CARE OF THE PATIENT WITH

CRITICAL ILLNESS

BASICS FOR STUDENT NURSESH. Deepani

RN, BN, Nursing TutorSchool of Nursing

Colombo

DEATH Irreversible cessation of

circulatory and respiratory functions

Irreversible cessation of all functions of the entire brain, including the brain stem

STAGES –(KUBLER-ROSS) Denial/ isolation – refuse the

diagnosis- go from one Dr. to

another Anger -angry about sickness Bargaining - makes

negotiation for cure Depression – withdrawal, crying Acceptance – ready for death

DENIAL“They made wrong diagnosis. This

is not about me”

ANGER“why me? I’m such a nice person.

Why I was selected?”

BARGAINING“if I can wait until my son’s

graduation I will be satisfied. Please god let me alive until then”

Fulfill bargaining as much as possible to help the client to go to next stage

DEPRESSION“ I waited so long to see my

daughter’s wedding and to cuddle my grand children. I can’t bear the thought of not being their for her wedding”

ACCEPTANCE“I’ve completed all my

responsibilities. Made my last will. Everybody can live peacefully even without me. So I’m happy to go to last sleep”

SIGNS OF IMPENDING DEATH Inability to swallow Decreased GI tract and urinary tract activity Bowel & bladder incontinence Loss of sensation Loss of motion Slight elevation of body temperature Cold clammy skin Cyanosis Low BP Noisy & irregular respiration- cheyne stokes

respiration unconsciousness

PROBLEMS OF DYING PATIENT Pain Anxiety Depression Fear Loss of dignity

CARE OF DYING CLIENT Fulfill psychological needs

according to the stage of death-keep relative with-never leave alone-answer questions-encourage to cope-allow religious practices-no discussion about pt at his presence

Fulfill physiological needs1. Environment

-close to nurses station-well ventilated-pleasant- provide privacy with screen-adequate light-equipment for manage emergency-allow a relative

2. Relieve pain-give anelgesics-keep in comfortable position-explain every procedures

3. Positioning-lateral-semi prone-supine with head turned to a side

( allows draining of secretion)-semi fowler’s and O2 via mask if dyspnoec

4. Nutritional needs-very small amount of oral feed at a time if swallowing reflex present-feed with a spoon-sip of ice water-NG feed as ordered if unconscious or no swallowing reflex-IV infusions

5. Personal hygiene-provide total hygeine care

6. Elimination-catheterization for urinary incontinence & retention-incontinence pad for bowel incontinence-suppository for constipation

7. Protect from injuries-bar bed-never leave client alone

8. Assist with last will-inform Dr.-inform relative if client wish-arrange legal facilities-nurse should stay away during documentation of last will

9. Facilitate organ donation-provide informations-can donate heart, lungs, liver , kidney and cornea-help to fill up the consent form-consent can be given by the immediate relatives of the client

10. Inform family members-if relatives are present inform them verballyand get the signature-if not inform over the phone or telemailusually this is done by the Dr. after making records about pt’s condition in the BHT

SIGNS OF DEATH No pulse No respiration No heart sounds BP unrecordable Flat ECG wave Fixed & dialated pupils No reflexes Flat EEG

AUTOPSY Examination of the organ & tissues of a

human body after death. Consent - before death by the person - after death by immediate

relative-taken by physician

Contribute to the advancement of medical science

Autopsy which doesn’t require consent of person or guardian

1. Death occurred by within 24 hours of the admission to the hospital

2. Death due to accidents3. Suicide4. Homicide5. Illegal therapeutic practice

Dr. writes in the BHT “inquest ordered”

These deaths should inform to the coroner &Judicial Medical Officer (JMO)

Coroner decides the need of autopsy

CHANGES IN BODY AFTER DEATH Rigor mortis – stiffness of the

body within 2-4 hours after death

Algor mortis – decreasing temperature

-loss of elasticity of the skin

Livor mortis – discoloration of dependant body parts due to blood pooling (back)

NURSES RESPONSIBILITY AFTER A DEATH OF A CLIENT Caring for dead body Caring for family members Legal responsibilities Care of patient’s valuables Issuing and signing of death

certificate Labeling the body Review organ donation

arrangements

CARE OF THE BODYAfter written confirmation of

death by the Dr. nurse should prepare the dead body to discharge

Keep body in normal anatomical position

Close eyes Remove soiled garments

CARE OF THE BODY Remove every attached devices

(cannula, catheters, NG tube, drain tubes, POP casts etc.) do not remove if autopsy(inquest) is required

If necessary wash the body (controversial ideas)

Cover any wounds with tight dressing

Pack every orifice with cotton swabs For female cover perineum with a pad Replace dentures Dress with light color or white dress Keep hands interlaced over the chest Tie both thumbs, both knees and both

big toes together with a cotton bandage

Apply barrel bandage to jaw Attach identification tags to the dress

and big toes

Keep another tag attached to the death record book

Cover whole body with a white cloth If relatives want to stay with body

allow them for grieving If relatives want to stay with body

allow them for grieving Keep the unit screened Inform the mortuary about the time

of death Keep the body in the ward for 2

hours

CARING FOR FAMILY MEMBERS Listen them Allow them to express feelings, grief, loss and helplessness

Provide them to sit Give First aid for fainting attacks of relatives

Reassure them Review them their dedication for care, optimal care given at the hospital

CARING FOR FAMILY MEMBERS Explain the need of keeping

body 2 hours at the ward Help them in legal aspects Participate for the funeral Refer for appropriate services if

family not coping well

DEATH IDENTIFICATION CARD Name of the client BHT No Ward No Age Sex Race Religion Address of the guardian Date & time of admission Date & time of death Diagnosis Signature of ward sister & date

Prepare 3 cards Attach 2 to the body and send

the remaining card to the mortuary with person accompanying the body

If inquest ordered write “inquest ordered” in the cards

LEGAL RESPONSIBILITIESOnce the death is confirmed by the Dr. Get the death certificate filled Inform director- BHT to director’s office Inform relatives- BHT to inquiry office If inquest ordered send the BHT to the

police post for necessary action Get the permission of the hospital

director Police will inform to the coroner, police

of the dead person’s area

LEGAL RESPONSIBILITIES Coroner, Dr., relevant police

officer & relative will discuss about the death

If no suspicion cause of death will be mentioned

If suspicious post mortem is held

POST MORTEM If the cause of death is uncertain

post mortem is held Done by Judicial Medical Officer

(JMO) Usually conducted for death

followed byAssault, accidents, poisoning,

gunshot injury, stab and any suspicious deaths

CARE OF THE VALUABLES Prepare a list of valuables Record it in the BHT and hand over to

the relatives Get the signature of guardian If relatives not available hand over

valuables to ward sister with a list If its difficult to remove the wedding

ring or relatives want to keep the wedding ring, cover it with an adhesive plaster & make note in the BHT

DOCUMENTATION Admission register- patient expired at

2.40 am on 22/12/2014 In the death register In the day report/ night report{condition of the client, how the situation occurred, treatment and care given, and the time of death in red ink “pt. expired at 2.40 am on 22/12/2015” If death certified by the Dr. “death

certified by the doctor” If inquest ordered “inquest ordered” Giving over book

DEATH AT HOME Get the death confirmed by a

doctor Inform the G.S. in the area Inform the registrar of the area If any suicide or homicide occur

inform the police

Questions ?

Thank you!