Understand common features of support during the last days of life
1.1 Describe the common signs of approaching death
There are many signs of approaching death such as a cold touch to the individual’s hands, arms and feet. They may feel increasingly cool to the touch and their skin may also change colour. Which is normal as it is an indication that the circulation is decreasing to the bodies extremities in order to preserve it for the vital organs. They may also sleep more than usual, sometimes unresponsive- although their cognitive state has altered they are still able to hear what is going on around them and when you speak to them as hearing is one of the last senses to go. You should always talk calmly and clearly as you normally would.
They may appear to be more confused or even in a state of delirium. For example- they may be confused over time, place or may not even recognise your voice. It is important to offer reassurance during this time. The individual will eventually lose the ability to control their urine and bowel movements. This is due to the fact that their muscles are relaxing in that area- this can be discussed with the palliative nursing team and ensure it is reported to the office. Continence aids/ catheters can be supplied in order to preserve the individual’s dignity, tissue viability and wellbeing. There are other common signs such as a decline in fluid and food intake as the body begins to shut down it requires less. Restlessness can occur and their breathing pattern may change to a point it may become what is known as Cheyne stokes breathing.
1.2 Define circumstances when life prolonging treatment can be stopped or withheld
Circumstances where life prolonging treatment can be stopped or withheld can include several factors.
If it is not considered to of benefit to the individual. Treatment can be withdrawn if there is an agreement whereby continuing treatment is not in the individual’s best interests- however, this must be discussed with the individual and relatives – if the individual has the capacity to make that decision. The individual has the right to authorise a DNAR to be put in place when he/she has capacity to do so, if they do not a Power of Attorney is allowed to put one in place.
If the individual refuses treatment and has the capacity to make that informed decision. If treatment would be ineffective or cause unnecessary distress.
1.2 Analyse the importance of any advance care plan in the last days of life
Advance Care Planning (ACP) is a voluntary process of discussion and documentation about future care an individual wishes to receive or decline. This is discussed between the relevant individual, their care providers and family if the individual wishes for them to be included. It is recommended that the discussion is recorded and documented, regularly reviewed and communicated to the necessary parties involved in the individuals care.
An ACP is likely to include several things- The individuals concerns and wishes, their values, beliefs and personal care goals. Their understanding about their illness and the prognosis. Their preferences and wishes for types of care, treatment including the multi-disciplinary teams required input which may be crucial in the event that the individual was to lose capacity through their illness. Which is highly beneficial as this would cover any aspect of future health and social care, preferences, wishes, beliefs and values towards any future care in their best interests.
1.4 Identify the signs that death has occurred
The Individual will be totally unresponsive. No breathing, No heartbeat/ Pulse, Their entire body will be limp, loss of bodily fluids- bowel and or bladder control. The individuals pupils will be fixed in a certain place, the jaw will be relaxed and their mouth will be slightly open. Their finger and toe nails will begin to discolour and their body will begin to decrease in temperature- Riga mortice will set in.