N109: Foundations in Nursing Practice

N109: Foundations in Nursing Practice Study Guide Glaser and Strauss identified four different trajectories of death that might be followed: • Certain death at a known time • Certain death at an unknown time • Uncertain death with a known time when certainty will be established • Uncertain death at an unknown time This model led to the development of a process of dying by E. Mansell Pattison. In this model, the individual experiences an initial health crisis that begins the process of dying: • Health crisis • Acute crisis phase • Chronic phase • Terminal phase • Death Physiological Problems A dying patient may face physiologic problems as their body begins to shut down. Airway clearance, bowel and urinary elimination, sensory and perceptual changes, pain, hygiene, physical mobility, and nutrition are all areas the nurse must address with the dying patient. Position the conscious patient in an upright position and use suction as needed. If the patient is unconscious, he should be positioned on his side. Increase dietary fiber, water intake, and administer stool softeners or laxatives to deal with constipation. If the patient becomes incontinent, be sure to provide skin care and a moisture barrier and catheterize as needed. The nurse should speak clearly and ask the patient about their preference for room lighting. Continually assess pain and intervene appropriately. Bathe the patient and change linens frequently. Ensure mouth care is completed. Reposition frequently to prevent pressure ulcers and assist with mobility as needed. Stimulate the patient’s appetite and encourage liquid foods. Signs of Imminent Death As a patient nears death, the individual will likely exhibit signs that the nurse should observe for. These signs include disorientation, cool skin, scant, concentrated urine, noisy irregular breathing (called Cheyne-Stokes), loss of muscle tone, and a decrease in appetite and thirst. Legal Preparations An advance directive is a way to allow caregivers to know a patient’s wishes should the patient become unable to make a medical decision. The hospital must be told about a patient’s advance directive at the time of admission. Description of the type of care desired for different levels of illness should be in an advance directive. For instance, a patient may wish to have or not to have a certain type of care in the case of terminal or critical illness or unconsciousness. An advance directive will protect the patient's wishes in these matters. A living will is one type of advance directive and may take effect when a patient has been deemed terminally ill. Terminal illness in general assumes a lifespan of six months or less. A living will allows a patient to outline treatment options without interference from an outside party.

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