1. NURSING INTERVENTIONS BEFORE DEATH AND TIME OF DEATH
S. Tagapan- Dec14, 11
Nursing mgt- the nursing process is a helpful tool when caring for patients who are grieving or dying and
their families and siginificant others
ASSESSMENT
A. State of awareness:
1. Closed awareness- no open communication, patient is not oriented that s/he is dying
2. Mutual present-the patient knows about his upcoming death but they do not discuss about it
3. Open awareness- open communication is visible
B. Clinical manifestations of impending death:
1. Loss of muscle tone- difficulty in talking, poor gag reflex, incontinence
2. Slowing of circulation- bruises, hypotensive
3. Changes in respiration- tachypnea, chyne-stokes
4. Sensory impairment
C. Assessing
- Have you been close to someone who was dying before?
- What have you been told about what may happpen when death occurs?
- Do you have questions about what may happen at the time of death?
- How do you think would you like to say goodbye?
- How are you taking care of yourself during these times?
- Whom can you turn to for help this time?
- Is there anyone you would like us to contact when the death occurs?
D. Diagnosing
- Grieving
- Fear
- Hopelesseness
- Powerlessness
- For SO: risk for caregiver roles strain
o Interrupted family process
o Impaired adjustment
o Decisional conflict
o Ineffective coping and denial
o Grieving: anticipatory & dysfunctional
E. Planning
- Maintaining physiologic and psychologic comfort
- Achieving a dignified and peaceful death
F. Interventions

2. - Facilitating grief work
- Providing emotional support
- Helping clients die with dignity
- Hospice and palliative care
- Meeting physiologic needs- skin care, provide adequate air, change bed linens, spongebath,
nutritional support
- Providing spiritual support
- Supporting the family
- Post-mortem care- remove tubes (head to toe), close eyes, mouth, complete bed bath is not
necessary
o Rigor mortis: stiffening, 2-4hrs after death
o Algor mortis: decrease of temp until it reaches room temperatuure, mottling
discoloration or pooling of blood in extremities,
o Livor mortis:
G. Evaluation
- Listening to clients reports of feeling in control of death, pain relief and other tx. Plans
- Observing the client’s relationwhip with SO
- Listening to client’s thoughts and feelings related to hoplessness and powerlessness