1212C Session 1
MODULE 4
Exemplars: Death and Dying, Intercranial Regulation/Lumbar Puncture, Seizures
Death-Dying-End of Life Care
Part of the normal life cycle
Nurses can affect the dying process
Preventing death without dignity
Promoting a peaceful, meaningful death
Helping patient remain free from distress
Minimizing suffering for patients and families
Planning for End of Life and
Advance Directives
Patient Self-Determination Act (PSDA)
Documentation associated with PSDA
Advance directive
o also known as living will, personal directive, advance directive, medical
directive or advance decision, is a legal document in which a person specifies what
actions should be taken for their health if they are no longer able to make decisions for
themselves
Durable power of attorney for healthcare (DPOAHC)
Living will
Do not resuscitate (DNR)
Allow for Natural Death (AND)
Physician orders for life-sustaining treatment (POLST)
Compassion
Is the ability to be with someone who is suffering.
Is less like a feeling and more like a human capacity
that is developed and sustained in relation to
others.
Needs to be shared and passed on
Even brief and fleeting expressions of compassion
nourish this quality in ourselves and in others.
Truly hearing the suffering of others puts us
in touch with our own needs and vulnerabilities,
and we might want to turn away to protect ourselves.
Hospice Care
Multidisciplinary team is made up of the physician, nurse, chaplain, social worker, certified nursing aide,
volunteer, and bereavement counselor.
All medications and supplies related to a terminal diagnosis are covered by Medicare and reimbursed.
,Other insurance providers mimic Medicare benefits.
Hospice Care (Con’t)
Most patients are cared for in the “home.”
Short-term acute inpatient care is available.
Respite periods for caregivers are available.
Patients are perceived as living fully until they die.
Choices and preferences are incorporated in care.
Patient and family are considered the unit of care and both receive counseling and support in
anticipatory grief and mourning, as well as in spirituality and meaning making.
Electing hospice care is appropriate when the patient leaves the hospital or physician’s office
with the understanding that a cure is no longer possible, but many sophisticated medical and
holistic interventions are still available for this phase of living.
Palliative Care
Palliative care is an approach that improves the quality of life of patients (adults and children)
and their families who are facing problems associated with a life-threatening illness. It prevents
and relieves suffering through the early identification, correct assessment and treatment of pain
and other problems, whether physical, psychosocial, or spiritual.
Palliative care is a crucial part of integrated, people-centered health services, at all levels of care:
it aims to relieve suffering, whether its cause is cancer, major organ failure, drug-resistant
tuberculosis, end-stage chronic illness, extreme birth prematurity or extreme frailty of old age
(WHO, 2021)
Individual choices and decisions regarding care are paramount and must be followed.
Is more common in hospitals and other medical or home health care settings “whenever
comfort, support, and quality of life are significant concerns for terminal illness.”
Therapeutic Presence
People going through intense life experiences report that they do not remember what others said to
them, but only what the others made them feel. The intentional presence of another person makes
people feel seen, valued, and important.
End of Life Care
Vocabulary
Cachexia - weakness and wasting of the body due to severe chronic illness
Death Rattle - are sounds often produced by someone who is near death as a result of fluids
such as saliva and bronchial secretions accumulating in the throat and upper chest.
Cheyne-Stokes Respirations - cyclic breathing marked by a gradual increase in the rapidity
of respiration followed by a gradual decrease and total cessation for from 5 to 50 seconds
End of Life Care
, Managing Weakness
Aspiration precautions
Provide mouth care; apply emollient to lips
Altered routes of medication administration
Choose least invasive route with the most effective treatment
Managing Dyspnea
Supplemental 02 for comfort
Electric fan for air circulation
Reposition
End of Life Care
Managing Nausea and Vomiting
Antiemetic agents
Prochlorperazine (Compazine)
Ondansetron (Zofran)
Metoclopramide (Reglan, Maxeran)
Anti-inflammatory agent
Dexamethasone (Decadron, Deronil, Dexasone)
Remove any source of odors
Comfortable room temperature
Aromatherapy
Music Therapy
End of Life
Terminally ill patients in pain:
Adequate pain management is the priority for those with chronic pain
****Many patients’ primary wish is to die without pain, and the best intervention to meet this
goal is the administration of pain medication around the clock (SCHEDULED) with extra doses for
breakthrough pain. ***Morphine sublingual is most appropriate for someone unable to
swallow, is utilized, and available more readily than a pill or tablet.
Fentanyl (Sublimaze) [prescribed in mcg]
o Transdermal Fentanyl - *Change the patch every 72 hours*
End of Life Care
Managing Agitation and Delirium
Assess for pain, urinary retention, constipation
Music therapy; aromatherapy
Pharmacologic agents
o Opioids, bronchodilators, diuretics, antibiotics, anticholinergics, benzodiazepines,
antipsychotic medication for end-of-life psychosis
End of Life
MODULE 4
Exemplars: Death and Dying, Intercranial Regulation/Lumbar Puncture, Seizures
Death-Dying-End of Life Care
Part of the normal life cycle
Nurses can affect the dying process
Preventing death without dignity
Promoting a peaceful, meaningful death
Helping patient remain free from distress
Minimizing suffering for patients and families
Planning for End of Life and
Advance Directives
Patient Self-Determination Act (PSDA)
Documentation associated with PSDA
Advance directive
o also known as living will, personal directive, advance directive, medical
directive or advance decision, is a legal document in which a person specifies what
actions should be taken for their health if they are no longer able to make decisions for
themselves
Durable power of attorney for healthcare (DPOAHC)
Living will
Do not resuscitate (DNR)
Allow for Natural Death (AND)
Physician orders for life-sustaining treatment (POLST)
Compassion
Is the ability to be with someone who is suffering.
Is less like a feeling and more like a human capacity
that is developed and sustained in relation to
others.
Needs to be shared and passed on
Even brief and fleeting expressions of compassion
nourish this quality in ourselves and in others.
Truly hearing the suffering of others puts us
in touch with our own needs and vulnerabilities,
and we might want to turn away to protect ourselves.
Hospice Care
Multidisciplinary team is made up of the physician, nurse, chaplain, social worker, certified nursing aide,
volunteer, and bereavement counselor.
All medications and supplies related to a terminal diagnosis are covered by Medicare and reimbursed.
,Other insurance providers mimic Medicare benefits.
Hospice Care (Con’t)
Most patients are cared for in the “home.”
Short-term acute inpatient care is available.
Respite periods for caregivers are available.
Patients are perceived as living fully until they die.
Choices and preferences are incorporated in care.
Patient and family are considered the unit of care and both receive counseling and support in
anticipatory grief and mourning, as well as in spirituality and meaning making.
Electing hospice care is appropriate when the patient leaves the hospital or physician’s office
with the understanding that a cure is no longer possible, but many sophisticated medical and
holistic interventions are still available for this phase of living.
Palliative Care
Palliative care is an approach that improves the quality of life of patients (adults and children)
and their families who are facing problems associated with a life-threatening illness. It prevents
and relieves suffering through the early identification, correct assessment and treatment of pain
and other problems, whether physical, psychosocial, or spiritual.
Palliative care is a crucial part of integrated, people-centered health services, at all levels of care:
it aims to relieve suffering, whether its cause is cancer, major organ failure, drug-resistant
tuberculosis, end-stage chronic illness, extreme birth prematurity or extreme frailty of old age
(WHO, 2021)
Individual choices and decisions regarding care are paramount and must be followed.
Is more common in hospitals and other medical or home health care settings “whenever
comfort, support, and quality of life are significant concerns for terminal illness.”
Therapeutic Presence
People going through intense life experiences report that they do not remember what others said to
them, but only what the others made them feel. The intentional presence of another person makes
people feel seen, valued, and important.
End of Life Care
Vocabulary
Cachexia - weakness and wasting of the body due to severe chronic illness
Death Rattle - are sounds often produced by someone who is near death as a result of fluids
such as saliva and bronchial secretions accumulating in the throat and upper chest.
Cheyne-Stokes Respirations - cyclic breathing marked by a gradual increase in the rapidity
of respiration followed by a gradual decrease and total cessation for from 5 to 50 seconds
End of Life Care
, Managing Weakness
Aspiration precautions
Provide mouth care; apply emollient to lips
Altered routes of medication administration
Choose least invasive route with the most effective treatment
Managing Dyspnea
Supplemental 02 for comfort
Electric fan for air circulation
Reposition
End of Life Care
Managing Nausea and Vomiting
Antiemetic agents
Prochlorperazine (Compazine)
Ondansetron (Zofran)
Metoclopramide (Reglan, Maxeran)
Anti-inflammatory agent
Dexamethasone (Decadron, Deronil, Dexasone)
Remove any source of odors
Comfortable room temperature
Aromatherapy
Music Therapy
End of Life
Terminally ill patients in pain:
Adequate pain management is the priority for those with chronic pain
****Many patients’ primary wish is to die without pain, and the best intervention to meet this
goal is the administration of pain medication around the clock (SCHEDULED) with extra doses for
breakthrough pain. ***Morphine sublingual is most appropriate for someone unable to
swallow, is utilized, and available more readily than a pill or tablet.
Fentanyl (Sublimaze) [prescribed in mcg]
o Transdermal Fentanyl - *Change the patch every 72 hours*
End of Life Care
Managing Agitation and Delirium
Assess for pain, urinary retention, constipation
Music therapy; aromatherapy
Pharmacologic agents
o Opioids, bronchodilators, diuretics, antibiotics, anticholinergics, benzodiazepines,
antipsychotic medication for end-of-life psychosis
End of Life
