End of life care is provided to those in the final weeks before death and includes hospice and palliative care. Signs that death may be near include increased sleep, loss of appetite, withdrawal, and skin becoming cool to the touch. Legal documents like advance directives and medical power of attorney are used in end of life care planning. Religious and cultural beliefs around death involve spiritual support and specific interventions to facilitate expressions of feeling and prayer. Nursing management focuses on addressing compromised family coping, activity intolerance, and anticipatory grieving. The two main approaches to end of life care are palliative care, which aims to improve quality of life, and hospice care, which focuses on keeping pain and suffering to a minimum

2. Definition:
End of life care provided in the final weeks
before death that include both hospice and
palliative care.
OR
End of life care is the concluding phase of
normal life span although life can end at
any age.

3. Signs that death may be near:
• Drowsiness, increased sleep, and/or unresponsiveness
• Decreased socialization and withdrawal
• Decreased need for food and fluids
• loss of appetite
• Loss of bladder or bowel control
• Darkened urine or decreased amount of urine

4. • Increased difficulty controlling pain
• Involuntary movements
• Skin becoming cool to the touch
• Confusion about time, place, and/or identity of loved ones;
restlessness

5. Legal Documents Used in End of Life Care:
• Advance directives
• Durable power of attorney
• Medical power of attorney
• Euthanasia
• Organ donation

6. Religious & Cultural Beliefs on Death and Dying:
Death Related Religious and Cultural Practices
• Spiritual support is of great importance in dealing with death.
• Specific interventions may include facilitating expressions of feeling, prayer,
meditation, reading.
• Spirituality involves the “search for meaning and purpose of in life and
relatedness to transcendent dimensions”.
• The spiritual assessment is a key component of comprehensive nursing
assessment for terminally ill patients and their families.

7. Nursing Management:
1. Compromised family coping may be related to inadequate or
incorrect information.

8. 2. Activity intolerance may be related to generalized weakness, bedrest
or immobility.
3. Anticipatory grieving may be related to anticipated loss of
physiological well-being.

9. Approaches for End of Life Care:
It mainly includes two approaches, that are:
• Palliative care
• Hospice care

10. Definition of Palliative care:
It is an emerging and well-defined specialty that combines an
interdisciplinary approach to promote competent care. It should be
available and integrated into the beginning of the disease process until
death.

11. Goals of Palliative Care
• To improve the patient’s and family’s quality of life.

12. HOSPICE CARE:
The term hospice comes from the Latin word hopes which means “a
place to rest”. Hospice care isn't necessarily continuous, and a patient
may switch into and out of it as a medical condition improves or
deteriorates.

13. Goal of Hospice Care
• The goal of hospice is to keep pain and suffering to a minimum, not to
cure the underlying illness.

14. Physiologic Needs of the Dying Client:
• A routine for sleep and rest
• Nutritional considerations
• Changes in elimination
• Skin care
• Respiratory changes
• Cardiovascular changes
• Musculoskeletal System

15. Post Mortem Care:
Postmortem examination is an examination of the body after death.
It is performed in certain cases such as:
• o Committed suicide
• o Unknown cause of death
• o Unknown dead bodies
• o Homicide

16. • The organs and tissues of the body are examined to establish the exact
cause of death, to learn more about a disease
• A consent should be obtaining from the immediate relative: surviving
spouse, adult children, parents, siblings.
• After an autopsy, hospitals cannot retain any tissues/ organs without
the permission of the person who signed the consent form.