The nursing student will learn about key aspects of caring for patients who are dying or have died, including defining dying and death, signs of approaching death, diagnostic evaluation, management, cultural and religious beliefs, legal matters, and nursing diagnoses and family education. Key signs of impending death include irregular breathing patterns like Cheyne-Stokes respirations and alterations in vital signs. Proper care, respect and dignity must be provided to the deceased according to their wishes and beliefs. Documentation of death includes certifying and recording the cause and time of death along with notifications.

2. The nursing student will learn:
 Define dying & death.
 Enlist causes of dying and death.
 Signs of approaching death.
 Discuss the diagnostic evaluation.
 Discuss the management.
 Explain regarding the religious & cultural beliefs.
 Law & legal matter during hand over death body..
 Explain nursing diagnosis & family education.

3.  Occurs when a valued person, object, or situation is
changed
› Actual Loss can be recognized by others including
the person sustaining the loss, ex: a person losing a
limb, spouse, valued object, job etc.
› Perceived loss felt by the person but is intangible to
others loss of your youth, financial dependence.
› Anticipated loss the person displays loss and grief
behaviors for loss that has yet to take place. EX:
families with terminally ill patients and serves to lessen
the impact of actual loss

4. › Physical loss- loss of an arm from a car accident
Physical loss.
› Psychological loss- caused by an altered self
image and the inability to return to his or her
occupation. A person who is scared by has not
lost a limb may suffer from perceived and
psychological loss of self image.

5.  Grief- Is the Emotional Reaction to Loss.( eg
Many people who divorce experience grief,
loss of a body part, a job, a house or a pet.)
 Bereavement-State of grieving during which a
person goes through grief reaction. (eg when a
person neglects their own health to an
extreme.)
 Mourning-Period of acceptance of loss and
grief during which the person learns to deal
with the loss. (eg a person returning to normal
living habits.)

6.  Dying- Irreversible cessation of
circulatory, respiratory & brain function.
 Death- Death is the cessation or
permanent termination of all the
biological functions that sustain a living
organism.

7.  IHD.
 Cerebrovascular disease.
 COPD.
 Lower respiratory tract infection.
 Lung cancer
 Accidents.
 Cancer.
 HTN, Heart diseases.
 Suicide.
 Childhood diseases e.g- diarrhea

8.  Denial and isolation- Pt. Denies that he or she will
die.
 Anger- The pt expresses hostility in the anger stage
and adopts.
 Bargaining- The pt tries to beg for more time.
 Depression- Period of grief before death.
Characterized by crying and not speaking
 Acceptance- Accepted death and is prepared to
die.

9.  Facial appearance
1. Facial muscle relax.
2. Flaccid cheeks.
3. Loss of muscle tone.
4. Pinched sharp nose.
5. Pale skin.
6. Sunken eyes.
 Sight, speech &
hearing.
1. Gradual sight fails.
2. Pupil fail to react to
light
3. Sunken eyes
4. Difficult speech-
confused
5. Hearing gradually
becomes low.

10.  Respiratory system
1. Irregular.
2. Cheyne-stoke’s
respiration(rapid &
slow).
3. Stertorous due to
secretion.
 Circulatory system
1. Alteration in vital
signs.
2. Rapid pulse
gradually fails.

11.  Gastrointestinal system
1. Hiccoughs.
2. Nausea & vomiting.
3. Abdominal distension
4. Inability to swallow.
 Genito-urinary system
1. Retention of urine.
2. Distended bladder.
3. Incontinence of urine
& stool.
 Skin & musculoskeletal
system
1. Pale skin.
2. Cold sweats.
3. Ears & nose are cold
at touch
4. Stiff muscles.

12.  Central nervous system
1. Loss of reflexes & pain.
2. Restless due to lack of oxygen.
3. Raised body temperature.
 Signs of clinical death-
1. Absence of pulse, heart beat & respiration.
2. Fixed pupils & non reactive to light.
3. Absence of reflexes.
4. Rigor mortis(a stiffening of body after death due to
muscle fixation. Ie jaw-neck arms,trunk-legs)
5. cyanosis

13.  A- Airway maintenance with cervical
spine control.
 B- Breathing & ventilation.
 C- Circulation with hemorrhage
control.
 D-Disability, neurological status.
 E- Exposure/ Environmental control
complete undress the patient, but
prevent hypothermia.

14. 1. Oxygen inhalation.
2. Suctioning.
3. Positioning.
4. Well- ventilation.
5. Medication as prescribed.
6. IV fluids, oral fluids, or sips of water.
7. Perineal care, skin care, mouth care, eye care &
clean clothing's.
8. Rest & sleep.

15.  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.

16.  Palliative care is the prevention, relief,
reduction or soothing of symptoms of
disease or disorders throughout the
entire course of an illness, including care
of dying and bereavement follow-up for
the family.
- Ferrell & Coyle.

17. Curative therapy
Death
Presentation
Palliative care Hospice

18.  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.

19.  Death declaration/ Death certificate by
physician.
 Autopsy(written permission)
 Customs & principles are kept in mind.
 Positioning- body straitened & arms laid at the
side.
 Eyes are closed as in sleep.
 Dentures are removed & prop chin in position with
bandaging.
 Remove all appliances used for patient care( e.g -
catheter tubing's etc..)

20.  Remove all the appliances used for patient care.
(e.g. Catheter, tubing's, I,V.sets, etc)
 Remove ornaments and list them to relatives.
 All orifices are to be plugged with cotton to
prevent escape of body discharges.
 Prevention of spread of diseases (i.e sealing body)
 Send body clean and neatly dressed.
 An identification tag for body.

21.  If relatives are present then body is
 handed over them with proper written legal
authority permission.
 Maintain record of death and inform to authority
for register of deaths.
 Care of unit.

22. 1.Hispanic Culture-Extended family cares for ill, sharing
information and decisions. They often use special
objects, such as amulets or rosary beads, and prayer.
In traditional Hispanic families, respect, especially for
elders, is a cherished value.
2.Americans- Have a number of differing culture and
religions.
3.Native Americans-Encompass, with differing practices,
traditions and ceremonies. E.g. Use songs, chants,
prayers and sand paintings as rituals.
4.Many people culture hold back their public displays of
emotions, public wailings and physical demonstration.

23.  Deceased body is ritualistically washed, wrapped,
cried over, prayed for and buried. Non Muslims
should not touch the body.
 Autopsies are not allowed.
 Organ donation is sometimes allowed.

24.  Not touching the body after death to give
deceased smoother transition to after-life.
 Individual minimize emotional expressions and
maintain a peaceful, compassionate atmosphere.
 Persons often say prayers while touching and
standing at the deceased head.

25.  There should be no preparation of the body until it
is known whether members from Jewish burial
society are coming to the facility.
 Autopsy are avoided in some types.

26. 1.Spiritual resources include faith in a higher power,
communities of support, friends, a sense of hope
and meaning in life, and religious practices.
2.Spiritual integration occurs when an individual
come to terms with his or her life and puts life’s
pieces together in a way consistent with one’s
entire life.

27. Federal and state law require that institutions
develop policies and procedures for certain events
that occur after death.
1.Requesting organ or tissue donation
2. Autopsy
3.Certifying and documenting the occurrence of a
death.
4.Providing safe and appropriate post mortem care.

28.  The person requesting organ or tissue donation provides
information about who can legally give consent, which
organs or tissues can be donated, associated costs and
how donation will affect burial.
2.AUTOPSY
 Family members give consent for an autopsy, the surgical
dissection of a body after death to determine the exact
cause and circumstances of death or discover the pathway
of disease.
Law sometimes require that an autopsy be performed when
death is due to homicide, suicide, accidents etc.

29.  Documentation of a death provides a legal record of the
events.
 The registered nurse gathers information and records.
 A licensed professional witnesses the signing of forms (body
handover to belongings)
 Nursing documentation becomes relevant in high risk
management or legal reporting.
 Family members deserve and expects clear description of
death.
 State law and policy of agency govern the sharing of written
medical record information, which usually involves a
written request.

30.  The nurse provide care of body after death.
 Human body deserves the same respect and
dignity as a living person and needs to be
prepared in a manner consistent with the client’s
cultural and religious belief.

31. 1.Ineffective airway clearance related to increase mucous
production and decreased ciliary clearance.
2.Death anxiety related to imbalanced body mechanism
and ineffective tissue perfusion.
3.Compromosed family coping related to declining health
and refusal of life- prolonging medical interventions.
4.Impaired nutritional status related to less requirement of
food to body due to reduced appetite.
5.Disturbed personal identity related to impaired physical
mobility and body image.
6.Risk for complicated grieving related to permanent loss
of mobility.

32. 1.Name, Age, Sex, Cause of Death
2.Time and date of death and all actions taken to
respond to impending death.
3.Name of healthcare provider certifying the death.
4.Persons notified of the death.
(Health providers, Family members, organ requests
team, morgue, funeral home, spiritual care
providers.)
5.Request for organ or tissue donation made and by
whom.

33. 6.Special preparation of body .(desired or required)
7.Medical tubes, devices, or lines left in or on body.
8. Personal articles left on body.
9.Personnal articles given to family with description,
date, time to whom given.
10.Location of body identification tags.
11.Time of body transfer and destinations.
12.Any other information on family requests that
clarify special circumstances.

35. A nurse is caring for a pt who is dying of terminal
cancer. While assessing the pt. for signs of
impending death, the nurse should observe the pt
for:
A. Elevated B/P
B. Cheyne-Stokes respirations
C. Elevated pulse rate
D. Flushed skin

36.  “Potter perry” Fundamental of Nursing 7th
edition page no 462 to 481
 Sister Nancy “Fundamental of Nursing’
Page no
 ‘Hinduja Hospital’ TLS Trauma life sopport
page no 6 to 8 to 9
 www. google.com