Caring for the Dying

Alberta HCA Bridging Module 3: Caring for the Dying Page 1 of 20

Caring for the Dying

Handout

1.2 Topics 1.3 Death signs 1.4 Death signs … 2 1.5 Comfort measures 1.6 Personal care 1.7 Positioning 1.8 Communication 1.9 Visual 1.10 Elimination 1.11 Nutrition 1.12 Oral hygiene 1.13 Pain management 1.14 Emotional support 1.15 Oxygen therapy 1.16 Spiritual care 1.17 Family involvement 1.18 Summary

Bridging Module 3: Palliative and End-of-Life Care


Module 3: Palliative Care - Caring for the Dying

1.1 Title

Narration No narration, only music.


1.2 Topics

Narration JILL: Hi … I’m Jill and with me is my colleague Carlos. Welcome to Module 3: Palliative and End-of-Life Care. This lesson is about Caring for the Dying Client. CARLOS: So it looks like the three topics that we will be discussing are: signs of imminent death; meeting the needs of a dying client; and family involvement in end-of-life care. JILL: Yes, those are the topics for this lesson.

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1.3 Death signs

Narration JILL: So let’s begin with some of the more common signs that death may be imminent. Carlos, you start. CARLOS: Okay. A common sign that death is near is the loss of movement, muscle tone and sensation. This usually begins in the feet and legs. The jaw may relax causing the mouth to stay open. JILL: Another sign is the slowing of peristalsis and other digestive functions. Fecal and urinary incontinence is common. Nausea, vomiting and abdominal distention may also occur. CARLOS: Failure of circulation is another symptom. The pulse is fast, weak and irregular. The blood pressure drops and the skin may have a mottled appearance. JILL: The respiratory system begins to fail. Breathing patterns may become irregular with changes in depth and rate. There may be periods where breathing stops for up to 30 seconds. Mucous can accumulate in the airway causing gurgling sounds. This is commonly called the “death rattle”.

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1.4 Death signs ... 2

Narration CARLOS: Another sign that death is near is excessive fatigue and sleep. The metabolism slows causing increased sleep periods. The client may become difficult to awaken or loses consciousness. However, some clients do remain conscious until death occurs. JILL: There are changes in eating habits. A loss of appetite or strange food cravings are common. CARLOS: Social withdrawal is another symptom. As the body begins to shut down, the client may lose interest in their surroundings. They may not want visitors. They may seem disinterested and often stop talking. JILL: And the last sign is a coolness in the fingers and toes. As circulation slows, it shifts from the extremities to the major organs. The fingers and toes will have a noticeable coldness and cyanosis of the nailbeds.

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1.5 Comfort measures

Narration JILL: Next, we will discuss some of things a health care aide needs to do to meet a dying client’s needs.

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1.6 Personal care

Narration CARLOS: The HCA should continue to provide the same level of care as they would with any other client. As their condition deteriorates, the client will require help with activities of daily living.

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1.7 Positioning

Narration JILL: The HCA should position the client according to their needs and comfort. They should also be turned at least every two hours. CARLOS: Turning is important to prevent the development of painful pressure ulcers. JILL: Yes, that’s right.

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1.8 Communication

Narration CARLOS: Use your normal voice volume. Continue to speak even if the client appears to be unconscious. Introduce yourself, the dying person’s hearing is often the last sense to fail. JILL: Because of this, you need to be very careful what you say to other staff or family in the client’s presence. They may appear to be unconscious, but they will still hear what you say.

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1.9 Visual

Narration JILL: Adjust the light to suit the client’s needs and wishes.

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1.10 Elimination

Narration CARLOS: The client may lose control of the bowels and bladder as death approaches. Keep the body clean. Change sheets and clothing as necessary to prevent irritation of the skin.

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1.11 Nutrition

Narration JILL: Clients at end of life (near death) often have difficulty swallowing which can lead to aspiration and/or choking. It is important that clients are frequently checked for problems with swallowing (dysphagia). Dysphagia requires expert assessment and management in order to consider the risks and benefits of eating and drinking for each individual to enable optimal quality of life.

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1.12 Oral hygiene

Narration CARLOS: You should provide frequent mouth care. Use an applicator with glycerin to swab the client’s mouth and lips. A moist mouth makes it easier for the client to eat and breathe. If there are large amount of secretions, the client may need oral suctioning. Check the care plan and/or ask the nursing supervisor.

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1.13 Pain management

Narration JILL: Observe the client for signs of pain. If present, notify the nursing supervisor.

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1.14 Emotional support

Narration CARLOS: Provide the client with company. They may want to reminisce about the past. Utilize touch to provide comfort and reassurance.

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1.15 Oxygen therapy

Narration JILL: If the client is on oxygen, check the nose, ears and mouth. These areas can become irritated. Report to the supervisor any changes in skin integrity.

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1.16 Spiritual care

Narration CARLOS: Respect the needs of the client and family. Know the client’s and family’s wishes regarding spiritual or cultural care needs related to death and dying.

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1.17 Family involvement

Narration JILL: And our last topic in this lesson is the family’s involvement in the personal care for the dying client. It is a difficult time for the family as their loved one approaches death. During the final days and hours of life, the family should be encouraged to participate as much as they feel comfortable in all aspects of the client’s care. There are many ways that the family can be part of the client’s life during this time. CARLOS: The family members should be encouraged to talk to the client. They should continue to have conversations so that he or she is aware that their loved ones are around them. JILL: The family could participate in comfort measures such as mouth care, skin care, brushing hair, and so on. CARLOS: The HCA should teach the family how to position the client and encourage them to touch the client while providing care. JILL: When the client has died, the family is often emotionally drained. The HCA should offer nourishment such as a warm drink or snack and invite the family to remain with their loved one. If possible, provide a private space for the family to spend time with the deceased. Allow the family to participate in any religious or cultural rituals important to them.

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1.18 Summary

Narration JILL: This brings us to the end of this lesson on caring for a dying client. CARLOS: Yes it does. So to summarize, we discussed the various signs and symptoms that a client is nearing the end of life. We explained the various measures that HCAs can take to make the client’s remaining time more comfortable. And finally, we made some suggestions as to how the family could be involved in providing care for the dying person. JILL: Thanks for listening to Carlos and I. We hope that the information presented will make HCAs more aware and knowledgeable about providing palliative and end-of-life care. I’m Jill saying goodbye for now. CARLOS: And goodbye from me as well.

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1.19 The End

Narration No narration, only music.

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Documents

Caring for the Dying