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NURSING INTERVENTIONS BEFORE DEATH AND TIME OF DEATHS. Tagapan- Dec14, 11Nursing mgt- the nursing process is a helpful tool when caring for patients who are grieving or dying andtheir families and siginificant othersASSESSMENTA. State of awareness: 1. Closed awareness- no open communication, patient is not oriented that s/he is dying 2. Mutual present-the patient knows about his upcoming death but they do not discuss about it 3. Open awareness- open communication is visibleB. Clinical manifestations of impending death: 1. Loss of muscle tone- difficulty in talking, poor gag reflex, incontinence 2. Slowing of circulation- bruises, hypotensive 3. Changes in respiration- tachypnea, chyne-stokes 4. Sensory impairmentC. Assessing - Have you been close to someone who was dying before? - What have you been told about what may happpen when death occurs? - Do you have questions about what may happen at the time of death? - How do you think would you like to say goodbye? - How are you taking care of yourself during these times? - Whom can you turn to for help this time? - Is there anyone you would like us to contact when the death occurs?D. Diagnosing - Grieving - Fear - Hopelesseness - Powerlessness - For SO: risk for caregiver roles strain o Interrupted family process o Impaired adjustment o Decisional conflict o Ineffective coping and denial o Grieving: anticipatory & dysfunctionalE. Planning - Maintaining physiologic and psychologic comfort - Achieving a dignified and peaceful deathF. Interventions
- Facilitating grief work - Providing emotional support - Helping clients die with dignity - Hospice and palliative care - Meeting physiologic needs- skin care, provide adequate air, change bed linens, spongebath, nutritional support - Providing spiritual support - Supporting the family - Post-mortem care- remove tubes (head to toe), close eyes, mouth, complete bed bath is not necessary o Rigor mortis: stiffening, 2-4hrs after death o Algor mortis: decrease of temp until it reaches room temperatuure, mottling discoloration or pooling of blood in extremities, o Livor mortis:G. Evaluation - Listening to clients reports of feeling in control of death, pain relief and other tx. Plans - Observing the client’s relationwhip with SO - Listening to client’s thoughts and feelings related to hoplessness and powerlessness