Caring for a Dying Patient

Ronan Castronuevo
Fall 2017
Mrs. Click
 Disclaimer
Some of the information and research is taken from outside resources.

Google, Google, www.google.com/. Mayo Clinic. Mayo Clinic, Mayo Foundation for Medical Education and Bing. Bing, www.bing.com/.
Research, www.mayoclinic.org/.
 Cherry Abuy BSN
Works at Mainland Medical Center
RN in the ICU
Studied at Mary Chiles College for 4
years
Worked for 20 years
Has studied nursing, BSN
 What is ISM?
Course Description:
The Independent Study Mentorship (ISM) Advanced Academic course is designed for students wishing to mentor an adult professional in a
chosen career. With the mentor and the teacher-facilitator, each student will create a unique plan of study and receive individual instruction.
Students leave the high school campus and go to the mentors place of business to study with professionals. This course is ideal for the self-
motivated student with a passion for a particular area of study. ISM is a full year course. Students in this course must perform at a collegiate or
professional level. Students must provide their own transportation to mentorship sites. This course is recommended for students in grades 11-12
Requirements:
1. Complete an in-depth mentorship/study in an area of interest (must be approved by ISM teacher)
2. Document a minimum of 3 hours of mentorship each week (Mentorship Activity Log)
3. Complete a Journal Entry each week documenting mentorship experiences (ISM Journal)
4. Complete an ISM Professional Portfolio (online format/Weebly) showcasing assignments completed during the course and the final project
5. Complete all of the required assignments (See YAG and ISM Grading Sheet)
6. Complete a Mid-Term Presentation (must include PowerPoint or Prezi)
7. Develop a final product and presentation at the collegiate/professional level that is presented to a panel of graders at the conclusion of the
semester (must include PowerPoint, visuals, completed product, portfolio and handouts (See Product Guidelines section for guidance). The
final presentation will count as the FINAL EXAM Grade for this course. The grade is based on the Mentors Evaluation 50% and Grader
Evaluations 25% each of the presentation.
 Mentorship Site

Mainland Medical Center is located at

Texas City, caring for the patients of
Galveston County, and contains 223
beds with 6 operating rooms.

Mainland Medical Center, 6801 Emmett Lowry Expressway, Texas City | Hospital in Texas City - Reviews. Rate
Hospitals, www.ratehospitals.com/hospitals/texas-city/mainland-medical-center-14470/.
 Saf-T-Wing
(Butterfly Needle)
ICU Informational Brochure
Blood Test Results
Sepsis Diagram
Patient History Forms
Emergency Preparedness Guide
Patient Consent Form
EKG
ICU Room Assignments
Optalyse PE Study
 Caring for a Dying Patient Palliative Care
Palliative Care- Specialized medical care for people with serious illness. This type
of care is focused on providing relief from the symptoms and stress of a serious
illness. The goal is to improve quality of life for both the patient and the family.
Why?
I did this topic because I wanted to be able to present a topic that people will find
interesting and try to actively engage in, since it's a sensitive topic, it's much more
interesting. Also during my clinicals for HST II, two out of the three times I went to the
ICU, I witnessed a situation involving a patient that will most likely pass away.
 Key Points
My key points will be divided into two categories: pain management and communication.
Both are crucial aspects of caring for patients with serious illness, who are in a lot of pain and
stress. Some key points may crossover and fit in both.

Pain Assessment
Pain Medications
Levels of Sedation
Communicating with the Patient
Communicating with the Patients Family
 Pain Assessment
Methods of assessment should be selected considering the age, condition,
and level of comprehension that the patient has.
A common assessment method is the Wong-Baker FACES, which rates pain
using numerical values and images; the facial expression can make it easier
for younger children to rate the pain.
Pain assessment requires examination of multiple factors such as: the
frequency, the condition, the causes, the position, the components to the
injury, and any inhibiting factors to pain assessment.
Typically done on a regular basis, but also should be done if there is a
complaint, occurrence of pain, and after any pain medications

Foundation, Wong-Baker FACES. Home. Wong-Baker FACES Foundation, 2 Oct. 2017, wongbakerfaces.org/.
 Pain Medications
Pain medications include: NSAIDS, opioids, bisphosphonates, nerve blocks, and
epidurals.
Many patients in critical states are often sedated with drugs through an IV.
Most intensive care units will aim to place the patient in a light sleep, instead of a
full sleep.
In the ICU, it is much more imperative to create effective care plans and protocols,
with dosages and instruction, rather than finding the best pain relieving drug.
Maximizing pain relief is imperative at the end of life.
Some commonly used drugs in the ICU include: fentanyl, midazolam, lorazepam,
propofol, isoflurane, and dexmedetomidine.
 Levels of Sedation
Sedatives lower awareness for the purpose of relieving pain for patients
with severe symptoms.
They are dosed to match the patients level of distress.
To determine the effectiveness of a sedative, it should be lowered for
assessment.
Sedatives are typically continued until symptoms have waned, but
symptoms linger until death.
Product
 Communicating with Patients
Beginning with open ended questions helps establish a conversation, which
can lead to subjects which are difficult to talk about.
Use the patients responses to lead into more questions, typically about the
patients symptoms.
Ask patients for what their wishes are for end-of-life care.
Some patients refuse to give useful answers or any at all, in which health
care workers will have to try more indirect approaches.
Asking the patient for family member to be included in conversations is one
method, as they often raise additional issues or concerns.
 Communicating with the Patients Family
Death and dying heavily impact loved ones, with the patients family being
the most effected.
This leads health care workers to consider the needs of both the patient and
the family.
The main idea is to help families understand the patients position and the
care plan recommended by the physician and the healthcare team.
Comprehension and realization of a family members dying condition can be
difficult for the family to handle, so healthcare workers have to be patient
and empathize with them.
Informing families of what to expect can help give them peace of mind.

Heubeck, Elizabeth. For Patients and Families, a Greater Voice. Johns Hopkins Nursing Magazine, 29 July
2015, magazine.nursing.jhu.edu/2015/07/for-patients-and-families-a-greater-voice/.
 Current Event
The piece written by Linda Norlander is a commemorative article for National and Palliative Care Month. My project goes over how to
care for a dying patient, which is essentially palliative care. She states that its a time to honor those who provide end-of-life
care(Norlander, 1), and she does this by recalling several experiences she has had.
 Conclusion
I learned much more of what it means to be a nurse, the different skills
required to be a nurse, and the situations nurses must handle. I was able to use
my mentorship to gain first hand experience to learn about all of these aspects
of nursing. For my semester project I was able to better comprehend one of
the many challenges associated with nursing; dealing with the omnipresence
of death, and doing everything to prevent it or ease the passing.
Special thanks to both of my mentors, Cherry Abuy and Sara Thomas, for
accepting me and guiding me throughout my experience in the ICU. Ive
managed to learn a lot from experience, and I really enjoyed coming to the
hospital and gaining a firsthand experience with the patients. Thank you to
Mrs. Daffern for providing me with the room for the presentation today, for
teaching me last year, which led me to joining ISM for the mentorship
experience. Thank you to Mrs. Click for guiding me and the rest of the class
throughout the year with our ISM mentorship and final project.
Bing. Bing, www.bing.com/.
Works Cited
Foundation, Wong-Baker FACES. Home. Wong-Baker FACES Foundation, 2 Oct. 2017, wongbakerfaces.org/.

Gommers, Diederik, and Jan Bakker. Medications for Analgesia and Sedation in the Intensive CareUnit: An Overview. Critical Care
12.Suppl 3 (2008): S4.PMC. Web. 27 Oct. 2017.

Google, Google, www.google.com/.

Heubeck, Elizabeth. For Patients and Families, a Greater Voice. Johns Hopkins Nursing Magazine, 29 July 2015,
magazine.nursing.jhu.edu/2015/07/for-patients-and-families-a-greater-voice/.

Kishner, Stephem, et al. Pain Assessment. Edited by Erik D Shraga, Practice Essentials,Overview, Technique, 13 June 2016,
emedicine.medscape.com/article/1948069-overview.

Mainland Medical Center, 6801 Emmett Lowry Expressway, Texas City | Hospital in Texas City - Reviews. Rate Hospitals,
www.ratehospitals.com/hospitals/texas-city/mainland-medical-center-14470/.

Mayo Clinic. Mayo Clinic, Mayo Foundation for Medical Education and Research, www.mayoclinic.org/.

Norlander Reader columnist, Linda. Hospice Fills Last Days with Light and Love. Thenewstribune,29 Oct. 2017, 1:23 PM,
www.thenewstribune.com/opinion/article181332491.html.

Papadimos, Thomas J et al. An Overview of Endof life Issues in the Intensive Care Unit. International Journal of Critical Illness and
Injury Science 1.2 (2011): 138 146.PMC . Web.27 Oct. 2017.

Sugi.Wa. Memories. Memories, 25 Oct. 2017.