Review Ch. 10
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An illness or injury for which there is no reasonable expectation of recovery/
Hospice care focuses on physical, emotional, social, and spiritual needs. Cure and life-saving measures are not concerns. Pain relief and comfort are stressed. The goal is to improve the dying person's quality of life.
Cells reproduce for tissue growth and repair. Cells divide in an orderly way. Sometimes cell division and growth are out of control. A mass or clump of cells develops. This new growth of abnormal cells is called a tumor.
This kind of tumor grow slowly and within a loca area. They do not spread to other body parts. They usually do not cause death.
This tumor grows fast. It invades other tissues.
The spread of cancer to other body parts.
Metastasis. Cancer cells break off the tumor and travel to other body parts. New tumors grow in other bodys. This occurs if the cancer is not treated and controlled.
Dr. Elisabeth Kubler-Ross described five stages of dying:
- Denial is the fist stage. Persons refuse to believe they are dying. "No, not me" is a common response.
The person believes a mistake was made.
- Anger is stage two. The person thinks "Why me?" There is anger, rage, adn envy of those with life and
health. Family, friends, and the health team are often targets of anger.
- Bargaining is the third stage. Anger has passed. The person now says "Yes, me, but... "Promises are
made in exhange for more time. Bargaining is usually private adn on a spiritual level.
- Depression is the fourth stage. The person thinks "Yes, me," and is very sad.The person mourns
things that were lost and the future loss of life.
- Acceptance is the last stage. Thepersonis calm and at peace. The person has said what needs to be
said. Unfinished business is completed.
Physical Needs for dying people.
- Vision. Vision blurs and gradually fails. The room should be well lit. However, avoid bright lights and
glares. Good eye care is needed.
- Hearing. Hearing is noe of the last fucntions lost.
- Speach. Speech becomes difficult. It may be hard to understand the person. Sometimes the person
cannot speak. Anticipate his or her needs. Ask "yes" or "no" questions. Do not ask questions with
long answers. Despite speech problems, you must talk to the person.
- Mouth. Routine mouth care is given if the person can eat and drink. Frequient oral care is given as
death nears and when taking oral fluids is diffidcult. Oral hygiene is needed if mucus collects in the
mouth and the person cannot swallow.
- Nose. Crusting and irritation of the nostrils can occur. Nasal secretions , an oxygen cannula, a;nd a
nasogastric (NG) tube are common causes. Carefully clean the nose. Apply lubricant as directed by the
nurse and the care plan.
- Circulation. Circulation fails and body temperature rises as death nears. The skin is cool, pale, and
mottled (blotchy). Perspiration increases. Skin care, bathing, and preventing pressure ulcers are
necessary. Linens and gowns are changed whenever needed. Despite cool skin, only light bed
coverings are needed. Blankets may make the person feel too warm and cause restlessness.
- Elimination. Urinary and fecal incontinence may occur. Constipation and urinary retention are common.
Enemas and dcatheres may be needed.
- Comfort and positioning. Frequent position changes and dupportive devices also promote comfort.
Semi-Fowler's position is usually and gently. Semi-Fowler's postion is usually best for breathing
- The person's room. The person's room should be pleasant, well lit, and well ventilated.
There are signs that death is near. They may occur rapidly or slowly:
- Movement, muscle tone, and sensation are lost. This usually starts in the feet and legs. It eventually
spreads to other body parts. When mouth muscles relax, the jaw drops. The mouth may stay open.
The facial expression is often peaceful.
- Peristalsis and other gastrointestinal functions slow. Abdominal distention, fecal incontinence, fecal
impaction, nausea, and vomiting are common.
- Body temperature rises. The person feels cool or cold, looks pale, adn perspires heavily.
- Cirulation fails. The pulse is fast, wak, and irregular. Blood pressure starts to fall.
- The respiratory system fails. Slow respirations or rapid and shallow respirations are observed. Mucus
collects in the airway. This causes the dath rattle that is heard.
- Pain decreases as the person loses consciousness. Some people are conscious until the moment of
Signs of death
No pulse, respirations, or blood pressure. Pupils are fixed and dilated, a doctor determines that death has occurred and pronounces the person dead.
Care of the body after death.
Postmortem care. The care begins when the doctor pronounces the person dead. Postmortem care is done to maintain good body appearance. Discoloration and skin damage are prevented. Valuables and personal items are gathered for the family. The right to privacy and the right to be treated with dignity and respect apply after death.
The stiffness or rigidity of skeletal muscles that occurs after death.
Rigor mortis. It occurs within 2 to 4 hours after death.
- Children ages 3 to 5 years - death is temporary, they think it's a punishment for being bad
- Children between the ages of 5 and 7 know death is final.
Cells reproduce for tissure growth and repair. Cells divide in an orderly way. Sometimes cell division and growth are out of control. A mass or clump of cess develops. this new growth of abnoral cells is called a tumor.
This type of tumor grows slowly and within a local area. They do not spread to other body parts. They usually do not cause death.
This type of tumor grows fast. It invades other tissues.
malignant tumor (cancer)
The spread of cancer to other body parts.Cancer cells break off the tumor and travel to other body parts. New tumors grow in other body parts. This occurs if the cancer is not treated and controlled.
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