DISCHARGE CARE AND
- fear of death;
REHABILITATION
DEFINITION OF TERMS
• Death-cessation of Life
• Rehabilitative Care-process of
restoring the highest level of
possible wellness and returning
the person’s ability to live and
work as normally as possible
• Postmortem Care-care of body
after death to prevent
discoloration and other
processes that occur after death
and preserve dignity of the
deceased
• Grief- total response to the
emotional experience related to
loss
• Bereavement- subjective
response experienced by the
surviving loved ones after loss
PHYSIOLOGIC CHANGES AFTER DEATH
what?
Rigor stiffening
Mortis
Algor cooling
Mortis
Livor lividity
Putrefactio softening/decompositio
n n
END OF LIFE CARE
1. Cooling of Extremities- provide
blanket
2. Decreased Appetite- offer
glycerin swabs
3. Incontinence- provide diaper
4. Congestion and Gurgling-
elevate head, suction
secretions
5. Sleepiness- allow adequate rest
6. Sleeplessness- soothing music;
reduce no. of visitors
MANIFESTATIONS OF GRIEF
1. Verbalization of loss
2. Crying
3. Sleep disturbance
4. Loss of appetite
KUBBLER ROSS STAGES OF GRIEF
STAGE IX
Denial verbally support but do not reinforce denial
Anger do not take anger personally; help client understand that anger is normal
Bargaining listen attentively and encourage client to talk to relieve guilt or irrational
fear
Depression allow client to express sadness; convey caring by touch
Acceptance encourage participation in tx program
• Mourning- behavioral process c. 9-12 yrs.
through which grief is eventually understands own mortality
resolved or altered d. 12-18 yrs.- may fantasize that
• Dysfunctional Grieving- consists death can be defied and therefore act
of an extended time of recklessly
depression, severe physiologic e. 18-45 yrs.- attitudes towards death
symptoms, suicidal thoughts may be affected by religious and
after a loss cultural beliefs
• Loss- any actual or potential f. 45-65 yrs.- accepts own mortality
situation in which valued g. 65 and up- perceives death in their
objects/persons has changed or own understanding
is no longer accessible to the
individual CLINICAL SIGNS OF IMPENDING DEATH
• Loss of muscle tone
MODES OF DISCHARGE • Slowing of Circulation
1. As Ordered by Doctor • Changes in Respiration
2. Against Medical Advice • Sensory Impairment
3. Death
SIGNS OF EMOTIONAL DEATH
CONCEPT OF DEATH • Withdrawal/Preparing to let go
a. infancy to 5 yrs.- death is reversible • Vision-like experiences
b. 5-9 yrs.- death is final but can be • Letting go
avoided • Saying goodbye
when?/rate? IX others
2-4 hrs position body properly; place due to loss of ATP
dentures; close eyes and mouth
1 degree place blanket over patient cessation of metabolism
Celsius/hr
30 mins. then 6-10 due to accumulation of blood in
hrs. after small blood vessels
24-30 hrs. embalming due to bacterial action
5. Difficulty concentrating witnessed by 2 people and is
TYPES OF LOSS notarized
1. Actual- verified by others a. Health Care Proxy
2. Perceived- verified by self only b. Living Will
• Autopsy
CATEGORIES OF LOSS • Certification of Death
• External Object- thing is lost • DNR
• Familiar Object- environment • Euthanasia
changed • Inquest
• Aspect of Self- physical or
psychological TYPES OF GRIEF
• Significant Others 1. Abbreviated-brief but genuinely
felt
LEGAL ASPECTS OF DEATH 2. Anticipatory- occurs before loss
• Advance Directives/Durable
3. Disenfranchised- unable to
acknowledge grief to others
Power of Atty.-must be
4. Dysfunctional- unresolved and
inhibited