Nursing care of a critically ill and a dying patient demands an unusual degree of alertness, resourcefulness, observation, sympathy, and tact not only for the patient but also for the family, close friends, and caregivers. The nurse’s calm serene attitude will help the patient and his/her loved ones face the possibility of impending death. She should know the religious faith of her patient. She should be familiar with the various customs and traditions of the different faiths so that she can give understanding assistance in meeting his or her needs.
The emotional aspects that accompany any serious illness greatly distress members of the patient’s family. It is always a comfort to them to know that everything possible is being done for the patient. The nurse can reassure them, as their clergyman and doctor have, that death usually comes without pain since the patient is usually unconscious or under the influence of pain relieving medications.
People face impending death in many different ways, depending to a great extent on religious and cultural backgrounds. In order to help the patient and his or her family at this time it is important for the nurse to understand her own feelings and philosophy toward illness, life, and death.
The nursing care for these patients is symptomatic and aimed toward making the patient as comfortable as possible. The sickroom should be kept quiet. The family should be told that hearing is the last faculty to leave the body. Good oral hygiene to rid the patient’s mouth of thick secretions is very important to the patient’s comfort. Turn the patient’s head to the side. Suction as necessary. Place finely chopped ice inside the lips to keep the mouth moist when the patient is unable to swallow. Small amounts of water or weak tea may be given with a spoon or medicine dropper if the patient can swallow.
The following specific nursing measures may add to his comfort:
- Keep pads under the patient, provide good perineal care as often as necessary if he or her is incontinent of urine and or feces.
- Give morphine or some other medication as ordered to relieve pain and for restlessness and exhaustion.
- Report an unusually full bladder to doctor or nurse in charge. This condition might cause the patient to be restless.
- Turn the patient every 2 hours, keep head and shoulders slightly elevated and alternate turning the patient from side to side. If his breathing appears labored, elevate the head of bed and keep his head turned to the side, so that the tongue will drop to the side of the mouth and therefore will allow air to be inhaled more easily.
- Remove secretions from around the eye with cotton balls saturated with warm water.
*** We will discuss more in the future articles ***