NUR2392 Multidimensional Care II MDC 2 Exam 1
Blueprint | With 100% Accurate Expert Interventions | 78
Questions & Answers
NUR2392, MDCII – Examination Blue Print – Exam 1
End-of-Life
• Pathophysiology of Death- Death is defined as the
cessation of integrated tissue and organ function,
manifesting with lack of heartbeat, absence of
spontaneous respirations, or irreversible brain
dysfunction.
S/S of Approaching death- As death nears,
patients often have signs and symptoms of
decline in
• physical function- manifesting as weakness
• increased sleep.
• anorexia
• changes in cardiovascular function
• breathing patterns
• genitourinary function.
• Level of consciousness often declines to lethargy,
unresponsiveness, or coma.
• Cardiovascular dysfunction leads to decreases in
peripheral circulation and poor tissue perfusion
manifesting as cold, mottled, and cyanotic extremities.
• Blood pressure decreases and often is only palpable.
• The dying person’s heart rate may increase, become
irregular, and gradually decrease before stopping.
• Changes in breathing pattern are common, with
breaths becoming very shallow and rapid. Periods of
apnea and Cheyne-Stokes respirations (apnea
alternating with periods of rapid breathing) are also
common. Death occurs when respirations and
heartbeat stop.
o Management of symptoms
Patient and Family Education: Preparing for Self-Management
Common Physical Signs and Symptoms of Approaching Death With Recommended Comfort Measures
Coolness of Extremities
Circulation to the extremities is decreased; the skin may become mottled or discolored.
1. • Cover the patient with a blanket.
2. • Do not use an electric blanket, hot water bottle, or electric heating pad to warm the patient. Increased
Sleeping
,NUR2392 Multidimensional Care II MDC 2 Exam 1 Blueprint
Metabolism is decreased.
1. • Spend time sitting quietly with the patient.
2. • Do not force the patient to stay awake.
3. • Talk to the patient as you normally would, even if he or she does not respond.
Fluid and Food Decrease
Metabolic needs have decreased.
1. • Do not force the patient to eat or drink.
2. • Offer small sips of liquids or ice chips at frequent intervals if the patient is alert and able to swallow.
3. • Use moist swabs to keep the mouth and lips moist and comfortable.
4. • Coat the lips with lip balm.
Incontinence
The perineal muscles relax.
1. • Keep the perineal area clean and dry. Use disposable under pads and disposable undergarments.
2. • Offer a Foley catheter for comfort.
Congestion and Gurgling
The person is unable to cough up secretions effectively.
1. • Position the patient on his or her side. Use toothette to gently clean mouth of
secretions.
2. • Administer medications to decrease the production of secretions. Breathing Pattern
Change
,NUR2392 Multidimensional Care II MDC 2 Exam 1
Blueprint | With 100% Accurate Expert Interventions | 78
Questions & Answers
Slowed circulation to the brain may cause the breathing pattern to become irregular, with brief periods of no
breathing or shallow breathing.
1. • Elevate the patient’s head.
2. • Position the patient on his or her side.
Disorientation
Decreased metabolism and slowed circulation to the brain.
1. • Identify yourself whenever you communicate with the person.
2. • Reorient the patient as needed.
3. • Speak softly, clearly, and truthfully.
Restlessness
Decreased metabolism and slowed circulation to the brain.
1. • Play soothing music and use aromatherapy.
2. • Do not restrain the patient.
3. • Talk quietly.
4. • Keep the room dimly lit.
5. • Keep the noise level to a minimum.
6. • Consider sedation if other methods do not work.
o Postmortem Care
• Provide all care with respect to communicate that the person was important and valued.
• Ask the family or significant others if they wish to help wash the patient or comb his or her hair; respect and
follow their cultural practices for body preparation.
• If no autopsy is planned, remove or cut all tubes and lines according to agency policy.
• Close the patient’s eyes unless the cultural or religious practice is for a family member or other person to close the
eyes.
• Insert dentures if the patient wore them.
• Straighten the patient and lower the bed to a flat position.
• Place a pillow under the patient’s head.
• Wash the patient as needed and comb and arrange the patient’s hair unless the family desires to perform bathing
and body preparation.
• Place waterproof pads under the patient’s hips and around the perineum to absorb any excrement.
• Clean the patient’s room or unit.
• Allow the family or significant others to see the patient in private and to perform any religious or cultural customs
they wish (e.g., prayer).
• Assess that all who need to see the patient have done so before transferring to the funeral home or morgue.
• Notify the hospital chaplain or appropriate religious leader if requested by the family or significant others.
• Ensure that the nurse or physician has completed and signed the death certificate.
• Prepare the patient for transfer to either a morgue or a funeral home; wrap the patient in a shroud (unless the
family has a special shroud to use), and attach identification tags per agency policy.
• Hospice vs Palliative Care
, NUR2392 Multidimensional Care II MDC 2 Exam 1 Blueprint
• Impact of Pain & Pain Management Impact of Unrelieved Pain
Physiologic Impact Quality-of-Life Impact
Blueprint | With 100% Accurate Expert Interventions | 78
Questions & Answers
NUR2392, MDCII – Examination Blue Print – Exam 1
End-of-Life
• Pathophysiology of Death- Death is defined as the
cessation of integrated tissue and organ function,
manifesting with lack of heartbeat, absence of
spontaneous respirations, or irreversible brain
dysfunction.
S/S of Approaching death- As death nears,
patients often have signs and symptoms of
decline in
• physical function- manifesting as weakness
• increased sleep.
• anorexia
• changes in cardiovascular function
• breathing patterns
• genitourinary function.
• Level of consciousness often declines to lethargy,
unresponsiveness, or coma.
• Cardiovascular dysfunction leads to decreases in
peripheral circulation and poor tissue perfusion
manifesting as cold, mottled, and cyanotic extremities.
• Blood pressure decreases and often is only palpable.
• The dying person’s heart rate may increase, become
irregular, and gradually decrease before stopping.
• Changes in breathing pattern are common, with
breaths becoming very shallow and rapid. Periods of
apnea and Cheyne-Stokes respirations (apnea
alternating with periods of rapid breathing) are also
common. Death occurs when respirations and
heartbeat stop.
o Management of symptoms
Patient and Family Education: Preparing for Self-Management
Common Physical Signs and Symptoms of Approaching Death With Recommended Comfort Measures
Coolness of Extremities
Circulation to the extremities is decreased; the skin may become mottled or discolored.
1. • Cover the patient with a blanket.
2. • Do not use an electric blanket, hot water bottle, or electric heating pad to warm the patient. Increased
Sleeping
,NUR2392 Multidimensional Care II MDC 2 Exam 1 Blueprint
Metabolism is decreased.
1. • Spend time sitting quietly with the patient.
2. • Do not force the patient to stay awake.
3. • Talk to the patient as you normally would, even if he or she does not respond.
Fluid and Food Decrease
Metabolic needs have decreased.
1. • Do not force the patient to eat or drink.
2. • Offer small sips of liquids or ice chips at frequent intervals if the patient is alert and able to swallow.
3. • Use moist swabs to keep the mouth and lips moist and comfortable.
4. • Coat the lips with lip balm.
Incontinence
The perineal muscles relax.
1. • Keep the perineal area clean and dry. Use disposable under pads and disposable undergarments.
2. • Offer a Foley catheter for comfort.
Congestion and Gurgling
The person is unable to cough up secretions effectively.
1. • Position the patient on his or her side. Use toothette to gently clean mouth of
secretions.
2. • Administer medications to decrease the production of secretions. Breathing Pattern
Change
,NUR2392 Multidimensional Care II MDC 2 Exam 1
Blueprint | With 100% Accurate Expert Interventions | 78
Questions & Answers
Slowed circulation to the brain may cause the breathing pattern to become irregular, with brief periods of no
breathing or shallow breathing.
1. • Elevate the patient’s head.
2. • Position the patient on his or her side.
Disorientation
Decreased metabolism and slowed circulation to the brain.
1. • Identify yourself whenever you communicate with the person.
2. • Reorient the patient as needed.
3. • Speak softly, clearly, and truthfully.
Restlessness
Decreased metabolism and slowed circulation to the brain.
1. • Play soothing music and use aromatherapy.
2. • Do not restrain the patient.
3. • Talk quietly.
4. • Keep the room dimly lit.
5. • Keep the noise level to a minimum.
6. • Consider sedation if other methods do not work.
o Postmortem Care
• Provide all care with respect to communicate that the person was important and valued.
• Ask the family or significant others if they wish to help wash the patient or comb his or her hair; respect and
follow their cultural practices for body preparation.
• If no autopsy is planned, remove or cut all tubes and lines according to agency policy.
• Close the patient’s eyes unless the cultural or religious practice is for a family member or other person to close the
eyes.
• Insert dentures if the patient wore them.
• Straighten the patient and lower the bed to a flat position.
• Place a pillow under the patient’s head.
• Wash the patient as needed and comb and arrange the patient’s hair unless the family desires to perform bathing
and body preparation.
• Place waterproof pads under the patient’s hips and around the perineum to absorb any excrement.
• Clean the patient’s room or unit.
• Allow the family or significant others to see the patient in private and to perform any religious or cultural customs
they wish (e.g., prayer).
• Assess that all who need to see the patient have done so before transferring to the funeral home or morgue.
• Notify the hospital chaplain or appropriate religious leader if requested by the family or significant others.
• Ensure that the nurse or physician has completed and signed the death certificate.
• Prepare the patient for transfer to either a morgue or a funeral home; wrap the patient in a shroud (unless the
family has a special shroud to use), and attach identification tags per agency policy.
• Hospice vs Palliative Care
, NUR2392 Multidimensional Care II MDC 2 Exam 1 Blueprint
• Impact of Pain & Pain Management Impact of Unrelieved Pain
Physiologic Impact Quality-of-Life Impact
