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MEETING BASIC HUMAN NEEDS • Physical needs- provide meals, snacks, fresh drinking water, clean bed, oxygen, rest and sleep • Safety & Security-answer call bells, raise side rails, clean up spills, report safety hazards, check ID bracelet, clutter free environment, infection control precautions • Love and belonging- give good care, encourage participation in activities, family visits, support groups • Self esteem- allow resident to do as much as possible for self, groom nicely, compliments • Self actualization- allow resident to discuss past accomplishments, interests
Losses with aging • Spouse, family, friends • work • Mobility to favorite places, including church • Home • Health • Pets • LBGTQ + community members may be targeted in another environment
Loss of independence can lead to…. • Depression • Anger toward caregivers • Helplessness and hopelessness • Feeling useless • Poor self image
Culture makes a difference…. • Cultural background effects music, food • and style of dress preferences, attitudes, • values, religion, language, health practices, • death rituals • The best way to respect a person’s cultural beliefs is to educate yourself, ask questions and attempt to support as much as possible
A word about religion… • Listen, but don’t share your own beliefs and opinions…. • make referrals to nurse for clergy visits….. • you can pray with a person if they request it….. • be respectful of person’s religious beliefs….. • Respect religious items • Respect practices • Make referrals to nurse…social services can help
Dietary restrictions based on religion • Buddhists- vegetarian • Jewish- no pork or shellfish, food is Kosher and kosher cannot come into contact with non-kosher food on the plate • Mormons- no alcohol, coffee or tea • Muslims- no pork, practice Ramadan • Catholics- fish on Fridays and may abstain from certain foods during Lent
Sex and sexuality • Sex- the expression of intimacy • Sexuality- promote by makeup, jewelry, grooming, privacy during relations • Types: hetero, homo, bi, transv, transgender, transsexual • Give privacy during intimate times, post do not disturb sign on door • Privacy during masturbation
LGBTQ+ • LGBTQQIP2SAA. The term stands for lesbian, gay, bisexual, transgender, queer, questioning, intersex, pansexual, two-spirit, asexual, and ally.
Family • Nuclear- mom, dad, kids • Single parent • Married couple without kids • Extended families- parents, grands, aunts, uncles, cousins • Blended family- through divorced or widowed parents
Middle Adulthood (p. 124) 40 to 65 • Time of midlife crises, menopause, empty nest syndrome • Many physical changes to the body such as slowing of metabolism, wrinkles, gray hair, loss of vitality
Late Adulthood (65 and older) • Time of many losses • Must deal with own mortality • Make new friends, find new interests • Ageism: stereotyping and/or discrimination • Against elderly
Every system of the body responds to aging • Skin wrinkles, age spots, skin breaks easier and is dryer, nails thicken, hair thins, is dryer and grays, balding, • Bones lose density and become more brittle • Muscles weaken and lose tone • Heat regulation is off • Nerve endings less sensitive • Reflexes are slower • Heart doesn’t pump as well • Lungs are less elastic, secretions aren’t cleared as well and capacity decreases • Appetite decreases
Urinary output is more frequent • Oxygen in blood decreases • Digestion takes longer and is less efficient • Levels of hormones decrease • Immunity weakens • Lifestyle changes occur • Memory might slip • Joints stiffen • Height is lost • THESE ARE NORMAL CHANGES!!
0-12mos: growth from head down • 1-3yrs: independence, control of bladder/bowel; explorers; parents set rules and standards • 3-5 yrs: new words and playing important • 5-10 yrs: cognitive skills learned • 10-12 yrs: sense of self, understand permanency of death; puberty; social creatures • 12-18: mood swings; peer pressure; conflict
A WORD ABOUT DEVELOPMENTAL DISABILITIES • Cerebral Palsy- mostly rt lack of O2 in the fetus- leads to muscle coordination problems, intelligence may be affected • Down’s syndrome- mostly in advanced age moms- children have distinct facial features, short, webbed fingers, intelligence may be affected, aka Trisomy 21
Death and Dying • A terminal illness is one in which there is no reasonable chance of recovery • Attitudes about death are affected by a person’s culture, religion, age, and the cause of death • Death can be by suicide, homicide, an accident, an acute illness, or after a chronic illness
No death is easy, but some are harder than others……… • Suicide- survivor’s guilt, a preventable event, the ultimate sin, unanswered questions, mental illness • Homicide- desire for revenge, seeking impossible closure, unnecessary death • Accidents- desire to turn back the clock, last minute regrets • Acute illness- shock • Chronic illness- relief, accept the expected • Physician Assisted Suicide (Aid in Dying bill, NJ 2019)
AID in Dying • Patients with less than six months to live can request the medication. According to the law, two doctors must confirm the diagnosis of a terminal illness and that patients are capable of making a sound decision to end their lives. • Patients must be residents of New Jersey. They have to make two requests for life-ending medication at least 15 days apart, and also submit a written request that includes witness signatures. • Must be able to self-administer the drugs (secobarbital and Nembutal).
KUBLER-ROSS’ STAGES OF GRIEF • NO PARTICULAR ORDER, MAY REPEAT A STAGE • NOT EVERY STAGE MUST BE MET, BUT BETTER IF ALL ARE EXPERIENCED • FAMILY ALSO EXPERIENCE STAGES • A “GOOD” DEATH IS ONE THAT YOU KNEW WAS COMING AND HAD TIME TO PREPARE FOR….
Stages of Dying according to Kubler-Ross • Denial “no way, I’m too young!” • Anger “it’s not fair, why me?” • Bargaining “please God, cure me” • Depression “why has God abandoned me?” • Acceptance “OK, I’m ready”
Special Needs • Spiritual- private visits with clergy; keep rosary beads, Bible nearby, listen • Social- allow family private visits, extend visiting hours, if allowed • Psychological- listen, hold hands, encourage person to cry, vent feelings
Physical Needs of the Dying Resident • Vision, hearing and speech • Soft lighting, pupils reacting slower to change in light; eyes may be ½ open cleanse • Hearing is last sense to go; continue to explain all procedures • May not be as verbal, develop system for communicating
Mouth, Nose, Skin • Mouth may be dry, jaw not completely closed, give mouthcare Q2h, sips of liquids or ice chips, vaseline to lips • Nose may be irritated and dry if receiving oxygen therapy, apply vaseline • Skin may feel cold, but person is perspiring, place light sheet on resident, sponge baths prn, change gown/sheets as needed
Elimination • May be incontinent or constipated • Enemas may be ordered • Perineal care PRN
Comfort and Positioning • Inform CN if complaints of pain offered • Turn and repos Q2h • Use pillows to pad bony areas • Elevate HOB to ease breathing
Patient Controlled Analgesia (PCA) • Patient able to self-deliver a set amount of morphine intravenously at certain intervals; pump can be set to deliver a small, constant flow of medication too
The Family • This is a difficult time- give privacy, but be available- use touch to show concern, listen to feelings and fear, be courteous and empathetic to their experience
Signs of Death • Movement, muscle tone and sensation may be lost • Jaw drops open, eyes may not close completely • Peristalsis slows (don’t feed) • Body temp rises, but skin feels cold and is pale • Breathing becomes irregular • Pulse is fast, weak, irregular and BP drops • Pain decreases as person loses consciousness
Postmortem Care (PMC) • Determine if family will be visiting • Determine if an autopsy will be performed • Supplies: PMC kit, wash basin, soap, towel, disposable diaper • Standard Precautions, privacy, treat body with dignity • Handle body with open palms • Two caregivers will perform • Need to complete before rigor mortis (stiffening of body) occurs in 2-4 hours
PMC cont. • Wash face, eyes, perineal area and put on disposable diaper • Close eyes • Leave dentures in • Remove all jewelry except wedding ring (tape in place) • Apply chin strap • Straighten arms/legs and secure together with string • Tag body (big toe, outside of shroud) • Place wallet, watch, eyeglasses in small bag • Leave in gown with face exposed if family visiting, if not, wrap entire body
Hospice Care • Hospice was developed to allow people to die with dignity- either in the comfort of their own home or in a facility • Pain relief is given, but no treatments or hospitalization will be provided should the person’s health start to deteriorate • This person has signed a Do Not Resuscitate (DNR) order
Palliative vs Hospice Care • Palliative care- care for a dying person, with efforts made to treat symptoms, illnesses that develop • Hospice care- only comfort measures and pain control, no efforts made to treat/manage health issues that may develop
https://documentaryheaven.com/edge-life/ • What stage of death/dying were the families in (Aunt Bunny, Langston’s sister, Javier’s girlfriend and sister of man in nursing home)? • What factors contributed to the doctors stopping treatment for Dante, Langston and Javier? • Which doctor would you want if it was your loved one in the bed dying?
