This document discusses cardiac nursing and death and dying. It begins with objectives related to assessing signs of death, beliefs about death at different ages, helping dying patients meet needs, and legal implications. It defines death and lists physiologic signs. It describes beliefs about death at different ages. It discusses meeting patients' physical, spiritual, emotional needs and caring for the body after death. It lists changes that occur after death like rigor mortis, algor mortis, and livor mortis. It emphasizes providing comfort and respecting patient needs and beliefs during end of life.

1. QAISAR IQBALQAISAR IQBAL
SHIFA COLLEGE OF NURSINGSHIFA COLLEGE OF NURSING
CARDIAC NURSINGCARDIAC NURSING

2. Death and dyingDeath and dying

3. objectivesobjectives
1. Assess the physiologic signs of death.
2. Identify beliefs and attitude about death in relation to
age.
3. Discuss the various ways of helping the dying patient
meet his/her physiological, spiritual and emotional
needs.
4. Discuss care of the body after death.
5. Discuss the legal implications of death.
6. Describe how a nurse meets a dying patient s, need of
comfort.
7. Describe the important factors in caring for the body
after death.
8. List changes that occur in the body after death.

4. Definition of deathDefinition of death
The end of life of an organism or cell, in
human and animals
 OR
Death is manifested by the permanent
cessation of vital organic functions
(including heart beat, spontaneous
breathing and brain activity)

5. Physiologic signs of deathPhysiologic signs of death
The four main characteristic changes are ;
 Loss of muscle tone
 Slowing of the circulation
 Changes in the vital signs
 Sensory impairment.

6.  The following guidelines for physicians
as indications of death.
1. Total lack of response to external
stimuli
2. No musscular movement(esp breathing)
3. No reflexes
4. Flat encephalogram.

7. Beliefs and attitudes about death inBeliefs and attitudes about death in
relation to agerelation to age
Infancy to 5 years;
Does not understand concept of death,belives death is
reversible, temporary departure or sleep.
5 to 9 years;
Understand death is final, believes own death can be avoided,
believes wishes and unrelelated actions can be responsible
for death.
9 to 12 years;
Begin to understand own mortality, expressed in after life and
fear of death.

8. 12 to 18 years;
May still hold concept from previous developmental
stages, may seem to reach “adult’’ perception of death
but be emotionally unable to accept it.
18 to 45 years;
Has attitude towards death influenced by religious and
cultural beliefs.
45 to 65 years;
Accepts own mortality. encounters death of parents and
some peers experiences.

9. 65 years +;
Fears prolonged illness, sees death as
having multiple meanings,(eg,freedom
from pain, reunion with already deceased
family member.

10. Meeting physiologic needs of
the dying patient.
 providing personal hygiene measures
Controlling pain
Relieving respiratory difficulties
Assisting with
movement,nutrition,hydration and
elimination.

11. Spiritual support;
Identify patient spiritual needs
Respect the beliefs of patients
Be willing to listen and discuss
issues of spirituality.

12. Demonstrate empathy
Provide a supportive presence
Refer to community resources or
spiritual leaders.
Acknowledge and provide for the
rituals.

13. Emotional support,
Compassion (desire to help)
Responsiveness to emotional needs
Maintain a positive attitude
Expressing empathy
Attending wishes
Being present.

14. Body changes after death,
Rigor mortis,
Is the stiffening of the body that occurs
about 2 to 4 hrs after death.it starts in
the involuntary
muscles(heart,bladder,and so on)
progress to head, neck and finally reaches
the extremities.

15. Algor mortis,
Is the gradual decrease of the body
temperature after death, it falls about 1
c(1.8F)per hour until it reaches room
temperature
( (Latin: algor—coldness; mortis—of death) is
the reduction in body temperature following
death. This is generally a steady decline until
matching ambient temperature, although
external factors can have a significant influence)

16. Livor mortis,
skin becomes discolored and losses its
elasticity.tissues become soft .

17. Legal aspects of death,
Death must be certified by a physician
In unusual death,an autopsy(postmortem
examination)may be required.

18. Care of the body after death,
Make the environment clean to make
the body appear natural and
comfortable.
All equipment and supplies should be
removed from the bed side.

19. All tubes in the body be clamped
and remain in place(according to
hospital policy)
All soiled linen must be removed.

20. The nurse should check the client's
religion and make every attempt to
comply.
Normally, the body is placed in supine
position .Palms down or across the
abdomin. The wrist band is left untill it is
too tight. One pillow is placed under the
head and shoulder the eye lids are closed
dentures are usually inserted .

21. The mouth is then closed (a rolled towel
under the chin will hold it closed)
Soiled areas of the body are
washed,absorbent pads are placed under
the buttocks and a clean gown is placed
on the client,hair is brushed and all
jewelry is removed.
Identification tages are applied,one to the
ankle and on the wrist.

22. The body is wrapped in a shroud(a
winding sheet).
Another identification band is then
applied to the outside of the wrapped
sheet, Then the body is taken to the
mortuary.

23. For everything there is a
season,
And a time for every matter under
heaven:
A time to be born, and a time to die;
A time to plant, and a time to pluck up
what is planted;
A time to kill, and a time to heal;
A time to break down, and a time to
build up;

24. A time to weep, and a time to laugh;
A time to mourn, and a time to dance;
A time to throw away stones, and a time
to gather stones together;
A time to embrace, And a time to refrain
from embracing;

25. A time to seek, and a time to lose;
A time to keep, and a time to throw
away;
A time to tear, and a time to sew;
A time to keep silence, and a time to
speak;
A time to love, and a time to hate,
A time for war, and a time for peace.