End of Life Care for CNA

What is the main goal of end-of-life care?

To ensure a peaceful, comfortable, and dignified death.

As a Nursing Assistant, your job is to focus on comfort, not cure. Every action you take should be gentle and respectful, treating the resident as a living person until the very end.

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Define:

Terminal Illness

A disease with no cure that is expected to lead to death.

A terminal illness is a disease with no cure that is expected to lead to death.

CNA Insight: This is a very difficult time for the resident and family. Your calm presence and gentle care are the most important things you can offer.

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How can a nurse assistant support a patient’s emotional needs at the end of life?

Listening
Offering reassurance
Providing companionship

Emotional support helps reduce fear and anxiety.

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List THREE signs that death is approaching.

Weak pulse
Cool extremities
Irregular breathing

These are common indicators that the body is shutting down.

CNA Insight: Keep the resident warm with light blankets and report these changes to the nurse.

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Fill in the blank:

_______ care focuses on relieving symptoms rather than curing illness.

Palliative

Palliative care improves comfort for terminally ill patients.

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Define:

Hospice Care

A type of care that provides comfort and support to terminally ill patients and their families.

Hospice care is typically provided when a patient has six months or less to live.

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True or False:

A patient receiving hospice care can still receive curative treatment.

False

Hospice care means the resident has chosen to stop treatments aimed at curing the illness. The focus shifts completely to comfort and pain management.

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What is the role of family in hospice care?

Providing emotional support
Participating in care
Making decisions

Families play a crucial role in the dying process.

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What is the importance of hospice volunteers?

They provide:

Companionship
Respite care
Emotional support

Volunteers help both patients and families during the dying process.

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Which healthcare order specifies that no CPR should be performed if the heart stops?

Do-Not-Resuscitate

(DNR)

A DNR order must be documented and respected.

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True or False:

A nurse assistant should always initiate CPR unless told otherwise.

False

This is a legal order. If a resident has a DNR, you must not start CPR. You must know which residents have this order.

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What should a nurse assistant do if a family member expresses grief?

Offer a listening ear
Acknowledge their emotions

Grief is a normal part of the end-of-life process.

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Why is respecting a patient’s religious beliefs important in end-of-life care?

It ensures that the patient’s spiritual needs are met and provides comfort.

Spiritual beliefs can influence end-of-life decisions.

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List TWO ways to manage pain in a dying patient.

Administer pain medication as prescribed
Adjust positioning for comfort

Pain control is a priority in end-of-life care.

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List THREE common emotions experienced by dying patients.

Fear
Anger
Sadness

Emotional responses vary based on personal beliefs and past experiences. These are normal. Never take their anger personally. Be patient and let them express their feelings.

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What should a nurse assistant do if a patient expresses a desire to stop eating and drinking?

Report to the nurse and respect the patient’s wishes.

You should report to the nurse and respect the patient’s wishes. This is a natural part of the dying process. You must not force them to eat or drink.

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How can a nurse assistant help a dying patient feel in control?

Offer choices in care
Respect their wishes
Involve them in decisions

You can help them feel in control by offering choices in care, respecting their wishes, and involving them in decisions.

CNA Insight: Ask, “Would you like your bath now or in an hour?” This gives them back some control.

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Why should a dying patient not be left alone?

They may:

Experience fear and discomfort
Need assistance

Presence of loved ones or caregivers provides reassurance.

CNA Insight: Even if they are unresponsive, they may still be able to hear you. Talk to them gently and let them know you are there.

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List TWO benefits of music therapy for dying patients.

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Reduces anxiety
Promotes relaxation

Music therapy is a non-medication comfort measure.

How can a nurse assistant support a patient’s dignity at the end of life?

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Respect privacy
Communicate kindly
Ensure comfort

Preserving dignity is a fundamental part of compassionate care.

True or False:

Medications should always be continued until the moment of death.

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False

Some medications may be discontinued if they no longer provide comfort.

How can a nurse assistant help a patient experiencing terminal agitation?

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Provide a calm environment
Reassure the patient
Notify the nurse

Terminal agitation is a state of restlessness, anxiety, and confusion that can happen near the end of life.

CNA Insight: You can help by creating a calm environment—keep the room quiet and dim, and speak in a soft, reassuring voice. Sometimes, a gentle hand massage or a cool cloth on the forehead can help calm the resident. Always notify the nurse, as they may need medication to help them relax.

Why is mouth care important for terminally ill patients?

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It prevents dryness
It promotes comfort

Regular oral care can reduce discomfort from dry mouth.

List THREE ways of managing dehydration in a dying patient.

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Offer ice chips
Provide oral swabs
Keep lips moist

Many dying patients no longer tolerate fluids but need comfort measures.

# Fill in the blanks: \_\_\_\_\_\_ \_\_\_\_\_ \_\_\_\_\_\_ occurs when a dying patient becomes **withdrawn and less responsive**.

Nearing death awareness ## Footnote Patients may enter a state of reflection or disengagement from surroundings.

# Fill in the blanks: A \_\_\_\_\_\_ \_\_\_\_\_ order allows patients to **refuse life-prolonging measures** such as feeding tubes or ventilators.

living will ## Footnote A living will outlines a patient’s medical treatment preferences. It allows patients to refuse life-prolonging measures.

# True or False: Hearing is the **last sense to go** before death.

True ## Footnote Always assume the resident can hear you, even if they are unresponsive. Speak to them, not about them, and continue to explain what you are doing.

# Fill in the blanks: Patients nearing the end of life may experience \_\_\_\_\_ \_\_\_\_\_, a **noisy breathing** caused by mucus buildup.

death rattle ## Footnote This occurs as the body loses the ability to clear secretions. This can be very upsetting for the family.

What is one way to **ease a patient’s breathing** at the end of life?

**Elevate the head** of the bed. ## Footnote This helps reduce discomfort from shortness of breath.

What should a nurse assistant do **immediately** after **a patient dies**?

* **Notify** the nurse * Allow family members **private time** with the body ## Footnote You should notify the nurse and then prepare the body and the room for the family's visit. **CNA Insight**: After the nurse confirms the death, you should gently clean the body, close the eyes, and position the resident for viewing. Ensure the room is clean, quiet, and has chairs and tissues for the family. Your most important role is to allow the family private, uninterrupted time with their loved one. Postmortem care is done after the family has left.

# Define: Postmortem Care

The process of **preparing the body** after death. ## Footnote Postmortem care is the process of preparing the body after death. **CNA Insight**: This is your final act of care. It includes gently cleaning, positioning, and dressing the body. You must treat the body with the same dignity and respect you showed the resident when they were alive. You may also be responsible for placing the identification tag on the toe and transporting the body to the facility's morgue or designated area, following the nurse's instructions.

How should a patient’s **body be positioned** after death?

**Supine** with hands at the sides or on the chest. ## Footnote Proper positioning preserves dignity and appearance.

# Define: Rigor Mortis

The **stiffening of muscles** after death. ## Footnote Rigor mortis is the stiffening of muscles after death. **CNA Insight**: This happens a few hours after death. It is why you must position the body quickly for the family to view.

How can family members **be involved in postmortem** care?

They may assist with **washing or dressing the body** according to cultural practices. ## Footnote Family participation can bring closure and comfort.

# Define: Bereavement Care

Support given to **grieving family members** after a patient’s death. ## Footnote Bereavement support helps families cope with loss.

How can a nurse assistant **support a grieving family**?

* Provide a calm presence * Offer condolences * Respect their space ## Footnote Families need time to process their loss.

# Fill in the blank: The \_\_\_\_\_\_\_ model outlines **five stages of grief**.

Kübler-Ross ## Footnote The five stages are: 1. **Denial** ("This isn't happening") 2. **Anger** ("Why me?") 3. **Bargaining** ("If I just do this...") 4. **Depression** (sadness) 5. **Acceptance** ("I am ready")

# True or False: Every dying patient experiences **all five stages of grief**.

False ## Footnote Some patients may not go through every stage or may move back and forth between them.

# Define: Anticipatory Grief

Grief that occurs **before the actual loss** happens. ## Footnote Common in families of terminally ill patients.

What should be done with a patient’s **personal belongings** after death?

Collect them carefully and give them to the **designated family member**. ## Footnote Handling belongings with respect supports grieving families.

How can a nurse assistant help a terminally ill patient with **spiritual distress**?

* Arrange visits from clergy * Provide privacy for prayer * Listen without judgment ## Footnote Addressing spiritual needs can bring peace at the end of life.

List TWO **religious practices** that may affect end-of-life care.

1. Last rites in Christianity 2. Washing the body in Islam or Judaism ## Footnote Religious customs around death should be respected.

List TWO **cultural considerations** in end-of-life care.

1. Preferences for postmortem care 2. Rituals surrounding death ## Footnote Different cultures have unique traditions related to death.

# Fill in the blank: **Orthodox Jewish patients** may require their body to be \_\_\_\_\_\_\_ before burial.

washed by family members or religious personnel ## Footnote Following these practices is important for respecting cultural beliefs.

How can a healthcare provider support a **Buddhist patient’s end-of-life practices**?

* Allow for chanting or prayer * Avoid moving the body for several hours after death ## Footnote Honoring these practices respects spiritual beliefs.

End of Life Care Flashcards

Demonstrate best practices to support patients at the end of their lives (45 cards)