End-of-life care
Caring for the dying patient and his family
Caring for the dying patient and his family
The experience of dying is unique for each patient and family. Nurses must discover what each dying patient and his family need. What are they afraid of? What do they need to know? What will help them? It’s important to help both the patient and his family prepare for the dying process.
The dying process
The dying process is a total body system failure. Although each patient’s death progresses differently, the dying process usually occurs over 10 to 14 days, but can take as little as 24 hours. The following is a summary of the effect of the dying process on each body system.
Cardiovascular system
♦ Decreasing need for food and drink
♦ Dehydration
♦ Initial increase in the heart rate, followed by a decrease as hypoxia develops
♦ Decrease in blood pressure and the volume of Korotkoff sounds
Integumentary system
♦ Perspiration
♦ Cold, clammy skin
♦ Pale, ashen, or mottled skin
♦ Darkened skin at the sacrum and lower back
♦ Blanching of the skin when touched, with little or no return of color
Respiratory system
♦ Diminished or adventitious breath sounds
♦ Moist-sounding respirations
♦ Dyspnea or air hunger
♦ Tachypnea
♦ Irregular breathing, or Cheyne-Stokes respirations
Musculoskeletal system
♦ Muscle weakness
♦ Drooping of the mouth
♦ Difficulty swallowing
♦ Relaxation of the tissues of the soft palate
♦ Decline in the gag reflex and reflexive clearing of the oropharynx
Renal system
♦ Decreased urine output
♦ Urinary incontinence
Other signs and symptoms
♦ Moaning and grunting with breathing
♦ Agitation and restlessness
♦ Decreased communication (“transitional withdrawal” as a result of the body failing)
♦ Decreased hearing and vision
♦ Confusion
♦ Difficulty rousing the patient
♦ Visions of people and things not visible to others
♦ Bowel incontinence
Five signs of impending death
♦ Clouding of consciousness
♦ Death rattle
♦ Mandibular movement on respiration
♦ Cyanosis of the extremities
♦ No pulse in the radial artery
Meeting patient and family needs
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