Nursing-Foundation-29.by vision books pdf

CHAPTER- 29
CARE OF
TERMINALLY ILL
PATIENT

Experiencing a loss in life is an inevitable part of life.
People suffer from loss every other day. The loss can
be in the form of ending relationships, life changes
such as moving places, separation, divorce or death of
a loved one.In hospital settings, nurses encounter
people

In hospital settings, nurses encounter people losing their valued
relationships as they witness deaths. Not only this, loss can be witnessed
when a person loses his/ her body part, as in case of amputation, or the
loss can beanticipated, if someone is terminally ill. The family can expect
the impending death and grief and can mour the anticipated
loss.Therefore, a nurse must be able to understand the sensitivity of loss
and situation and assist the family and patients to cope up with the actual
or anticipated loss Nurse is expected to support the family and patient in
their grieving process.

LOSS
Definition : Loss is defined as a situation in which a
valised aspe of life is irreversibly changed, and/or is no
longer availableLoss can be experienced in various forms,
Loss can be considered when someone losses a loved one,
sense of well-being, monetary possessions and body
image, etc According to Collins Dictionary, "loss is the
fact of no longer having something or having less of it
than before.

Types of Loss
There can be generally the following types of loss
Actual loss : Actual loss can be recognized by others. For
example.death of a loved one.
Perceived loss: It is expereinced by one person,It cannot
be verified. For example, change in careerplans because of
financial instability.
Anticipatory loss : It is experienced before the loss has
actually occurred For example, it can be experienced by
the family of a terminaly ill patient.

Perceived Loss
This type of loss is said to be occurred when a person feels
the loss of something valuable, However it isn’t felt
By nay other person. Dor instance, a young Person when
turns 18,feels that the childhood days are gone and that he's
become an adult. So he feels the loss and this is only the
subjective feeling, which cannot be felt by anyone else but
him .

Actual Loss
This is the type of loss that has actually happened in one's
life. It can be recognized by the person who has sustained
the loss, as well as by the other people To if there is an
occurrence of actual loss, it can be felt by everyone. For
example, death of a loved and If someone dies, the loss can
be felt by the family and it is also recognized by others, say
acquaintances and neighbors.

Anticipatory loss
At times,loss hasn’t actually occurred but it can be expected
and felt before that. The loss that can be experienced before
the actual ccurrence of the loss is called the anticipatory
loss. For example, the family can feel the anticipatory loss
when their family member is suffering from a terminally ill
disease condition. They can expect the outcome of the
disease, which is most probably death and so they can
mourn and feel the loss in anticipation.

GRIEF, BEREAVEMENT AND
MOURNING

grief
• Grief is a reaction to loss that can involve a range of feelings, thoughts,
behaviors, and is experienced differently by the individuals according to
their culture, background, gender, beliefs, personality, and relationship to
the loss.
• Grief is a subjective feeling and cannot be measured or assessed by others.
People can grieve over an actual, perceived or anticipatory loss.
• For instance, a person can feel grief over the death of a loved one. In
addition to this, he/she can also grieve over the impending and
anticipatory death. Moreover, it can be felt when someone freedom and
independence in terms of finances, social life etc. This way, grief can be felt
when perceived loss has occurred

Bereavement and mourning
• Bereavement:- Bereavement is defined as the response of the surviving
loved ones after the death of a person. It is a subjective reaction.
• Mourning:- Mourning Mourning is defined as a process through which
people try to resolve or alter the grief. Mourning process is based on
and is generally influenced by cultural practices, spiritual beliefs, and
customs of the family. Customs may vary between diverse cultures.In
India, these customs are strictly in line with the religion. For instance,
Hindus and Buddhists are cremated, but Muslims are buried. It is
essential to work and resolve the grief since the stages of
bereavement can have deleterious effects on a person.

TYPES OF GRIEF RESPONSES
TYPE RESPONSES
Abbreviated
grief
This grief is brief but is genuinely felt. It occurs when the loss isn't significant enough and/or is instantly
replaced.
Anticipatory
grief
The loss is expected and the grief is experienced in advance. For example, in case of terminal illness
Disenfranchised
grief
This type of grief occurs when someone isn't able to acknowledge his/her loss to other people. Such grief
response occurs when the loss is often socially unacceptable or the person isn't comfortable to speak about
it. For example, suicide, abortion, etc.
Complicated
grief
When a person undergoing grief process cannot cope up with the grief and loss, and all his/her strategies to
cope are maladaptive, he/she is said to be experiencing complicated grief.
Unresolved grief When the grief is extended in length and severity, it is said to be unresolved or chronic grief.
Inhibited grief In this kind of grief response, the normal griefsymptoms are not evident, however, othereffects in the body
are apparent.
Delayed grief In this kind of response, the sad feelings aresuppressed, intentionally or subconsciously,until a very later
time.

MANIFESTATIONS OF GRIEF
• A grieving person can exhibit physical, emotional, cognitive responses
to loss. Manifestations of complicated grief are more intense.
• Physical manifestation: The grief is manifested physically in
the form of headaches, physical illness, muscular aches, insomnia,
weakness, and fatigue, etc.
• Cognitive manifestations: It can be lack of concentration,
disbelief, and hallucinations, etc. Emotional manifestations may
include anxiety, depression, anger, sadness, and excessive crying, etc.
• Behavioral manifestations: It can be withdrawal from the society,
avoiding anything which brings flashbacks, etc. grief

FACTORS INFLUENCING LOSS AND GRIEF RESPONSE
FACTORS DESCRIPTION
Age • It is apparent that age determines the understanding of a person. With age, an individual learns about
the concept of death, loss and grief. As a result, different responses toward death and grief are expected
from a child, adult and an older person. • Children can feel scared and lonely after they witness the death
of their grandparents while an elder person may lack support when their spouse or friend dies.
Significance of
loss
•The significance of loss is a subjective feeling. An individual who has immense feelings toward the dying
or ailing can feel devastated when the loss occurs, while others might take it lightly.
Cultural and
spiritual beliefs
• The expression of grief is generally directed by one's culture and spiritual beliefs.
• Almost all religions have rituals and practices related to death and dying and it's the responsibility of
nurses to support the beliefs at the time of death
Gender • As far as gender roles are concerned, men are expected not to show any emotions and not cry. While
women are expected to show grief by crying.
Support
system
• It is quite obvious that if a mourning person is provided with adequate support from family and friends,
the grieving process becomes easier and that it becomes easy to resolve the grief.
• Support and help shouldn't be underestimated in any case.

Impact on LOSS AND GRIEF THE
PATIENT AND FAMILY
• Impact on Patient:-
❑ Patient may experience behavioral and emotional changes like denial, hopelessness,
helplessness, and irritability, etc.
❑ Changes in self-concept like loss of self-esteem may be experienced by the patient.
• Impact on family:-
❑ Family members may experience changes of their role and responsibilities in the famiy
❑ Work load and demand of time is increased due to hospitalization of the patient.

“WE CANNOT CHANGE THE OUTCOME,
BUT WE CAN AFFECT THE JOURNEY.”
—ANN RICHARDSON

DOMAINS OF CARE FOR THE DYING PATIENT
PSYCHOLOGICAL ASPECT
• Assessment of psychological
status
• If necessary psychiatric problems
are taken care of.
CULTURAL ASPECT
Assessment and attempt tro meet
cultural needs of the client
SOCIAL ASPECT
Client social needs are
assessed and fulfilled
PHYSICAL ASPECT
• Plan of care is made.
• Based on detailed assessment of
patient and family.

DOMAINS
ETHICAL AND LEGAL
All the care , choices
and preferences are
fulfilled within the
ethical framework.
SPIRITUAL
Spiritual,
existential
dimensions are
assessed and are
respected and
responded well.
• Recognizing the signs
and symptoms of
impeding death.
• Appropriate care is
provided
CARE OF IMMEDIATELY DYING PATIENT

PHYSIOLOGICAL
NEEDS
According to the Maslow Hierarchy of Needs,
physiological needs must be met before others,
because they are essential for existence.
Areas that are often problematic for terminally ill
patients are
➢ Respiration
➢ Fluids and nutrition
➢ Mobility
➢ Skin care
➢ Elimination

RESPIRATION
01
Oxygen is frequently ordered for the client
experiencing labored breathing.Suctioning may
be needed to remove secretions that the client is
unable to swallow and keep the airway clean.

02
FLUID AND NUTRITION
o The refusal of food and fluids is almost universal in dying
patients.It is believed that the client is not feeling thirsty
and hungry.
o Artificial nutrition often increases the client agitation
leads to increased limb restraints and increases the risk
of aspiration pneumonia.
o Gain in IV access for fluid replacement and parental
nutrition must be checked as prescribed.

03
SKIN CARE
❑ Prevention of pressure ulcers is the top priority.
❑ In addition to the care of pressure points keeping the
skin clean moisturized promotes healthy tissue.
❑ Gentle massage with soothing lotions are comforting.
❑ Bed bath are adequate if the patient cannot get into the
tub or sit in the shower chair.
❑ The skin should be inspected every time when
positioning is done.

▪ As the patient condition deterioratews, mobility
decreases. The patient become less able to move
about in the bed or to get out of bed and requires
more asssistance.
▪ Physical dependenace increases the risk of
complication related to immobility.
For example , atrophy and pressure ulcers
Provide meticulous skin care to ease the
pressure on skin.
MOBILITY
04

❖ Constipation may occur due to side effects of
analgesics and the lack of physical activities.
❖ Fluid and foods with high fibre contained can be
effective preventive measures for the patient with
adequate oral intake.
❖ It can also be alleviated by maintaing a scheduled time
for bowel elimination and administrating suppositories.
❖ The patient may have incontinence of bladder, so the
nurse needs to check the patient frequently , clean the
skin, apply a moisture barrier after each incontinence
episode.
05ELIMINATION

COMFORT
• Pain relief as prescribed.
• Keep the patient clean and dry.
• Provide safe and non- threatening environment.
• Provide a respectful , careful attitude to provide
psychological comfort by establishing good rapport.

❖ A soothing physical environment can significantly increase increase the clients
comfort , like non- slippery floor, side rails in the room – support to walk
independently to washroom, availibility of call bell.
❖ Adequate lightening enhances vision without causing discomfort associated
with harsh, glaring light.
❖ Provide night light if patient requires.
❖ Provide quiet and calm environment .
❖ Analgesics are prescribed for the pain and it may cause sedation, therefore
precautions shall be taken that proper safe environment is provided to the
patient like bed rails raised.
PHYSICAL ENVIRONMENT

▪ Death presents a threat to not only to ones physical
existence but to ones psychological integrity.
▪ Even though in the presence of the nurse, the family
members should be encouraged and invited to participate in
the clients care, if they desire to do so and the client is willing.
▪ Maintain a well groomed appearance is important. Cutting
the nails, shaving the beard will help to promote patients
dignity.
▪ Combing and brushing not only improves appearance but is
also a comforting and relaxing activity for many, it helps to
boost self- esteem, also orient the client with time, place and
person.
PSYCHOSOCIAL NEEDS

SPIRITUAL NEEDS
The nurses play a major role in promoting the
dying clients spiritual comfort . Dying persons are
among the most venerable members of the
human family.
● Communicate empathy
● Play music
● Use touch
● Pray with client
● Read religious literature aloud , at the
patient request.
● Contact religious preacher if requested by
the client.

Palliative Care
• “An approach that improves the quality of life of
patients and their families facing the problems
associated with life threating illness, through the
prevention and relief of suffering by means of early
identification and impeccable assessment and
treatment of pain and other problems, physical
,psychosocial and Be spiritual”

Nursing Implication
PALLIATIVE CARE PALLIATIVE CARE REQUIRED FOR
1. Is associated with pain relief due toillness
2. Relieves various other distressing symptoms
3. Regards death as a normal process
4. Neither fastens or delays death
5. Act as a support system for the client6. Act as a
support system for thefamily members and
caregivers.
Cardiovascular diseases-38.5%
Cancer-34%
Chronic Respiratory
Diseases-10.3%
AIDS-5.7%
Diabetes-4.6%

Settings for palliative care
• Different settings for palliative care
• 1-Palliative care in hospital settings
• 2-Palliative care in long-term care facilities
• 3-Hospice Care

Palliative Care in Hospital Settings
• The family members need consistent information about their
sick family members and the dying patient too might need
regular symptomatic treatment for pain and other
symptoms. Therefore, in recent years, the hospital settings
have been improved and it is made sure that pain is regularly
assessed.Therefore,the dying patients generally opt for end
of life care in hospital settings.

Palliative Care in Long-term Care facilities
• The long-term care facilities are increasing rapidly across the world
and measures are taken to improve care facilities since the resident of
long-term care facilities don’t have adequate access to high quality
palliative care
• Along with providing care,long-term facilities are involved
ineducational programs for the staff, residents and their families.The
education can be based on symptons management and pain relief.

Hospice Care
• Hospice care is a coordinated program that focuses on support and care of dying
person and his/her family. It can be carried out in various settings, majorly at
home or hospice centers.Hospice was founded by Cicely Saunders, who was the
founder of world-renowned St Christopher's Hospice, London, England.Hospice
aims to facilitate death peacefully, with dignity. Generally, patients are eligible for
hospice care if itis stated by the physician that the patient is likely to diewithin
next 6 months.Hospice not only cares for physical needs but also the emotional
signs of terminal illness. A regular assessment and evaluation is needed to assess
for any physical or behavioral change.

Barrier to palliative care
• Lack of awareness among policy makers, healthcare professionals,
and public.
• Cultural and social barriers.
• Misconception about palliative care, for example, some consider that
palliative care is only meant for cancer or AIDS patients.
• Misconceptions regarding use of opioids in care and pain relief.

PHYSICAL CARE OF TERMINALLY ILL PATIENT
PHYSICAL CARE Description
PAIN Administration of pain medication. • Don't ignore pain or delay pain medication.• Opioids are essential for
pain management.
DYSPNEA Administration of oxygen reposition the client by providing side position or elevating thehead end.•
Perform suctioning as indicated. • Opioids can relieve distressing symptoms including breathlessness.
SKIN Skin changes are apparent.Monitor for breakdown and implementcertain interventions to prevent
thebreakdown.. Check for any discoloration.• Assess body temperature..
DEHYDRATION Provide plenty of fluids orally, but don't forcethe client to eat or drink.• Perform oral care regularly. • Apply
moisturizers on lips to lubricate them.
ANOREXIA,NAUSEA,V
OMITING
Administer antiemetic drugs, if indicated by the physician.vomitingProvide small, frequent meals and
involvefamily in providing care and following food fads
ELIMINATION Monitor output of the client.
WEAKNESS AND
FATIGUE
Allow the client to rest as much as required.• Provide support to client while walking, or maintaining sitting
or lying position.
RESTLESSNESS • To avoid restlessness, a peaceful environment is maintained.. A family member can be allowed to stay
with the client but the number of visitors has to be avoided.• Avoid restraining the client.

PHYSIOLOGICAL CHANGES AFTER
DEATH
➢After death, the body undergoes complex reactions
and processes, which result in physiological changes
the body. These changes can depend on wide range
of factors, such as temperature, season, cause of
death, injuries to the body, etc.

STAGES OF PHYSIOLOGICAL CHANGES
➢IMMEDIATE CHANGES
➢EARLY CHANGES
➢LATE CHANGES

Immediate changes
➢After death, all the bodily functions cease and are
irreversibly stopped.
➢Vital functions such as breathing, and circulation, etc.
halt. A flat ECG can indicate cessation of circulation.
➢Cessation of nervous system takes place, which can be
manifested by flat ECG.
➢Muscle movements are lost.

Early changes
➢The early changes are associated with cell death.
➢Rigor mortis : It is defined as the stiffening of body. It
occurs after 2-4 hours of death. It begins in the
involuntary muscles of heart, lungs, etc., and reach the
other parts of the body. It is important that the dead
body looks normal, therefore, nurses must close the
eyes and mouth of deceased before rigor mortis comes
into action.
➢It leaves the body after approximately 96 hours of
death.

Algor mortis: After death, the body temperature
gradually decreases due to cessation of blood
circulation. The temperature reaches the room
temperature as it falls at rate of about 1° every hour
➢Livor mortis : After the blood circulation has
terminated the RBCS break to release hemoglobin,
which then dissolves the surrounding tissues. The
lack of hemoglobin results in discoloration in
lowermost areas of the body. This is referred to as
livor mortis.
➢Skin changes also occur. The elasticity of skin is lost,
which results in breakage.

➢ALGOR MORTIS ➢LIVOR MORTIS

Late changes
➢Autolysis of the body takes place
➢Bacterial action can also cause decomposition of
body. These bacteria can be external or internal.

A new terminology “care after death” has been
introduced to reflect the range of nursing responsibilities
involved. These include:-
❖Providing support to grieving family and care giver.
❖Honoring the religious or cultural wishes/requirements
of the patient and allowing the family to perform any
rituals but in a legal boundary.
❖Preparing the deceased for transfer to the mortuary.
❖Ensuring the privacy and dignity of the deceased/ body.
❖Ensuring the health and safety of everyone who came in
contact with the deceased is protected.
❖Returning the personal possessions to the primary care
giver.

PROCEDURE
ARTICLES- Clean tray
with
➢ Clean bed sheet 03
➢ Long artery Forceps,
Gauze pieces and
Absorbent cotton balls.
➢ Identification labels.
➢ Bandages
➢ Clean towel and water
for sponge bath.
➢ Kidney tray and paper
bag for waste.

Procedure for care after death is-
Procedure
Once death has been declared by doctor,
cover patient with clean sheet.
The eyelids are closed and held in place for
few seconds to remain closed.
Body should be placed in supine position
with arms either on side or across the
abdomen.
Documentation of death shall be done in
medical as well as in nursing records.
Contract relatives and breaking of news is
done. Offer guidance and support.
Rationale
To make body sightful.
For legal safety and
recording of event and
cause of death.
For psychological
support.

Allow relatives to assess any religious
practice if need to be performed.
Assemble all articles near the bedside.
Wash hand. Wear clean gloves.
Pull curtains or close the room.
Remove all bags and tubes. Replace
soiled dressing with new ones.
Cover IV punctures or any other wound
properly.
Provide mouth care. Clean the soiled
parts of the body.
Put clean gloves. Plug all the orifices by
absorbent cotton balls.
Apply jaw bandage. Fold the hands on
chest in praying position and tie
thumbs.
Straighten legs and tie greater toes.
For cultural practice
respect.
For packing body.
Prevent cross infection.
Provide privacy.
Provide pleasant look to
body.
To prevent leakage of
body fluids.
To give the face a natural
appearance.
Prevent leakage of fluids
from orifices.
Close the mouth.
Prevent rigor mortis.

Apply identification slips on left
wrist and ankle. Wrap patient in
clean sheet. Tie the bedsheet at
neck.
If patient had infectious disease
then body should be packed in
plastic bag.
Cover packed body with bedsheet
while transporting to mortuary or
handing over to relatives.
Arrange transport to mortuary
and document the details in
mortuary book while shifting the
body.
Handing over the body to the
relatives is usually done by the
mortuary.
For identification of the
body.
To prevent cross
infection.
To maintain dignity of
the body.

Termination of Procedure
• Discard all the used sponges, dressing ,cotton ,gloves in
yellow bag.
• Replace the used articles after appropriate cleaning and
disinfection.
• While shifting the body-
- check all documents available.
- hand over all the valuables and patient’s belongings
to his/her relatives and receive signature.
- Document the procedure.

After the death of a patient in the unit, special measures have to
be taken to normalize the ward.
❑First the nurse in charge and the medical staff is informed about the
death.
❑The confirmation of death must be recorded in record files.
❑The dead body is taken care of and is sent to the morgue.
❑After this the nurse along the ward attendant , disinfect the dead
patient’s bed.
❑Fresh linen is placed on the bed.
❑All the waste generated during the life saving procedures is disposed of.
❑Bedside lockers are cleaned and the articles are replaced.
❑The other patients are educated and are made to feel relaxed.
❑Proper documentation should be done, including the date and time of
death.
❑Death of one patient should not cause any issue in caring for other
patients.

Death declaration Certificate
A death certificate is a legal document, issued by the govt. to the
family of deceased. This certificate states the day, date, cause of
death etc.
It’s the responsibility of family members to register death and
obtain the death certificate to prove death. A death certificate is
required for various purposes :
• Monetary issues
• Insurance policies
• Legal purposes
• Inheriting jobs, property etc.

AUTOPSY
SUBMITTED TO : PROF. JYOTI KATHWAL
SUBMITTED BY: TANUSHREE GUPTA
BSC. NURSING 1ST YEAR

AUTOPSY/POST MORTEM
•An autopsy or post mortem is a procedure
performed after the death of a person, to rule
out the exact cause of death. It is the surgical
dissection of the body, which is helpful to
discover the circumstances.

TYPES OF AUTOPSIES
•Following are the types of autopsies:
➢Medicolegal or forensic or coroner’s autopsy
➢Clinical or pathological autopsy
➢Anatomical or academic autopsies

Types of Autopsies
Medicolegal or forensic or coroner’s autopsy: It is done to
find the cause of death and to identify the reason. It is mainly
performed when prescribed by law, mysterious death, violent
or suspicious death occurs.
Clinical or pathological autopsy: It is performed to diagnose a
disease for research purpose, ultimate aim is to identify or
confirm diagnosis which has been unclear or unknown before
the death of the individual.
Anatomical or academic autopsies: It is performed by medical
students for learning purpose mainly the anatomy of the
human body.

Purposes
❑ To find the cause of death
❑ To ascertain if the death was natural or unnatural
❑ To identify the unknown body
❑ Medicolegal cases
❑ To acknowledge the time of death
❑ For research and academic studies

Nurses Responsibility
❑ Obtain the consent for performing autopsy
❑ Ensure that autopsy doesn't deform natural body shape or structure
❑ Explain that autopsy may be useful for medical research and advancement in the
technology
❑ Answer any questions put forward by the family
❑ Motivate for organ donation
❑ Respect the family’s final wishes and honour their decision on organ donation.

EMBLAMING
• DEFINITION OF EMBLAMING
• Emblaming is the process of prevention of body from
being decomposed .It is performed by treating the body
with chemicals ,which help to prevent decomposition .
It delays the natural process of all cell breakdown ,which
starts immediately after the person dies.

What is need to emblamed patients
• It temporarily preserves the body for public display at funeral or at
anatomical specimen. Some people get their loved ones emblamed
so as to spend some more time with them .

Method of emblaming patients
• Some of the solutions used in emblaming the patients are
• Formaldehyde
• Glutaraldehyde
• Ethanol
These solution are used to delay the first few stages of
decomposition .
In emblaming body fluid are replaced with the above mentioned
fluid since the natural body fluid no longer circulate inside the body

Types of emblaming
Types of emblaming are as follows
•Aterial emblaming
•Cavity emblaming
•Surface emblaming
•Hypodermic emblaming

Aterial Emblaming
• In this type of emblaming, the body fluids are drained through the
veins and the emblaming fluids are replaced through the arteries.
• The fluid replacement is done through the tubes which are
connected to the machine. This machine pumps the emblaming fluid
into the body . The vein of choice is generally jugular or femoral.

Cavity Emblaming
• The fluid inside the body is removed surgically, as an incision is done
and a tube is inserted in the body through the incision.
• A suction machine is attached to the tube to remove the fluids. The
fluids are replaced by emblaming fluids and then the incision is
closed.

Hypodermic Emblaming
• It is the supplement method of injecting the emblaming fluid using
the emblaming fluids using the hypodermic needles and syringes.
• This method is used when areas are left and aterial fluids has not
been distributed successfully during the aterial injection in aterial
emblaming.

Surface Emblaming
• Surface emblaming is also supplement method , which is used to
emblam the areas directly on the skin surface. Also other superficial
area of the body can be preserved.
• If the deceased happened due to the accident, surface emblaming
can help fix the area damaged due to the accident.
• In addition, the damage due to cancerous growth and skin grafting or
donation can be fixed.

Disadvantages of emblaming
• Formalin treated surface and irritant to other eyes and mucosa and
need gloves for handling.
• The natural colour of specimen is changed.
• The solution need to be replaced frequently.

In the mortuary
Placing the body
Department of Forensic Medicine provide mortuary services and preserves
the body
• Body is transferred ton the morgue after proper labelling.
• Nursing staff should ensure that all the orifices and drainage sites are
wrapped appropriately.
• Mortuary attendant must be informed about pickup of the dead body.
• Mortuary staff is responsible for assessing the identification band on the
dead body and keeping the body in the refrigeration and maintenance of
the temperature.
• Body is kept safe until it is released.

In the mortuary
Releasing the body
• If the relatives wish to receive the body, a dead body slip is issued and
signed by the nursing officer and a copy is preserved in the records .
The other slip is given to the relatives by which they can receive the
dead body from the morgue easily .

INTRODUCTION
• Medico-legal case (MLC) refers to a case of injury or illness
that indicates investigation by law enforcement agencies to
establish and fix the criminal responsibility for the case
according to the law of the country.

Dying Declaration
1. Statement of a dying person, relating to the cause and
circumstances of his death
2. Magistrate having jurisdiction should be called to record
the declaration
3. Before recording doctor should certify that person and
his/her mental faculties are normal

Dying Declaration
4. If situation
demands the doctor
himself can record in
the presence of two
witnesses
5. The declaration is
then sent to the
magistrate in a
sealed envelope with
a letter

Injury/Wound Report
• Record details of the injuries found in the Accident Register
cum Injury or Wound Report/Certificate.
• The original is the Injury or WoundReport/Certificate,which
is to be detached and issued to the Police Officer,the carbon
copy will remain in the register and serve as a permanent
record for the Medical Officer

WILL
• A living will is a document which attempts to set out the kind of health care
that would be authorised by a patient who is unable to choose, for
example, because he or she is unconscious, delirious or otherwise
incapacitated.
• Any person who is above the age of 18 years has the right to make a will.
• It may or may not require a lawyer’s aid.

Organ Donation
• Organ donation and
transplantation is removing an
organ from one person (the
donor) and surgically placing it
in another (the recipient) whose
organ has failed.
• Organs that can be donated
include the liver, kidney,
pancreas and heart.
• It can be done when a person is
dead or alive.
• Most donations are done after
the death of the patient.

Death certificate
Death Certificate is Issued only :
• If cause of death is known beyond all doubts
• A person is admitted in hospital, clinical diagnosis is made
based on signs, symptoms and diagnostic procedures
• Death occurs due to natural consequences after diagnosis is
made

Death certificate
Don’t certify death in the following conditions:
• Person brought death/dead on arrival to casualty
• Persons dying after admission and before making a
diagnosis • In all alleged cases of unnatural
death(accident/suicide/homicide)
• Anaesthetic deaths
• Snakebites
• Death of a woman in her husband’s house within 7 yrs of
marriage

Medical Negligence
“the ommission to do something which a reasonable
man guided by those ordinary considerations which
ordinarily regulate human affairs,would do,or the
doing of something which a reasonable and prudent
man would not do”

EUTHANASIA
DEFINITION :-
Euthanasia is defined as painless killing of patient suffering from an incurable and painfull
disease

Classification
1. Voluntary Euthanasia
It is conducted with consent of the patient. It is of two types active
and passive. It is concerned as a right to choice of the patient.
2. Nonvoluntary Euthanasia
It is conducted when consent of the patientis not available like who is
mentally incompetent or comatose patient. In this case the family
membersmake the choice of nonvoluntary Euthanasia.
3.Active Euthanasia
Death of individual caused when medical professional or any other person
deliberately does an action like using lethal injection to painlessly resulting in
death of terminally ill patient.

4.Passive Euthanasia
It is by means of withdrawal of life support which is essential for
continuance of life and gradually patient moves to death. It is legal in
throughout US.

Euthanasia In India
• On 9 March 2018 the supreme court of india legalized passive
Euthanasia by means of the withdrawal of life support to patients in a
permanent vegetative state. The decision was made as part of the
verdict in a case involving Aruna Shahnbaug(nurse by profession),
who had been in a persistent vegetative state (PVS) for 42 Year Until
her death in 2015.

“Textbook of Foundation of
Nursing" by Jyoti Kathwal

Nursing-Foundation-29.by vision books pdf

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