Free the individual from pain.It can be acute or chronic. Acute pain is limited in duration that is it does not last long if treated appropriately by the administration of analgesics give on time consistently. Position patient properly and provide other physical assessment and measurements.
Chronic pain is a pain that have lasted for over six months or more. And it has become part of patient pathological condition. Patient is occupied dealing with the pain .The usual method of pain relief does not work for chronic pain.In acute pain case scenario in which pain will be expected to dissipate the patient will be weaned off narcotics and starts with non narcotics. But chronic pain is not treated this way because it requires a combination of narcotics and non narcotics The drug is administered round the clock and not as patient requested.The narcotics addiction for a dying patient is not the issue. The issue is that the dying patient must be free from pain.So relief of pain is paramount.”When physical pain is controlled proactively, the amount of narcotic medication required by the dying patient does not endlessly increase”.The nurse should realize that there is no fear of addiction on a dying patient rather patient should be well medicated and comfortable when moving to the other side.The key to effectiveness of care is the ability to knowledge the need for Pain control and Management. Most often psychological pain,depression, emotional pain needs are not met on dying person so the whole pain experience can be exacerbated or intensified. Sometimes medications alone cannot do the trick rather empathetic listening and allowing the dying patient to express what is in their mind.If patient is shading tears and sadness is evident, silent and touching might be more appropriate. Other things that can help a dying person include backrub to ease tension, foot message,assess to television or radio,gentle touch, dim the light,closeness and sitting close to the person.If vision is impaired a volunteer reader can be helpful ,talking books. The dying should be free from loneliness.The dying aged has gone through so many losses. Dying patient are often isolated because of smell coming from patient’s room or body.We often put coffee in a 🥣 bowl stick in a small candle lit it to reduce the smell or light candles.
The dying in the hospitals is placed in single room knowing fully well that death is imminent. Care is reduced,lighting in the room decreased, decreased tactile and audio simulation. Curtain is drawn and no noise.Nobody wants to die alone but most often the dying are left to die alone by nurses either because they are unaware or they are very busy or understaffed. Some family members usually come to support their love one that is dying. Families should be encouraged to be with their love ones during the dying stage.
From my experience many families are very good at being there for their love ones. They stay and support their family member who is about to exist the earth.
Energy of the dying should be conserved during the dying stage since they will need it in their journey. So patient should not be moved frequently at that stage.Nursing intervention should be directed towards Patient energy conservation.Patient need to be involved in decisions making of what he or she wants.Do patient want to be fed,bathe,talk to visitors or receive visitors ?. The emotional turmoil and anxiety that patient go through when they are not included in their plan of care can be devastating. So it is important to spare the energy and reduce the anxiety by listening, touching, talking to patient and provide environment that allows patient to be dependent as the need arises. I had wonderful patient over fifteen years ago, she was in control till the end.I listened and followed all that she wanted me to do .At a point she became dependent and cannot communicate.She could see my face and look me in the eyes. Each timexthat l am leaving to see another patient, I let her know. Patient need the nurse faces when caring for a dying patient.She already told me that her children were coming from various part of the country and what I need to do to make them comfortable and pleased with me. She asked me to provide enough chairs, some tissue papers because there will be lots of crying and ice water, including keeping the hospital room clean and provide privacy.By the time that her children arrived she was unable to talk to them or open her eyes but she could hear them.Before they arrived I focused on making sure that she is cleaned,no odors coming from her,her hair combed. and put together with a clipping pin,spread air freshener in the room.Did not wait for house keeper I removed the trash. It is important as a caregiver to listen allow the dying aged to their loneliness, fear of pain ,grief over losses and separation. She told me about the lost of her mother,brothers, sisters and her husband. And that she has struggled with separation because she has no family and her children were very busy. I looked her in the face and promised to be there for her.She moved on two after my shift ended. Reconciliation with family, friends and God almighty for a smooth transition to the other side. “Symptomatic control in a milieu that response to social, psychologic,and religious need can facilitate the dying process. This requires a multidisciplinary team. The pastoral care of the dying is a high priority “Schuman (1997)Pastoral care will facilitate humanistic approach. Dying patient and family deserves to be involved as long as there is the existence of life.
Self Esteem should be maintained and patient treated with dignity. Self image must not be lost because the patient has lost independence. Patient should be well respected at death and properly taken care of and their privacy maintained. The needs of the dying must not be neglected the nurse should assess the patient and medicate frequently. Dying Patients are often placed on continuous intravenous pain medication of morphine sulfate drip or dilaudid drip to prevent any delays in making the patient frequently. Nurse perform psychological and physical assessment of the dying patient. Providing Intervention for the dying patient such as holding patient hand,communication, relieving of pain and reducing anxiety, allowing patient to make decisions. When death is very close the spiritual and physical signs and symptoms will be there,patient will withdraw. What I often observe is the dying patient refusal to take his medication, eat food,decreased in urine due to decreased circulation to the kidney because of decreased in fluid in take.That is my observation from the dying Patients. Other things to look for are coolness of the skin,and body temperature. Change in color of the extremity,disorientation to place ,time and prson Altered breathing pattern ,incontinent of bowel and bladder.You will be hearing a gurgling, bubbling, rattling due to congestion as a result of poor circulation of body fluid. Do not force patient to eat or take medication, elevated the head,dim the light, provide gentle back rub.Be there with the patient and do not talk too much. Not needed at this time.Communicate with a normal voice. Some dying patient can be restless due to decreased oxygen to the brain and metabolic changes. Most families will prepare for transition making arrangements with funeral homes for the final departure of their love one. Where this arrangement is not made patient will be prepared wrapped tagged body per hospital policy and procedures will transfer to hospital morgue pending transfer to the arranged funeral services nursesyoumoveme.com(Philomena N Okeke RN, MSN)