patient



Identify all potential nursing diagnoses and the related interventions



Discuss nursing care of the patient after death.



Emotional feeling r/t perception of loss



Outward social expression of loss



Fears about death

-Greatest fear: pain
-Family and patient: life altering


Spiritual aspects of death

-Christian Views- eternal life thru faith in Jesus Christ
-Jewish Views- good works earn place in heaven
-Muslim Views- good works earn place in a heaven
-Oriental Mysticisms Views- re-incarnation
-Non-religious Views- death – cease to exist


Alabama state law for determining death

An individual who, in the opinion of a medical doctor licensed in Alabama, has sustained either
(1) irreversible cessation of circulatory and respiratory functions, or
(2) irreversible cessation of all functions of the entire brain, including the brain stem, is dead.
-A certified or authenticated copy of a death certificate purporting to be issued by an official or agency of the place where the death purportedly occurred is prima facie evidence of the fact, place, date and time of death and the identity of the decedent.
-A certified or authenticated copy of any record or report of a governmental agency, domestic or foreign, that a person is missing, detained, dead or alive is prima facie evidence of the status and of the dates, circumstances and places disclosed by the record or report.
-In the absence of prima facie evidence of death under paragraph 2 or 3, the fact of death may be established by clear and convincing evidence, including circumstantial evidence.
-A person whose death is not established under paragraphs 1 through 4, who is absent for a continuous period of five years, during which time that person has not been heard from, and whose absence is not satisfactorily explained after diligent search or inquiry is presumed to be dead. That person's death is presumed to have occurred at the end of the period unless there is sufficient evidence for determining that death occurred earlier.
-In the absence of evidence disputing the time of death stated on a document described in paragraph 2 or 3, a document described in paragraph 2 or 3 that states a time of death one hundred twenty hours or more after the time of death of another person, however the time of death of the other person is determined, establishes by clear and convincing evidence that the person survived the other person by one hundred twenty hours.


Alabama state law for the definition of death

An individual is considered dead if:
-In the opinion of a physician licensed or exempt from licensing or a registered nurse authorized to pronounce death based on acceptable medical standards.
-In the opinion of a mobile intensive care: paramedic, physician assistant, or emergency medical technician authorized to pronounce death
-The individual has sustained irreversible cessation of circulatory and respiratory functions, or irreversible cessation of all functions of the entire brain, including the brain stem. Death may be pronounced in this circumstance before artificial means of maintaining respiratory and cardiac function are terminated.


Durable power of attorney for health care

-Designates who makes decisions if individual cannot
-Living Wills
-Designates what decisions the individual desires


Medical aspect definition of death

No heart rate (not no pulse), no spontaneous respirations, or irreversible brain dysfunctions



-Do not resuscitate
-Allow natural death
*Doesn't mean don't care


Law for codes

-All patients are codes unless Health Care Provider orders differently
-No code pts may identify themselves outside hospital by arm band or card.
-Slow codes?? -no


ANA Code of Ethics

Dying process does not change the worth or dignity of a person


How treat symptoms and maintain comfort

Pain, dyspnea, agitation, N/V, fatigue, weakness, constipation, anorexia, delirium, meds ATC
Weakness and lethargy increases
LOC and ability to communicate decreases- moaning, restlessness
Patient can hear, hearing is the last thing to go


5 stages of grief



Feeding a dying pt

No glycerin or lemon swabs, just plain water. Offer food/fluids. If can’t swallow – NO – aspiration increases discomfort


Death rattle treatment

No suctioning, turn- wash cloth under mouth