DEATH

AND DYING
 INTRODUCTION
• It is important for CNAs to
understand the stages and signs
of dying as well as the grieving
process so that they may help
provide support to the resident
and the family.
 Stages of Grief
Dr. Kubler-Ross’s discusses the five stages of dying.
• Denial: refusal to believe they are dying
• Anger: “Why me?”
• Bargaining: “Yes me, but…”
• Depression: need to mourn and review their lives
• Acceptance: preparing for death

Emphasize that not every resident goes through all

these stages or in this order.
 The Death of a Loved One
There are 7 stages a person may go through when
they have someone close to them who dies.
• Shock: especially at our own feelings
• Denial: usually lasts a short time
• Anger: at God, the doctors, even at the person who
died
• Guilt: that we are still alive
• Regret: for what we did or did not do
• Sadness: depression, headaches, or insomnia
• Loneliness: missing the person and painful
memories
 Advance Directives
Definition: legal documents that allow you to
convey your decisions about end of life
care ahead of time (living will).

• They provide a way for you to

communicate your wishes to family,
friends and health care professionals, and
to avoid confusion later on.
 Caring for a Dying Resident
• Diminished senses
• Care of mouth and nose
• Skin care
• Comfort
• Environment
• Emotional and spiritual support
 How can you treat
residents with dignity
when they are
approaching death?
 Treating the Resident and Their Family
With Dignity
• Respect their wishes in all ways possible.
• Do not isolate or avoid a resident who is dying.
• Do not make promises that cannot or should not be kept.
• Continue to involve the dying person in facility activities.
• Listen if they want to talk.
• Do not babble, or be especially cheerful or sad.
• Keep the resident comfortable.
• Assure privacy when they want it.
• Respect the privacy of the family and other visitors.
• Help with the family’s physical comfort.
 Resident Rights to Remember

• The right to refuse treatment

• The right to have visitors
• The right to privacy
 Common Signs of Approaching Death
• Blurred vision that gradually fails; Unfocused eyes
• Impaired speech
• Diminished sense of touch
• Loss of movement, muscle tone, and feeling
• Rising body temperature or below normal
temperature
• Decreasing blood pressure
• Weak pulse that is abnormally slow or rapid
 Common Signs of Approaching Death
• Slow, irregular respirations or rapid, shallow
respirations
• “Rattling” or “gurgling” sound when breathing
• Cold, pale skin
• Mottling, spotting, or blotching of skin caused
by poor circulation
• Incontinence
• Disorientation or confusion
 Changes That Occur After Death
• No heartbeat, pulse, respiration, or
blood pressure
• Rigor mortis (death stiffness)
• Eyelids partially open; eyes in fixed
stare
• Mouth may remain open
• Incontinence
 Postmortem Care
Definition: Care provided for a person immediately
after death

• Rigor mortis may make body difficult to move.

• Bathe the body gently.
• Place drainage pads.
• Do not remove tubes or other equipment.
• Put in dentures if instructed by the nurse.
• Close eyes.
 Postmortem Care
• Position body. Put a small pillow under head.
• Follow facility policy on personal items.
• Strip the bed after body is gone.
• Open windows to air the room. Straighten
room.
• Respect wishes of family and friends.
• Document procedure.