SlideShare a Scribd company logo
1 of 29
KING GEORGE’S MEDICAL UNIVERSITY
KING GEORGE’S ,COLLEGE OF NURSING
SEMINAR ON
END OF LIFE CARE
SUBMITTED TO: SUBMITTED BY:
MRS. PRIYANKA SINGH DIVYA PAL
CLINICAL INSTRUCTOR M.SC. N. 1ST YEAR
K.G.M.U. COLLEGE OF NURSING K.G.M.U. COLLEGE OF NURSING
1
OUTLINES
• Introduction
• Definition of end of life care
• Terminologies
• Types of grief
• Theories of grief
• Indications of death
• Psychosocial manifestation of approaching death
• Physical manifestation of approaching death
• Care of the body after death
2
INTRODUCTION
End –of -life care includes physical, emotional, social and spiritual support for
patients and their families. The goal of end -of -life care is to control pain and other
symptoms so the patient can be as comfortable as possible.
3
DEFINITION
“End-of –life care refers to health care, not only of patients in the final hours or
days of their lives, but more broadly care of all those with a terminal illness or
terminal disease condition that has become advanced ,progressive and incurable.”
4
TERMINOLOGIES
Loss:- an aspect of self no longer available to a person.
Death:- cessation of life.
Grief:- pattern of physical and emotional responses to bereavement.
End of life:- final phase of a patient’s illness when death is imminent.
Death rattle:- a sound that is something heard coming from a dying person’s
throat or chest.
Palliative care:- making life as easy as possible for patients and families living
with serious illness.
5
Hospice care:- Hospice care is given when there is life expectancy of 6 months
or less.
6
DEFINITION OF GRIEF
Grief is a strong sometime overwhelming emotion for people, regardless of
whether their sadness stems from the loss of a loved one or from a terminal
diagnosis they or someone they love have received.
7
TYPES OF GRIEF
Normal grief:- Complex emotional, social, physical, behavioural and spiritual
responses to loss and death.
Anticipatory grief:- Associated with the normal grief response before the loss
actually occurs.
Delayed or inhibited grief:- Absence of evidence of grief when it ordinarily
would be expected.
Distorted grief:- Symptoms associated with normal grieving are exaggerated.
8
Chronic or prolonged grief:- Maintaining personal possessions aimed at keeping
a lost loved one alive.
Disenfranchised grief:- When relationship to the decreased person is not socially
sactioned.
9
Ambiguous loss:- The lost person is physically present but not psychologically
available.
Complicated grief:- Prolonged or significantly difficult time moving forward
after a loss.
Masked grief:- Disruptive behaviour due to loss and ineffective grief resolutions.
10
KUBLER-ROSS THEORY
5 STAGES OF GRIEVING(1969):- The five stages of grief model or the kubler ross
model is popularly known as a model that describes a series of emotions
experienced by people who are grieving:-
DENIAL
ANGER
BARGAINING
DEPRESSION
ACCEPTANCE
11
12
BOWLBY 4 PHASES OF MOURNING (1980)
Bowlby and markes (1980) identify four phases of mourning :-
 Numbing
 Yearning and searching
 Disorganization and despair
 Reorganization
NUMBING:- feeling “stunned” or “unreal” can be interrupted by periods of
intense emotion. 13
YEARNING AND SEARCHING:- Full effects of emotional outbursts and
uncontrollable crying.
DISORGANIZATION AND DESPAIR:- Evaluation of loss, may become angry at
perceived person at fault.
REORGANIZATION:- Person begins to move forward with life, roles , skills and
relationships.
14
WORDEN’S FOUR TASKS OF MOURNING
WORDEN’S FOUR TASKS OF MOURNING(1991):-
Task 1:- To accept the reality of the loss.
Task 2:- To work through the pain and grief.
Task 3:- To adjust to the environment in which the decreased is missing.
Task 4:- To emotionally relocate the decreased and move on with life.
15
16
INDICATIONS OF DEATH
Relaxed muscles
No pulse
No breathing
Fixed eyes
Total lack of response to external stimuli.
No muscular movement , especially breathing.
No reflexes
A bowel or bladder release
No response
17
PSYCHOSOCIAL MANIFESTATIONS OF APPROACHING DEATH
Altered decision making
Anxiety
Helplessness
Life review
Peacefulness
Unfinished business
18
Restlessness
Saying goodbyes
Decreased socialization
Fear of loneliness
Fear of meaninglessness
Unusual communication of one’s life
Fear of pain
Vision like experience
19
PHYSICAL MANIFESTATION OF APPROACHING DEATH
Sensory:- decreased sensation , perception, blurring of vision, siking and glazing
of eyes, blink reflex absent, eyelids remain half open.
Integumentary:-mottling on hands ,feet, arms and legs , cold, clammy skin,
cyanosis on nose, nail beds, knees , wax like skin when very near to death.
Respiratory:- increased respiratory rate , chyne-stokes respiration , inability to
cough or clear respiration , secretions resulting in grunting , gurgling.
20
Urinary:- decreased urine output , urinary incontinence, unable to urinate.
Gastrointestinal :-accumulation of gas, distension, nausea , loss of sphincter
control.
Musculoskeletal :- inability to move, sagging of jaw , difficulty in swallowing ,
difficulty in maintaining posture and alignment , loss of gag reflex, jerking.
Cardiovascular:- increased heart rate, slower and weakening pulse, irregular
rhythm . decreased in blood pressure , delayed absorption of drugs.
21
CARE OF BODY AFTER DEATH
PROCEDURAL GUIDELINES:-
EQUIPMENTS:- Bath towels, wash clothes, wash basin, scissors, shroud kit with
name tags, bed linen , room deodorizer, documentation forms.
22
NURSES:-
 Make arrangements for staff, spiritual advisor or other to stay with the family
while the body is prepared for viewing.
Prepare the death care tray.
23
Cleanse body thoroughly, apply clean sheets.
Brush and comb clients hair.
Encourage family to say good bye through both touch and talk.
24
Do not rush good bye process.
Remove all equipments and ornaments.
Clarify the personal belongingness to handover the personal objects and body.
Do not discard items found after the family is gone, tell them what is found. 25
Apply name tags.
Cover the body while shifting on the death trolly.
Complete documentation
Follow all protocols and policies to meet all legal requirements in caring for the body.
26
APPROPRIATE DOCUMENTATION
Time of death and actions taken to prevent or cardiac arrest record if applicable.
Name of the person that pronounced the client’s death.
Make special preparation and type of donation , including time, staff, company.
27
The name of the family member or friend who was called and who came to the
hospital- donor organization, morgue, funeral home, chaplain.
Time of discharge and destination of the body , location of the name tags on the
body, special requests .
 Made by the family ,any other statements that might be needed to clarify the
situation.
28
29

More Related Content

What's hot

Do not resuscitate
Do not resuscitate  Do not resuscitate
Do not resuscitate wcmc
 
Unit vii tele nursing
Unit vii tele nursingUnit vii tele nursing
Unit vii tele nursinganjalatchi
 
Theory based nursing care plan
Theory based nursing care planTheory based nursing care plan
Theory based nursing care planKoyel Basak
 
Acute and critical care, IN NURSING, MANAGEMENT OF CLIENT IN ICU.
Acute and critical care, IN NURSING, MANAGEMENT OF CLIENT IN ICU.Acute and critical care, IN NURSING, MANAGEMENT OF CLIENT IN ICU.
Acute and critical care, IN NURSING, MANAGEMENT OF CLIENT IN ICU.dharmendra raval
 
Coping wth loss,death and grieving
Coping wth loss,death and grievingCoping wth loss,death and grieving
Coping wth loss,death and grievingsalman habeeb
 
palliative Care related MCQs.pptx
palliative Care related MCQs.pptxpalliative Care related MCQs.pptx
palliative Care related MCQs.pptxanjalatchi
 
Nsg care with Fluid & Electrolyte imbalance.pptx
Nsg care with Fluid & Electrolyte imbalance.pptxNsg care with Fluid & Electrolyte imbalance.pptx
Nsg care with Fluid & Electrolyte imbalance.pptxAbhishek Joshi
 
Hospice and palliative care
Hospice and palliative careHospice and palliative care
Hospice and palliative carestaciyac
 
The Nursing Role In Palliative Care
The Nursing Role In Palliative CareThe Nursing Role In Palliative Care
The Nursing Role In Palliative CareAl-Sadeel Society
 
Chapter 038 Long Term
Chapter 038 Long TermChapter 038 Long Term
Chapter 038 Long Termbholmes
 
endoflifecare-180224144308.pdf
endoflifecare-180224144308.pdfendoflifecare-180224144308.pdf
endoflifecare-180224144308.pdfMarkCatipon
 
Trends in critical care nursing
Trends in critical care nursingTrends in critical care nursing
Trends in critical care nursingJohny Wilbert
 
Palliative Symptom Management
Palliative Symptom ManagementPalliative Symptom Management
Palliative Symptom Managementmeducationdotnet
 
Nursing management of critically ill patient in intensive care units
Nursing management of critically   ill patient in intensive care unitsNursing management of critically   ill patient in intensive care units
Nursing management of critically ill patient in intensive care unitsANILKUMAR BR
 
Loss and Grief
Loss and GriefLoss and Grief
Loss and Griefaneez103
 

What's hot (20)

Do not resuscitate
Do not resuscitate  Do not resuscitate
Do not resuscitate
 
2 transcultural nursing
2 transcultural nursing2 transcultural nursing
2 transcultural nursing
 
Unit vii tele nursing
Unit vii tele nursingUnit vii tele nursing
Unit vii tele nursing
 
Theory based nursing care plan
Theory based nursing care planTheory based nursing care plan
Theory based nursing care plan
 
Nursing Orientation
Nursing OrientationNursing Orientation
Nursing Orientation
 
Acute and critical care, IN NURSING, MANAGEMENT OF CLIENT IN ICU.
Acute and critical care, IN NURSING, MANAGEMENT OF CLIENT IN ICU.Acute and critical care, IN NURSING, MANAGEMENT OF CLIENT IN ICU.
Acute and critical care, IN NURSING, MANAGEMENT OF CLIENT IN ICU.
 
Coping wth loss,death and grieving
Coping wth loss,death and grievingCoping wth loss,death and grieving
Coping wth loss,death and grieving
 
palliative Care related MCQs.pptx
palliative Care related MCQs.pptxpalliative Care related MCQs.pptx
palliative Care related MCQs.pptx
 
Nsg care with Fluid & Electrolyte imbalance.pptx
Nsg care with Fluid & Electrolyte imbalance.pptxNsg care with Fluid & Electrolyte imbalance.pptx
Nsg care with Fluid & Electrolyte imbalance.pptx
 
Hospice and palliative care
Hospice and palliative careHospice and palliative care
Hospice and palliative care
 
Presentation of palliative care
Presentation of palliative carePresentation of palliative care
Presentation of palliative care
 
The Nursing Role In Palliative Care
The Nursing Role In Palliative CareThe Nursing Role In Palliative Care
The Nursing Role In Palliative Care
 
Chapter 038 Long Term
Chapter 038 Long TermChapter 038 Long Term
Chapter 038 Long Term
 
endoflifecare-180224144308.pdf
endoflifecare-180224144308.pdfendoflifecare-180224144308.pdf
endoflifecare-180224144308.pdf
 
End of Life Presentation
End of Life PresentationEnd of Life Presentation
End of Life Presentation
 
Long-Term Care
Long-Term CareLong-Term Care
Long-Term Care
 
Trends in critical care nursing
Trends in critical care nursingTrends in critical care nursing
Trends in critical care nursing
 
Palliative Symptom Management
Palliative Symptom ManagementPalliative Symptom Management
Palliative Symptom Management
 
Nursing management of critically ill patient in intensive care units
Nursing management of critically   ill patient in intensive care unitsNursing management of critically   ill patient in intensive care units
Nursing management of critically ill patient in intensive care units
 
Loss and Grief
Loss and GriefLoss and Grief
Loss and Grief
 

Similar to end of life care

LOSS OF GREVING.pptx
LOSS OF GREVING.pptxLOSS OF GREVING.pptx
LOSS OF GREVING.pptxAbidaLaghari2
 
Loss, Death, and Grieving.pptx 222222-1.pptx
Loss, Death, and Grieving.pptx 222222-1.pptxLoss, Death, and Grieving.pptx 222222-1.pptx
Loss, Death, and Grieving.pptx 222222-1.pptxMuhammadAbbasWali
 
Fon.Concept of Loss & Grieving and Death and Dying .pptx
Fon.Concept of Loss & Grieving and Death and Dying .pptxFon.Concept of Loss & Grieving and Death and Dying .pptx
Fon.Concept of Loss & Grieving and Death and Dying .pptxRawalRafiqLeghari
 
fon Unit xv-care of terminally ill patient
fon Unit xv-care of terminally ill patientfon Unit xv-care of terminally ill patient
fon Unit xv-care of terminally ill patientAtul Yadav
 
Death and dying patient
Death and dying patientDeath and dying patient
Death and dying patientAbhay Rajpoot
 
Endof lifecareproject
Endof lifecareprojectEndof lifecareproject
Endof lifecareprojectandreamgarcia
 
Endof lifecareproject
Endof lifecareprojectEndof lifecareproject
Endof lifecareprojectandreamgarcia
 
Loss,grief, grieving process, death, medico legal issues
Loss,grief, grieving process, death, medico legal issuesLoss,grief, grieving process, death, medico legal issues
Loss,grief, grieving process, death, medico legal issuesBinand Moirangthem
 
Grief reaction and therapy
Grief reaction and therapy Grief reaction and therapy
Grief reaction and therapy Prerna Khar
 
Lecture 21: Psychological issues at the end of life Dr.Reem AlSabah
Lecture 21: Psychological issues at the end of life Dr.Reem AlSabahLecture 21: Psychological issues at the end of life Dr.Reem AlSabah
Lecture 21: Psychological issues at the end of life Dr.Reem AlSabahAHS_student
 
Nursing-Foundation-29.by vision books pdf
Nursing-Foundation-29.by vision books pdfNursing-Foundation-29.by vision books pdf
Nursing-Foundation-29.by vision books pdfNeha Singh
 

Similar to end of life care (20)

LOSS OF GREVING.pptx
LOSS OF GREVING.pptxLOSS OF GREVING.pptx
LOSS OF GREVING.pptx
 
Loss
LossLoss
Loss
 
Loss, Death, and Grieving.pptx 222222-1.pptx
Loss, Death, and Grieving.pptx 222222-1.pptxLoss, Death, and Grieving.pptx 222222-1.pptx
Loss, Death, and Grieving.pptx 222222-1.pptx
 
Fon.Concept of Loss & Grieving and Death and Dying .pptx
Fon.Concept of Loss & Grieving and Death and Dying .pptxFon.Concept of Loss & Grieving and Death and Dying .pptx
Fon.Concept of Loss & Grieving and Death and Dying .pptx
 
fon Unit xv-care of terminally ill patient
fon Unit xv-care of terminally ill patientfon Unit xv-care of terminally ill patient
fon Unit xv-care of terminally ill patient
 
Concept of Loss.docx
Concept of Loss.docxConcept of Loss.docx
Concept of Loss.docx
 
Death and dying patient
Death and dying patientDeath and dying patient
Death and dying patient
 
Epilogue
EpilogueEpilogue
Epilogue
 
Concept of Loss.pdf
Concept of Loss.pdfConcept of Loss.pdf
Concept of Loss.pdf
 
Stages of dying
Stages of dyingStages of dying
Stages of dying
 
Endof lifecareproject
Endof lifecareprojectEndof lifecareproject
Endof lifecareproject
 
Endof lifecareproject
Endof lifecareprojectEndof lifecareproject
Endof lifecareproject
 
Loss,grief, grieving process, death, medico legal issues
Loss,grief, grieving process, death, medico legal issuesLoss,grief, grieving process, death, medico legal issues
Loss,grief, grieving process, death, medico legal issues
 
POST-MORTEM CARE
POST-MORTEM CARE POST-MORTEM CARE
POST-MORTEM CARE
 
Grief reaction and therapy
Grief reaction and therapy Grief reaction and therapy
Grief reaction and therapy
 
Death and dying
Death and dyingDeath and dying
Death and dying
 
Lecture 21: Psychological issues at the end of life Dr.Reem AlSabah
Lecture 21: Psychological issues at the end of life Dr.Reem AlSabahLecture 21: Psychological issues at the end of life Dr.Reem AlSabah
Lecture 21: Psychological issues at the end of life Dr.Reem AlSabah
 
Death and dying
Death and dyingDeath and dying
Death and dying
 
End of-life care
End of-life careEnd of-life care
End of-life care
 
Nursing-Foundation-29.by vision books pdf
Nursing-Foundation-29.by vision books pdfNursing-Foundation-29.by vision books pdf
Nursing-Foundation-29.by vision books pdf
 

More from vaibhavpaul9

Importance and purposes of Literature Review
Importance and purposes of Literature ReviewImportance and purposes of Literature Review
Importance and purposes of Literature Reviewvaibhavpaul9
 
ROLE OF RESEARCH, LEADERSHIP AND MANAGEMENT.pptx
ROLE OF RESEARCH, LEADERSHIP AND MANAGEMENT.pptxROLE OF RESEARCH, LEADERSHIP AND MANAGEMENT.pptx
ROLE OF RESEARCH, LEADERSHIP AND MANAGEMENT.pptxvaibhavpaul9
 
peripheral vascular disease.pptx
peripheral vascular disease.pptxperipheral vascular disease.pptx
peripheral vascular disease.pptxvaibhavpaul9
 
breast cancer ppt.pptx
breast cancer ppt.pptxbreast cancer ppt.pptx
breast cancer ppt.pptxvaibhavpaul9
 
myasthenia gravis.pptx
myasthenia gravis.pptxmyasthenia gravis.pptx
myasthenia gravis.pptxvaibhavpaul9
 
lecture method ppt
lecture method pptlecture method ppt
lecture method pptvaibhavpaul9
 
Lecture Method in Nursing Education
Lecture Method in Nursing EducationLecture Method in Nursing Education
Lecture Method in Nursing Educationvaibhavpaul9
 
Assessment of respiratory system ptx
Assessment of respiratory system ptxAssessment of respiratory system ptx
Assessment of respiratory system ptxvaibhavpaul9
 

More from vaibhavpaul9 (8)

Importance and purposes of Literature Review
Importance and purposes of Literature ReviewImportance and purposes of Literature Review
Importance and purposes of Literature Review
 
ROLE OF RESEARCH, LEADERSHIP AND MANAGEMENT.pptx
ROLE OF RESEARCH, LEADERSHIP AND MANAGEMENT.pptxROLE OF RESEARCH, LEADERSHIP AND MANAGEMENT.pptx
ROLE OF RESEARCH, LEADERSHIP AND MANAGEMENT.pptx
 
peripheral vascular disease.pptx
peripheral vascular disease.pptxperipheral vascular disease.pptx
peripheral vascular disease.pptx
 
breast cancer ppt.pptx
breast cancer ppt.pptxbreast cancer ppt.pptx
breast cancer ppt.pptx
 
myasthenia gravis.pptx
myasthenia gravis.pptxmyasthenia gravis.pptx
myasthenia gravis.pptx
 
lecture method ppt
lecture method pptlecture method ppt
lecture method ppt
 
Lecture Method in Nursing Education
Lecture Method in Nursing EducationLecture Method in Nursing Education
Lecture Method in Nursing Education
 
Assessment of respiratory system ptx
Assessment of respiratory system ptxAssessment of respiratory system ptx
Assessment of respiratory system ptx
 

Recently uploaded

Real Sex Provide In Goa ✂️ Call Girl (9316020077) Call Girl In Goa
Real Sex Provide In Goa ✂️ Call Girl   (9316020077) Call Girl In GoaReal Sex Provide In Goa ✂️ Call Girl   (9316020077) Call Girl In Goa
Real Sex Provide In Goa ✂️ Call Girl (9316020077) Call Girl In GoaReal Sex Provide In Goa
 
Cash Payment 😋 +9316020077 Goa Call Girl No Advance *Full Service
Cash Payment 😋  +9316020077 Goa Call Girl No Advance *Full ServiceCash Payment 😋  +9316020077 Goa Call Girl No Advance *Full Service
Cash Payment 😋 +9316020077 Goa Call Girl No Advance *Full ServiceReal Sex Provide In Goa
 
ITM HOSPITAL The hospital has also been recognised as the best emerging hosp...
ITM  HOSPITAL The hospital has also been recognised as the best emerging hosp...ITM  HOSPITAL The hospital has also been recognised as the best emerging hosp...
ITM HOSPITAL The hospital has also been recognised as the best emerging hosp...jvomprakash
 
The 2024 Outlook for Older Adults: Healthcare Consumer Survey
The 2024 Outlook for Older Adults: Healthcare Consumer SurveyThe 2024 Outlook for Older Adults: Healthcare Consumer Survey
The 2024 Outlook for Older Adults: Healthcare Consumer SurveyMedia Logic
 
Goa Call Girls Service +9316020077 Call GirlsGoa By Russian Call Girlsin Goa
Goa Call Girls Service  +9316020077 Call GirlsGoa By Russian Call Girlsin GoaGoa Call Girls Service  +9316020077 Call GirlsGoa By Russian Call Girlsin Goa
Goa Call Girls Service +9316020077 Call GirlsGoa By Russian Call Girlsin GoaReal Sex Provide In Goa
 
No Advance 931~602~0077 Goa ✂️ Call Girl , Indian Call Girl Goa For Full nig...
No Advance  931~602~0077 Goa ✂️ Call Girl , Indian Call Girl Goa For Full nig...No Advance  931~602~0077 Goa ✂️ Call Girl , Indian Call Girl Goa For Full nig...
No Advance 931~602~0077 Goa ✂️ Call Girl , Indian Call Girl Goa For Full nig...Real Sex Provide In Goa
 
Post marketing surveillance in Japan, legislation and.pptx
Post marketing surveillance in Japan, legislation and.pptxPost marketing surveillance in Japan, legislation and.pptx
Post marketing surveillance in Japan, legislation and.pptxDimple Marathe
 
Test Bank -Medical-Surgical Nursing Concepts for Interprofessional Collaborat...
Test Bank -Medical-Surgical Nursing Concepts for Interprofessional Collaborat...Test Bank -Medical-Surgical Nursing Concepts for Interprofessional Collaborat...
Test Bank -Medical-Surgical Nursing Concepts for Interprofessional Collaborat...rightmanforbloodline
 
TEST BANK For Little and Falace's Dental Management of the Medically Compromi...
TEST BANK For Little and Falace's Dental Management of the Medically Compromi...TEST BANK For Little and Falace's Dental Management of the Medically Compromi...
TEST BANK For Little and Falace's Dental Management of the Medically Compromi...rightmanforbloodline
 
Spauldings classification ppt by Dr C P PRINCE
Spauldings classification ppt by Dr C P PRINCESpauldings classification ppt by Dr C P PRINCE
Spauldings classification ppt by Dr C P PRINCEDR.PRINCE C P
 
TIME FOR ACTION: MAY 2024 Securing A Strong Nursing Workforce for North Carolina
TIME FOR ACTION: MAY 2024 Securing A Strong Nursing Workforce for North CarolinaTIME FOR ACTION: MAY 2024 Securing A Strong Nursing Workforce for North Carolina
TIME FOR ACTION: MAY 2024 Securing A Strong Nursing Workforce for North CarolinaMebane Rash
 
Test bank for community public health nursing evidence for practice 4TH editi...
Test bank for community public health nursing evidence for practice 4TH editi...Test bank for community public health nursing evidence for practice 4TH editi...
Test bank for community public health nursing evidence for practice 4TH editi...robinsonayot
 
❤️ Chandigarh Call Girls Service ☎️99158-51334☎️ Escort service in Chandigarh...
❤️ Chandigarh Call Girls Service ☎️99158-51334☎️ Escort service in Chandigarh...❤️ Chandigarh Call Girls Service ☎️99158-51334☎️ Escort service in Chandigarh...
❤️ Chandigarh Call Girls Service ☎️99158-51334☎️ Escort service in Chandigarh...rajveerescorts2022
 
VIP ℂall Girls Madhavaram Chennai 7877925207 WhatsApp: Me All Time Serviℂe Av...
VIP ℂall Girls Madhavaram Chennai 7877925207 WhatsApp: Me All Time Serviℂe Av...VIP ℂall Girls Madhavaram Chennai 7877925207 WhatsApp: Me All Time Serviℂe Av...
VIP ℂall Girls Madhavaram Chennai 7877925207 WhatsApp: Me All Time Serviℂe Av...chaddakomal #v08
 
Goa Call Girl 931~602~0077 Call ✂️ Girl Service Vip Top Model Safe
Goa Call Girl  931~602~0077 Call ✂️ Girl Service Vip Top Model SafeGoa Call Girl  931~602~0077 Call ✂️ Girl Service Vip Top Model Safe
Goa Call Girl 931~602~0077 Call ✂️ Girl Service Vip Top Model SafeReal Sex Provide In Goa
 
ISO 15189 2022 standards for laboratory quality and competence
ISO 15189 2022 standards for laboratory quality and competenceISO 15189 2022 standards for laboratory quality and competence
ISO 15189 2022 standards for laboratory quality and competencePathKind Labs
 
Goa Call Girl 931~602~0077 Call ✂️ Girl Service Vip Top Model Safe
Goa Call Girl  931~602~0077 Call ✂️ Girl Service Vip Top Model SafeGoa Call Girl  931~602~0077 Call ✂️ Girl Service Vip Top Model Safe
Goa Call Girl 931~602~0077 Call ✂️ Girl Service Vip Top Model SafeReal Sex Provide In Goa
 
ACNE VULGARIS , ALLERGIES, ECZEMA, PEMPHIGUS.pdf
ACNE VULGARIS , ALLERGIES, ECZEMA, PEMPHIGUS.pdfACNE VULGARIS , ALLERGIES, ECZEMA, PEMPHIGUS.pdf
ACNE VULGARIS , ALLERGIES, ECZEMA, PEMPHIGUS.pdfDolisha Warbi
 
clostridiumbotulinum- BY Muzammil Ahmed Siddiqui.pptx
clostridiumbotulinum- BY Muzammil Ahmed Siddiqui.pptxclostridiumbotulinum- BY Muzammil Ahmed Siddiqui.pptx
clostridiumbotulinum- BY Muzammil Ahmed Siddiqui.pptxMuzammil Ahmed Siddiqui
 

Recently uploaded (20)

Real Sex Provide In Goa ✂️ Call Girl (9316020077) Call Girl In Goa
Real Sex Provide In Goa ✂️ Call Girl   (9316020077) Call Girl In GoaReal Sex Provide In Goa ✂️ Call Girl   (9316020077) Call Girl In Goa
Real Sex Provide In Goa ✂️ Call Girl (9316020077) Call Girl In Goa
 
Cash Payment 😋 +9316020077 Goa Call Girl No Advance *Full Service
Cash Payment 😋  +9316020077 Goa Call Girl No Advance *Full ServiceCash Payment 😋  +9316020077 Goa Call Girl No Advance *Full Service
Cash Payment 😋 +9316020077 Goa Call Girl No Advance *Full Service
 
ITM HOSPITAL The hospital has also been recognised as the best emerging hosp...
ITM  HOSPITAL The hospital has also been recognised as the best emerging hosp...ITM  HOSPITAL The hospital has also been recognised as the best emerging hosp...
ITM HOSPITAL The hospital has also been recognised as the best emerging hosp...
 
The 2024 Outlook for Older Adults: Healthcare Consumer Survey
The 2024 Outlook for Older Adults: Healthcare Consumer SurveyThe 2024 Outlook for Older Adults: Healthcare Consumer Survey
The 2024 Outlook for Older Adults: Healthcare Consumer Survey
 
Goa Call Girls Service +9316020077 Call GirlsGoa By Russian Call Girlsin Goa
Goa Call Girls Service  +9316020077 Call GirlsGoa By Russian Call Girlsin GoaGoa Call Girls Service  +9316020077 Call GirlsGoa By Russian Call Girlsin Goa
Goa Call Girls Service +9316020077 Call GirlsGoa By Russian Call Girlsin Goa
 
No Advance 931~602~0077 Goa ✂️ Call Girl , Indian Call Girl Goa For Full nig...
No Advance  931~602~0077 Goa ✂️ Call Girl , Indian Call Girl Goa For Full nig...No Advance  931~602~0077 Goa ✂️ Call Girl , Indian Call Girl Goa For Full nig...
No Advance 931~602~0077 Goa ✂️ Call Girl , Indian Call Girl Goa For Full nig...
 
Post marketing surveillance in Japan, legislation and.pptx
Post marketing surveillance in Japan, legislation and.pptxPost marketing surveillance in Japan, legislation and.pptx
Post marketing surveillance in Japan, legislation and.pptx
 
Obat Penggugur Kandungan Cytotec Dan Gastrul Harga Indomaret
Obat Penggugur Kandungan Cytotec Dan Gastrul Harga IndomaretObat Penggugur Kandungan Cytotec Dan Gastrul Harga Indomaret
Obat Penggugur Kandungan Cytotec Dan Gastrul Harga Indomaret
 
Test Bank -Medical-Surgical Nursing Concepts for Interprofessional Collaborat...
Test Bank -Medical-Surgical Nursing Concepts for Interprofessional Collaborat...Test Bank -Medical-Surgical Nursing Concepts for Interprofessional Collaborat...
Test Bank -Medical-Surgical Nursing Concepts for Interprofessional Collaborat...
 
TEST BANK For Little and Falace's Dental Management of the Medically Compromi...
TEST BANK For Little and Falace's Dental Management of the Medically Compromi...TEST BANK For Little and Falace's Dental Management of the Medically Compromi...
TEST BANK For Little and Falace's Dental Management of the Medically Compromi...
 
Spauldings classification ppt by Dr C P PRINCE
Spauldings classification ppt by Dr C P PRINCESpauldings classification ppt by Dr C P PRINCE
Spauldings classification ppt by Dr C P PRINCE
 
TIME FOR ACTION: MAY 2024 Securing A Strong Nursing Workforce for North Carolina
TIME FOR ACTION: MAY 2024 Securing A Strong Nursing Workforce for North CarolinaTIME FOR ACTION: MAY 2024 Securing A Strong Nursing Workforce for North Carolina
TIME FOR ACTION: MAY 2024 Securing A Strong Nursing Workforce for North Carolina
 
Test bank for community public health nursing evidence for practice 4TH editi...
Test bank for community public health nursing evidence for practice 4TH editi...Test bank for community public health nursing evidence for practice 4TH editi...
Test bank for community public health nursing evidence for practice 4TH editi...
 
❤️ Chandigarh Call Girls Service ☎️99158-51334☎️ Escort service in Chandigarh...
❤️ Chandigarh Call Girls Service ☎️99158-51334☎️ Escort service in Chandigarh...❤️ Chandigarh Call Girls Service ☎️99158-51334☎️ Escort service in Chandigarh...
❤️ Chandigarh Call Girls Service ☎️99158-51334☎️ Escort service in Chandigarh...
 
VIP ℂall Girls Madhavaram Chennai 7877925207 WhatsApp: Me All Time Serviℂe Av...
VIP ℂall Girls Madhavaram Chennai 7877925207 WhatsApp: Me All Time Serviℂe Av...VIP ℂall Girls Madhavaram Chennai 7877925207 WhatsApp: Me All Time Serviℂe Av...
VIP ℂall Girls Madhavaram Chennai 7877925207 WhatsApp: Me All Time Serviℂe Av...
 
Goa Call Girl 931~602~0077 Call ✂️ Girl Service Vip Top Model Safe
Goa Call Girl  931~602~0077 Call ✂️ Girl Service Vip Top Model SafeGoa Call Girl  931~602~0077 Call ✂️ Girl Service Vip Top Model Safe
Goa Call Girl 931~602~0077 Call ✂️ Girl Service Vip Top Model Safe
 
ISO 15189 2022 standards for laboratory quality and competence
ISO 15189 2022 standards for laboratory quality and competenceISO 15189 2022 standards for laboratory quality and competence
ISO 15189 2022 standards for laboratory quality and competence
 
Goa Call Girl 931~602~0077 Call ✂️ Girl Service Vip Top Model Safe
Goa Call Girl  931~602~0077 Call ✂️ Girl Service Vip Top Model SafeGoa Call Girl  931~602~0077 Call ✂️ Girl Service Vip Top Model Safe
Goa Call Girl 931~602~0077 Call ✂️ Girl Service Vip Top Model Safe
 
ACNE VULGARIS , ALLERGIES, ECZEMA, PEMPHIGUS.pdf
ACNE VULGARIS , ALLERGIES, ECZEMA, PEMPHIGUS.pdfACNE VULGARIS , ALLERGIES, ECZEMA, PEMPHIGUS.pdf
ACNE VULGARIS , ALLERGIES, ECZEMA, PEMPHIGUS.pdf
 
clostridiumbotulinum- BY Muzammil Ahmed Siddiqui.pptx
clostridiumbotulinum- BY Muzammil Ahmed Siddiqui.pptxclostridiumbotulinum- BY Muzammil Ahmed Siddiqui.pptx
clostridiumbotulinum- BY Muzammil Ahmed Siddiqui.pptx
 

end of life care

  • 1. KING GEORGE’S MEDICAL UNIVERSITY KING GEORGE’S ,COLLEGE OF NURSING SEMINAR ON END OF LIFE CARE SUBMITTED TO: SUBMITTED BY: MRS. PRIYANKA SINGH DIVYA PAL CLINICAL INSTRUCTOR M.SC. N. 1ST YEAR K.G.M.U. COLLEGE OF NURSING K.G.M.U. COLLEGE OF NURSING 1
  • 2. OUTLINES • Introduction • Definition of end of life care • Terminologies • Types of grief • Theories of grief • Indications of death • Psychosocial manifestation of approaching death • Physical manifestation of approaching death • Care of the body after death 2
  • 3. INTRODUCTION End –of -life care includes physical, emotional, social and spiritual support for patients and their families. The goal of end -of -life care is to control pain and other symptoms so the patient can be as comfortable as possible. 3
  • 4. DEFINITION “End-of –life care refers to health care, not only of patients in the final hours or days of their lives, but more broadly care of all those with a terminal illness or terminal disease condition that has become advanced ,progressive and incurable.” 4
  • 5. TERMINOLOGIES Loss:- an aspect of self no longer available to a person. Death:- cessation of life. Grief:- pattern of physical and emotional responses to bereavement. End of life:- final phase of a patient’s illness when death is imminent. Death rattle:- a sound that is something heard coming from a dying person’s throat or chest. Palliative care:- making life as easy as possible for patients and families living with serious illness. 5
  • 6. Hospice care:- Hospice care is given when there is life expectancy of 6 months or less. 6
  • 7. DEFINITION OF GRIEF Grief is a strong sometime overwhelming emotion for people, regardless of whether their sadness stems from the loss of a loved one or from a terminal diagnosis they or someone they love have received. 7
  • 8. TYPES OF GRIEF Normal grief:- Complex emotional, social, physical, behavioural and spiritual responses to loss and death. Anticipatory grief:- Associated with the normal grief response before the loss actually occurs. Delayed or inhibited grief:- Absence of evidence of grief when it ordinarily would be expected. Distorted grief:- Symptoms associated with normal grieving are exaggerated. 8
  • 9. Chronic or prolonged grief:- Maintaining personal possessions aimed at keeping a lost loved one alive. Disenfranchised grief:- When relationship to the decreased person is not socially sactioned. 9
  • 10. Ambiguous loss:- The lost person is physically present but not psychologically available. Complicated grief:- Prolonged or significantly difficult time moving forward after a loss. Masked grief:- Disruptive behaviour due to loss and ineffective grief resolutions. 10
  • 11. KUBLER-ROSS THEORY 5 STAGES OF GRIEVING(1969):- The five stages of grief model or the kubler ross model is popularly known as a model that describes a series of emotions experienced by people who are grieving:- DENIAL ANGER BARGAINING DEPRESSION ACCEPTANCE 11
  • 12. 12
  • 13. BOWLBY 4 PHASES OF MOURNING (1980) Bowlby and markes (1980) identify four phases of mourning :-  Numbing  Yearning and searching  Disorganization and despair  Reorganization NUMBING:- feeling “stunned” or “unreal” can be interrupted by periods of intense emotion. 13
  • 14. YEARNING AND SEARCHING:- Full effects of emotional outbursts and uncontrollable crying. DISORGANIZATION AND DESPAIR:- Evaluation of loss, may become angry at perceived person at fault. REORGANIZATION:- Person begins to move forward with life, roles , skills and relationships. 14
  • 15. WORDEN’S FOUR TASKS OF MOURNING WORDEN’S FOUR TASKS OF MOURNING(1991):- Task 1:- To accept the reality of the loss. Task 2:- To work through the pain and grief. Task 3:- To adjust to the environment in which the decreased is missing. Task 4:- To emotionally relocate the decreased and move on with life. 15
  • 16. 16
  • 17. INDICATIONS OF DEATH Relaxed muscles No pulse No breathing Fixed eyes Total lack of response to external stimuli. No muscular movement , especially breathing. No reflexes A bowel or bladder release No response 17
  • 18. PSYCHOSOCIAL MANIFESTATIONS OF APPROACHING DEATH Altered decision making Anxiety Helplessness Life review Peacefulness Unfinished business 18
  • 19. Restlessness Saying goodbyes Decreased socialization Fear of loneliness Fear of meaninglessness Unusual communication of one’s life Fear of pain Vision like experience 19
  • 20. PHYSICAL MANIFESTATION OF APPROACHING DEATH Sensory:- decreased sensation , perception, blurring of vision, siking and glazing of eyes, blink reflex absent, eyelids remain half open. Integumentary:-mottling on hands ,feet, arms and legs , cold, clammy skin, cyanosis on nose, nail beds, knees , wax like skin when very near to death. Respiratory:- increased respiratory rate , chyne-stokes respiration , inability to cough or clear respiration , secretions resulting in grunting , gurgling. 20
  • 21. Urinary:- decreased urine output , urinary incontinence, unable to urinate. Gastrointestinal :-accumulation of gas, distension, nausea , loss of sphincter control. Musculoskeletal :- inability to move, sagging of jaw , difficulty in swallowing , difficulty in maintaining posture and alignment , loss of gag reflex, jerking. Cardiovascular:- increased heart rate, slower and weakening pulse, irregular rhythm . decreased in blood pressure , delayed absorption of drugs. 21
  • 22. CARE OF BODY AFTER DEATH PROCEDURAL GUIDELINES:- EQUIPMENTS:- Bath towels, wash clothes, wash basin, scissors, shroud kit with name tags, bed linen , room deodorizer, documentation forms. 22
  • 23. NURSES:-  Make arrangements for staff, spiritual advisor or other to stay with the family while the body is prepared for viewing. Prepare the death care tray. 23
  • 24. Cleanse body thoroughly, apply clean sheets. Brush and comb clients hair. Encourage family to say good bye through both touch and talk. 24
  • 25. Do not rush good bye process. Remove all equipments and ornaments. Clarify the personal belongingness to handover the personal objects and body. Do not discard items found after the family is gone, tell them what is found. 25
  • 26. Apply name tags. Cover the body while shifting on the death trolly. Complete documentation Follow all protocols and policies to meet all legal requirements in caring for the body. 26
  • 27. APPROPRIATE DOCUMENTATION Time of death and actions taken to prevent or cardiac arrest record if applicable. Name of the person that pronounced the client’s death. Make special preparation and type of donation , including time, staff, company. 27
  • 28. The name of the family member or friend who was called and who came to the hospital- donor organization, morgue, funeral home, chaplain. Time of discharge and destination of the body , location of the name tags on the body, special requests .  Made by the family ,any other statements that might be needed to clarify the situation. 28
  • 29. 29