A complete study material for a good presentation for the subject advance nursing practice in MSc Nursing level. It is presented by Angelina samuel lal.

1. CARE OF DYING
AND DEATH
ANGELINA SAMUEL LAL
M.SC. NURSING 1ST YEAR
ADVANCE NURSING PRACTICE

2. INTRODUCTION
• Birth and death are two aspects of
life, which will happen to everyone.
Good palliative care does not
hasten death.
• Dying and death are painful and
personal experiences for those that
are dying and their loved ones
caring for them. Whether the death
is sudden and unexpected, or
ongoing and expected.
• Care of the dying patient generally
refers to care in the last days or
hours of life are to ensure comfort
and dignity.

3. DEFINITION
Dying and Death is defined as:
1. Dying- Dying is a process of
Irreversible cessation of
circulatory, respiratory &
brain function.
2. Death- Death is the cessation
or permanent termination of
all the biological functions
that sustain a living organism

4. CAUSES OF DYING AND
DEATH:
• IHD - Ischaemic Heart
Disease
• Cerebrovascular disease.
• COPD.
• Lower respiratory tract infection.
• Lung cancer
• Accidents.
• Cancer.
• HTN, Heart diseases.
• Suicide.
• Childhood diseases e.g.-
diarrhoea

6. Kubler And Ross Grief And Death
Reactions (Stages Of Dying Process)
Patients become frustrated, irritable
and angry that they are sick.
The pt. expresses hostility in the
anger stage and adopts.
Anger
Period of grief before death.
Characterized by crying and not
speaking
Depression
The pt. tries to beg for more time.
Bargaining
Accepted death and is prepared to
die.
Acceptance
Pt. Denies that he or she will die.
Denial and isolation

7. CAUSES OF DYING AND DEATH:-
• Irregular.
• Cheyne- stoke’s respiration(rapid &
slow).
• Stertorous due to secretion.
Gastrointestinal & Genito-urinary system
• Abdominal distension
• Inability to swallow.
• Retention of urine.
• Incontinence of urine & stool.
Sight, speech & hearing.
• Pupil fail to react to light
• Sunken eyes
• Difficult speech
• Hearing gradually becomes low
Circulatory system
• Alteration in vital signs.
• Rapid pulse gradually fails.
Skin & musculoskeletal system
• Pale skin.
• Cold sweats.
• Ears & nose are cold at touch
• Stiff muscles.
Facial appearance
• Facial muscle relax.
• Loss of muscle tone.
Respiratory system

8. CARE OF THE DYING PATIENT:-
Advance Planning For
Imminent Death
Legal and Ethical
Concern
Pain Management
Symptomatic
Management
Psychological Support
Financial Concerns
Helping the Patient
Transition
The Patient's Right to
Information

9. PSYCHOLOGICAL
SUPPORT :-
• Relief from loneliness, fear &
depression.
• Maintenance of security, self-
confidence & dignity.
• Maintenance of hope & spiritual
comfort.
• Maintenance of a comfortable &
peaceful environment.
• Use therapeutic communication.
• Protect against Isolation.
• Assist with end- of- life decision
making.

10. SYMPTOMATIC MANAGEMENT:-
• Cleanliness and appearance
are important until the end.
• Cleanliness of the skin, hair,
mouth, and cloth has to be
maintained..
Problem associated with
cleanliness and grooming:
• Explain the procedure to the pt.
because patient loses sight.
• Since the eyes are opened,
protect the eyes from corneal
ulceration.
Problem associated with
sense organ:
• Maintain calm and quit
environment.
• The visitors should be
instructed not to disturbed the
patient during his resting.
Problem associated with rest
and sleep:
• Oxygen inhalation to remove his
discomfort.
• Elevation of the patient’s head
and shoulders may make
breathing easier.
Problem associated with
breathing:
• I.V fluids.
• Sips of water is given with
teaspoon.
• The denture are removed and
kept safely.
Problem associated with
eating and drinking:
Problem associated with
communication:
• Confusion.
• Withdrawal.

11. PALLIATIVE CARE :-
FIFTH
SECOND THIRD
FIRST FOURTH
Respects the
goals, likes and
choices of the
dying pt.
Looks after medical,
emotional, social,
and spiritual needs
of the dying person.
Supports the
needs of the
family members.
Helps pt. gain access
to needed healthcare
providers and
appropriate settings.
Builds ways to
provide excellent
end of life care.
 Five principles of palliative care
(hospice care)

12. SIGNS OF DEATH :-
• Absence of heartbeat and
respirations.
• Fixed pupils
• Skin color turns to a waxen
pallor and extremities may
darken.
• Body temperatures drops
• Muscles and sphincters relax,
sometimes resulting in release
of stool or urine.
SIGNS OF DYING :-

13. PHYSIOLOGICAL CHANGES AFTER
DEATH :-
Rigor mortis
Stiffening of the body that occurs about 2-4hrs
after death. Results from a lack of ATP, which
causes the muscles to contract, which in turn
immobilize the joints It starts in the involuntary
muscles( heart, bladder) then progress to head,
neck, trunk , extremities.
01
Livor mortis
Discoloration of body after death. After blood
circulation has ceased , the RBC broken down ,
leads to discoloration of surrounding tissues
03
Algor mortis
Gradual decrease of the body temperature after
death. When blood circulation terminates and
hypothalamus ceases to function , body
temperature falls down.
02
Decomposition
Tissues after death become soft and eventually
liquified by bacterial fermentation . The hotter the
temperature, the more rapid the change. So
bodies are stored in cool places / embalming
04

14. PURPOSE OF DEAD BODY CARE :-
 To prevent discoloration
or deformity of the
body.
 To protect the body
from post mortem
discharge.
 To prepare the dead body for
hand over to the relatives.
 To prepare the body for the
morgue.

15.  CARE OF BODY AFTER DEATH
1. Death declaration / death is certificate by
physician.
2. Check order for any specimens or organ
or tissue donation or check written
permission for autopsy, if any.
3. Patient cultural, spiritual and religious
beliefs and there customs and principles
are kept in mind.
4. Positioning the body straitened and arms
laid at the side.
5. Eyes are closed as in sleep.
6. Dentures are removed & proper chin in
position with bandaging to close the
mouth.
PROCEDURE :-

16.  Cont.…
7. Remove all application used for patient
care (e.g. catheters, tubing, IV set or IV
cannula, dirty linens, etc.
8. Remove ornaments and list then to
relatives with written consent.
9. Cleanse the body thoroughly including
brush and comb the hairs and change the
hospital gown.
10.All orifices are to be plugged with cotton
to prevent escape of body discharge.
11.Prevention of spread of disease cover the
body with a clean sheet up to the chin.
12.Spray a room freshener to remove
unpleasant odour.
13.An identification tag should be placed on
wrist, right big toe.

17.  Cont.…
17.Maintain record of death by recording:-
 Time of death and action taken to prevent
the death.
 Who pronounced the death
 Any organ donation.
 Personal items given to family.
 Location of name tags on the body.
 Time of discharge and destination of the
body.
 Attach the consent of hand overing dead
body or sent to the mortuary.
NOTES :- Human body deserves the same
respect and dignity as a living person and
needs to be prepared in a manner consistent
with the client cultural and religious belief.

18. THANK YOU!!