4. DEFINITION
• The irreversible cessation of all vital function
especially as indicated by permanent stoppage
of the heart, respiration brain activity etc.
7/4/2017 4
12. 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.
127/4/2017
13. CARE OF THE DYING PATIENT
Psychological support
Advance Planning For Imminent Death
Financial Concerns
Legal and Ethical Concern
Helping the Patient Transition
Pain Management
The Patient's Right to Information
Symptomatic Management
137/4/2017
14. SYMPTOMATIC MANAGEMENT
Problem associated with breathing:
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.
147/4/2017
15. Problem associated with eating and drinking:
Anorexia, nausea, and vomiting are commonly
seen in dying patient. They are unable to take any
form of food and if they taken, they are unable
to retain the food.
I.V fluids.
Sips of water is given with teaspoon.
Give frequent oral hygiene.
Apply emollients to the dry lips.
The denture are removed and kept safely.
157/4/2017
16. 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 thing 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.
167/4/2017
17. 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.
Problem associated with communication
Confusion
Withdrawal
177/4/2017
18. Problem associated with rest and sleep:
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.
Pharmacological management
Anti-pyretic
Analgesic
Anti-emetic
Lifesaving drug if required 187/4/2017
19. SIGNS OF CLINICAL DEATH
Absence of pulse, heart beat and respirations
Pupil becoming fixed and not reacting to light
Absence of all reflex.
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.
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20. NURSING MANAGEMENT
A. Role of Nurse
B. Assessment
I. History taking
II. Physical Examination
C. Nursing Diagnosis
207/4/2017
RESPIRATORY SYSTEM-Respiration becomes irregular, cheyne –strokes rapid and shallow 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,