last chapter

2. Suicide and elderly
• Greatest risk presented by elderly white male
• Risk factors include depression, previous attempt, family hx of,
stressful life event, easy access to lethal methods, incarceration,
firearms in home, hx of SA or ETOHism
• “I just don’t want to live anymore”
• “I wish I was dead”
• “Everyone would be better off without me”
• Report! Stay with person!

3. Chapter 44: end of life care

4. Death and Dying
• A terminal illness is one in which there is no reasonable chance of
recovery
• Attitudes about death are affected by a person’s culture, religion, age,
and the cause of death
• Death can be by suicide, homicide, an accident, an acute illness, or
after a chronic illness

5. HARDEST DEATHS ARE
• THOSE BY SUICIDE, HOMICIDE
• THOSE IN CHILDREN, THOSE CLOSE TO YOUR AGE
• THOSE OF SPOUSE, CHILD

6. KUBLER-ROSS’ STAGES OF GRIEF
• NO PARTICULAR ORDER, MAY REPEAT A STAGE
• NOT EVERY STAGE MUST BE MET, BUT BETTER IF ALL ARE
EXPERIENCED
• FAMILY ALSO EXPERIENCE STAGES
• A “GOOD” DEATH IS ONE THAT YOU KNEW WAS COMING AND HAD
TIME TO PREPARE FOR….

7. Stages of Dying according to Kubler-Ross
• Denial “no way, I’m too young!”
• Anger “it’s not fair, why me?”
• Bargaining “please God, cure me”
• Depression “why has God abandoned me?”
• Acceptance “OK, I’m ready”

8. Special Needs
• Spiritual- private visits with clergy; keep rosary beads, Bible nearby,
listen
• Social- allow family private visits, extend visiting hours, if allowed
• Psychological- listen, hold hands, encourage person to cry, vent
feelings

9. Physical Needs of the Dying Resident
• Vision, hearing and speech
1. Soft lighting, pupils reacting slower to change in light; eyes may be
½ open cleanse
2. Hearing is last sense to go; continue to explain all procedures
3. May not be as verbal, develop system for communicating

10. Mouth, Nose, Skin
• Mouth may be dry, jaw not completely closed, give
mouthcare Q2h, sips of liquids or ice chips, vaseline to
lips
• Nose may be irritated and dry if receiving oxygen
therapy, apply vaseline
• Skin may feel cold, but person is perspiring, place light
sheet on resident, sponge baths prn, change
gown/sheets as needed

11. Elimination
• May be incontinent or constipated
• Enemas may be ordered
• Perineal care PRN

12. Comfort and Positioning
• Inform CN if complaints of pain offered
• Turn and repos Q2h
• Use pillows to pad bony areas
• Elevate HOB to ease breathing

13. The Family
• This is a difficult time- give privacy, but be available- use touch to
show concern, listen to feelings and fear, be courteous and
empathetic to their experience

14. Hospice Care
• Hospice was developed to allow people to die with
dignity- either in the comfort of their own home or
in a facility
• Pain relief is given, but no treatments or
hospitalization will be provided should the person’s
health start to deteriorate
• This person has signed a Do Not Resuscitate (DNR)
order

15. Legal Stuff
• Do not witness a will, inform CN if a family or resident request it
• An advance directive is similar to a living will- it gives healthcare
providers pre instructions for what care a person wants/does not
want in case he or she is unable to do so at a later time

16. Signs of Death
• Movement, muscle tone and sensation may be
lost
• Jaw drops open, eyes may not close completely
• Peristalsis slows (don’t feed)
• Body temp rises, but skin feels cold and is pale
• Breathing becomes irregular
• Pulse is fast, weak, irregular and BP drops
• Pain decreases as person loses consciousness

17. Postmortem Care (PMC)
• Determine if family will be visiting
• Determine if an autopsy will be performed
• Supplies: PMC kit, wash basin, soap, towel, disposable diaper
• Standard Precautions, privacy, treat body with dignity
• Handle body with open palms
• Two caregivers will perform
• Need to complete before rigor
mortis (stiffening of body) occurs in 2-4 hours

19. PMC cont.
• Wash face, eyes, perineal area and put on disposable diaper
• Close eyes
• Leave dentures in
• Remove all jewelry except wedding ring (tape in place)
• Apply chin strap
• Straighten arms/legs and secure together with string
• Tag body (big toe, outside of shroud)
• Place wallet, watch, eyeglasses in small bag
• Leave in gown with face exposed if family visiting, if not, wrap entire body