End-of-life care refers to health care for a person with a terminal condition that has become advanced, progressive, and incurable.

1. Presented by
Mr.Kalyan kumar Msc(N)

2.  Loss is any situation either actual potential or perceived in
which a valued object is changed or is no longer accessible
to individual. Because change is major constant in life,
everyone experiences.

3. Actual
loss
Perceived
loss
Maturational
loss
Situational
loss

4.  Actual loss: An actual loss is any loss of a person or
object that can no longer be heard,known or
experienced by the individual.
Example-
 Loss of body part
 Loss of child
 Loss of relationship or role at work

5. Perceived loss: It is any loss that is uniquely defined by
the grieving. It may be loss obvious to others.
Example :
Loss of confidence or prestige, perceived loss are easily
overlooked or misunderstood
Maturational loss: It includes any change in
development process that is normally expected during
the life time
Example: Would be mothers feeling of loss as a child
goes to school for the first time. Events associated with
maturational loss are part of normal life transitional,
but the feelings of lost persist as grieving helps a person
cope with the change

6. Situational loss: It includes any sudden unpredictable
external event, Often this type of loss includes
multiple types of losses rather than a single loss.
Example- When a person is fired from job, the tangible
loss is income, whereas loss of self esteem is
intangible.

7. Loss related
to life
experiences
Loss related
to illness
Loss related
to death

8.  Death of loved one or friend
 Separation divorce
 Breakup of friendship
 Change of school , job
 Flood or other natural Disaster

9.  Loss of good health
 Loss of bodily function
 A body part or part of system body

10.  A valued person
 Significant support
 A defined role
 Opportunity to resolve conflict
 Hope for the future with that individual

11. Denial
Anger
Bargaining
Depression
Acceptance

12.  The psychological defense mechanism by which a person refuses
to believe certain information, helps people to cope initially with
reality of death. Terminally ill clients may first refuse to believe
that their diagnosis is accurate. They may speculate that test
results are wrong or their reports have been mixed-up with
other’s reports.

13.  Emotional response to feeling victimized occurs because
there is no way to retaliate against fate.Clients often displace
their anger onto nurses,physicians,family members,even
God. They may express anger in less obvious way.
Example- Overreacting to even slight annoyance

14.  A psychological mechanism for delaying the inevitable,
involves a process of negotiation usually with God or other
high Power. Usually dying clients are willing to accept
death but want to extend their lives temporarily until some
significant event takes place. Example- Child’s wedding

15.  Sad mood indicates the realization that death will come
sooner rather than later. The sad mood is a result of
controlling social loss.

16.  Attitude of complacency occurs after the clients have
dealt with their losses and completed unfinished
business. Kubler described the unfinished business in
two ways. Literally it refers to completing legal and
financial matters to provide best security for survivors.
 It also refers to addressing social and spiritual matters
such as saying good bye to loved ones and making
peace with God.After tying up all the loose ends, dying
clients feel prepare to die.

17.  Death is defined as the cessation of all vital functions of
the body including the heart beat, brain activity(including
brainstem) and breathing.

18.  Cardiac dysfunctions: Failing cardiac function is one of
the first signs that a clients condition is worsening. At first,
heart rate increases in a futile attempt to deliver oxygen to
cells. The apical pulse rate may reach 100 or more per
minute. Cardiac output per minute increases.

19.  Peripheral circulation changes: Reduced cardiac output
compromises pripheral circulation and impaires cellular
metabolism and produces less heat. Skin become pale, nail
beds and lips may appear blue,client may feel cold.
 Pulmonary function impairment: Failure of heart pumping
function causes fluid to collect in pulmonary circulation.
Breath sounds become moist and client can’t exhale CO2
adequately compounding sate of Hypoxia

20.  Central nervous system alterations: Client Experiences
periods of Apnea. Pain perception decreased, client may
state blankly through partially opened eyes, senses become
impaired
 Renal impairement: Low cardiac output decreases the urine
volume and waste products accumulate.
 Gastrointestinal tract: Peristalisis decreases, causes
intestinal contents to accumulate. This stimulates vomiting
center inducing nausea and vomiting.

21.  Near death Experience: Person almost dies but is
resuscitated, have been reported for sometime. People
who experience near death experiences report similar
events such as-
 Floating above their bodies
 Moving rapidly toward a bright life
 Seeing familiar people who have already died
 Feeling warm and peaceful
 Being told that it is not time yet for them to die.

22.  Grief is a series of intense physical and psychological
response that occur following a loss. It is manifested in
variety of ways that are unique to an individual and
based on personal experiences, cultural expectation
and spiritual beliefs. it is normal natural,necessary
and adaptive response to loss . Grieving is a walk
through unknown territory.

23.  Mourning: Coping with grief after a loss involves the
process of Mourning, the outward, social expression of
loss. It involves working through the grief until an
individual accepts and adapts to his or her expectations
to go on in life without that which was lost. It is a
behavior determined by cultural norms and values.

24. Normal grief
Anticipatory
grief
Complicated
grief
Disenfranchised
grief

25. Chronic
grief
Delayed
grief
Exaggerated
grief
Masked
grief

26. Therese Rando
Researcher and clinical psychologist
Recognize the loss
React
Recollect and re-experience
Relinquish
Readjust
Reinvest