Medical Ethics

1. CARE OF DYING
PATIENT

2. INTRODUCTION
Life begin with birth and ends with
death. clients death is often viewed as
personal failure on the part of health
personnel. The family turns to the nurse
for support and assistance. To provide
effective care nurse must have reconciled
his or her own feelings about death and
must understand the phases of grieving &
dying and should be able to recognize their
manifestations.

3. Cont………..
Death will come to all people at some
time. caring allows the patient to die
with dignity. an important aspect of
patient care is to the patient sense of
identity & self esteem. every person has
the right to die with dignity.

4. Definition
 Terminal illness is a disease that cannot be
cured or adequately treated and that is
reasonably expected to result in the death of
the patient within a short period of time.
This term is more commonly used for
progressive diseases such as cancer or
advanced heart disease than for trauma.

5. MEETING THE NEEDS OF DYING
INDIVIDUAL
Assessing needs
Explaining the clients condition and treatment
Maintaining good communication
Promoting self care & Self Esteem
Allowing family members to assists in care.
Meeting clients needs.
 Physiological needs
 Psychological needs
 Spiritual needs

6. STAGES OF DYING
(DR.ELIZABETH KUBLER ROSS)
DENIAL
ISOLATION
ANGER
BARGAINING
DEPRESSION
ACCEPTANCE

7. GRIEF AND STAGES OF GRIEF REACTION
# Grief is the emotional pain caused by a loss.
Engel (1964) was among the first to define six
stages of grief reaction. Which includes the
following steps.
 Shock And Disbelief
 Developing Awareness: Shows physical and
emotional response such as anger, crying why me?
 Restitution: Act of giving back
 Idealization: Acceptance of loss
 Outcome:

8. SIGNS OF APPROACHING DEATH
Facial appearance.
Changes in sight, speech, and hearing.
Respiratory system.
Circulatory system.
Gastro intestinal system.
Genito urinary system.
Skin and musculo skeletal system.
Central nervous system.

9. Facial appearance.
 Facial muscle relax, cheek becomes flaccid moving in
and out with each breath. Facial structure may change
so the dentures cannot be worn, mouth structure may
collapse, loss of muscles tone & prominent cheeks,
pale, sunken eyes.
 CHANGES IN SIGHT, SPEECH, AND HEARING.-
Sight gradually fail. The pupil’s fails to react to light.
Eyes are sunken and half closed. Speech becomes
increasingly difficult, confused. Loss of Hearing.

10.  RESPIRATORY SYSTEM-Respiration becomes
irregular, rapid and shallow breath or very slow &
Sertorius due to the presence of secretions.
 CIRCULATORY SYSTEM.-Circulatory changes cause
alterations in the temperature, pulse and respirations.
Radial pulse gradually fails. Once it stops, the apical
pulse may continue for some time. Usually the
pulsations are seen even after the patient has stopped
breathing.
 GASTRO INTESTINAL SYSTEM.-Hiccoughs,
Nausea, Vomiting, abdominal distensions are seen.
The gag reflux disappears; the patient feels the
inability to swallow,

11.  “DEATH RATTLE”-A rattling sound heard in throat
caused by secretions that the patient cannot cough
longer.
 GENITO URINARY SYSTEM-Retention of urine,
distention of the bladder, incontinence of urine and
stool due to loss of sphincter control.
 SKIN AND MUSCULO SKELETAL SYSTEM.-The skin
may become pale, cool and sweats lot (cold
sweats).Ears and nose are cold to touch. Skin is pale &
mottled due to congestion of blood in the veins as a
result of circulatory failure.
 CENTRAL NERVOUS SYSTEM.-Reflexes and pain are
gradually lost. Patient may be restless due to lack of
oxygen and due to raised body temperature, although
the body surface is cool.

12. SIGNS OF CLINICAL DEATH
Absence of pulse, heart beat and respirations
Pupil becoming fixed and not reacting to light
Absence of all refluxes.
Rigor mortis: Stiffing of the body after death. The
arms & legs cannot be bent or straightened while
rigor mortis is present unless the tendons are torn.
 POSTMORTEM HYPOSTASIS-It is a dark red or
bluish discoloration due to the settling of the
blood.

13. CARE OF THE DYING PATIENT
Psychological support:
The psychological need of a dying person can be
summarized as follows:
 Relief from loneliness, fear and depression.
 Maintenance of security, self confidence and dignity.
 Maintenance of hope.
 Meeting the spiritual needs according to his religious
customs.
The dying person may be shifted to privet room, or
privacy is maintained by putting the screen, so that other
patients may not be disturbed by the unpleasant sight, the
crises and other disturbances.

14. SYMPTOMATIC MANAGEMENT
Problem associated with breathing:
The dying person who is restless, apprehensive and
short of breath may be given-
Oxygen inhalation to remove his discomfort.
 Elevation of the patient’s head and shoulders may
make breathing easier.
Keep the room well ventilated and keep crowed away.
Periodic suctioning is necessary.

15. Problem associated with eating and
drinking:
Anorexia, nausea, and vomiting are commonly seen in
dying patient person. They are unable to take any
form of food and if they taken, they are unable to
retain the food.
The patient is unable to swallow even the sips of water
poured in the mouth. Most of them may require I.V
fluids.
If they can tolerate the oral fluids, sips of water is given
with teaspoon. That will help the patient to keep the
mouth moist.
Give frequent oral hygiene.
Apply emollients to the dry lips.
The denture are removed and kept safely.

16. Problem associated with elimination:
Constipation, retention of urine and incontinence
of urine and stool are some of problem faced by the
patient.
Catheterization has to be done
Through skin and Perineal care is to be given, to keep
the patient clean and to prevent skin breakdown.
Problem associated with immobility:
Frequent skin care should be given with particular
attention to the pressure point.
Patient should be comfortably placed and their position
frequently changed in the bed.

17. Problem associated with sense organ:
Since the patient loses sight, before given any care to
the patient, the nurse should touch the patient and
say what she is going to do.
Since the hearing is retained longer, speak only what
is appropriate.
Avoid whispering any think in patient room.
Speak distinctly so that patient may understand what
is done for him.
Since the eyes are opened, protect the eyes from
corneal ulceration with protective ointment.

18. Problem associated with rest and sleep:
Patient may distressing symptoms in these patients.
Patient should not be disturbed while sleeping.
The visitors should be instructed not to disturbed the
patient during his resting.
Maintain calm and quit environment.
Problem associated with cleanliness and
grooming:
Cleanliness and appearance are important until the
end.
Cleanliness of the skin, hair, mouth, and cloth has to
be maintained.

19. CARING FOR THE BODY AFTER
DEATH
 After the physician has pronounced death legally
documented the death in the medical record, care
of the body is usually performed by the nurse.
 An autopsy consent may be requested & obtained
if required.
 If the patient is to be an organ donor arrangements
will be made immediately.
 The family often wishes to view the body before
final preparations are made, they may be allowed.
 If the patient had any valuables, they are handed
over to the relatives

20. PURPOSES
Make body look as natural & beautiful
as possible.
Perform his last duty tenderly.
Protect other patients from unpleasant
sights and sounds which could frighten
them

21. ARTICLES REQUIRED
Articles for bath
Extra bandages and cotton swabs
Perineal pads
Sheets
Restraints for jaw, hands and legs.
Pair of gloves
Thumb forceps
Patients own set of clothes.

22. PROCEDURE
Wash hands and put on gloves
Soon the death is pronounced, remove the
backrest, extra pillows and gently put the
patient in a supine position with the head
elevated on the pillow.
Positioning is important after death,
because of rigor mortis. close the patients
eyes and mouth.
Remove all tubes and other devices from the
patients body.

23. Cont…..
Consult close relatives before preparing the body
for removal from the ward to the mortuary where
the relatives will receive the body.
If the relatives require, the nurse should help
them to sponge the patient as necessary. brush
and comb hair.
Replace soiled dressing with cleaned ones.
Apply perineal pads and plug the rectum &
vagina (in females) with cotton balls.
Provide clean cloths(own).

24. Cont……..
Take care of valuables and personal
belongings by handing over to members of
family.
Allow members of family to see the patient
& remain in the room & remember that the
body is still dear to someone.
Close the body from side to side and head to
foot with the sheet.

25. Cont……
Prepare the identification slip and attach it
to the patients pack sheet.
Attach a special label if the patient had a
contagious disease.
Transfer the body to the mortuary.
Remove contaminated articles from room.

26. IDENTIFICATION TAG SHOULD CONTAIN
 Patient name
 Age
 Registration number
 Relatives name (specify)
 Address
 Ward number
 Bed number
 Date and time of death
 Cause of death

27. CONCLUSION
When death cannot be prevented it becomes
imperative that the doctor and nurse do all
whatever is necessary to make dating less difficult
for the patient. the dying patient has a variety of
needs ranging from the need for open
communication to physiological and spiritual
needs. they should maintain self care as long as
possible. families of the dying patient may like to
assist in providing care. The nurse should provide
emotional support for the grieving family.

28. THANK
YOU