Module 16: Death and Dying
Statement of Purpose: The Nurse Assistant is introduced to the various stages of the grieving process and physical signs of approaching death. This unit introduces death as a normal stage of life. The health care provider must recognize the physical, psychological, and spiritual needs of the patient/resident during this period to understand coping mechanisms and provide support to the patient/resident and family members.
Module 16 Vocabulary Study Tool: https://claude.ai/public/artifacts/ffc848c8-72b3-49bb-a575-ad5be84960e9
Performance Standards (Objectives): Define key terminology:
1. Acceptance
2. Advanced directives
3. Apnea
4. Anger
5. Artificial hydration/nutrition
6. Autopsy
7. Bargaining
8. Cachexia
9. Cheyne-stokes respirations
10. Denial
11. Depression
12. Do Not Resuscitate (DNR)
13. Durable power of attorney
14. Hospice
15. Living will
16. Morgue
17. Mottling
18. Palliative care
19. Patient Care Self-Determination Act
20. Postmortem care
21. Prognosis
22. Reminiscence
23. Reincarnation
24. Rigor mortis
25. Shroud
26. Terminal
Patient, resident, and client are synonymous terms referring to the person receiving care
Based on Module 16’s Death and Dying vocabulary and the corresponding definitions from the nursing curriculum glossary, here are sentences for adult English learners preparing for the CNA California Exam:
Module 16: Death and Dying – Vocabulary Sentences
- Acceptance is the final stage of grief when a person comes to terms with their situation and finds peace with dying.
- Advanced directives are pre-written and signed documents that tell doctors what medical treatment a person wants if they cannot speak for themselves.
- Apnea means a temporary absence of breathing, which can occur during the dying process.
- Anger is a normal feeling of great displeasure or hostility that dying patients and their families may experience during grief.
- Artificial hydration/nutrition refers to providing fluids and food through tubes when a person cannot eat or drink normally.
- An autopsy is an examination of the organs and tissues of a dead body to determine the cause of death or study disease.
- Bargaining is a defense mechanism where a person promises to change their behavior to avoid loss, such as “I’ll be good if I can live longer.”
- Cachexia is severe malnutrition and body wasting that often occurs in terminally ill patients.
- Cheyne-Stokes respirations are an abnormal breathing pattern of shallow breaths followed by deeper breaths, then stopping, often seen near death.
- Denial is the refusal to accept or believe something, often used to protect a person from painful feelings about death.
- Depression is a state of sadness, grief, or low spirits that may range from mild to severe during the grieving process.
- Do Not Resuscitate (DNR) is an order written by a physician indicating that no extraordinary means should be used when death occurs.
- A durable power of attorney is a document giving someone the right and responsibility to make health care decisions for another person.
- Hospice care focuses on comfort and quality of life for terminally ill patients and can take place at home or in a facility.
- A living will is an advance directive that provides specific instructions for medical treatment or organ donation.
- A morgue is a place where dead bodies are kept until they are identified or prepared for burial.
- Mottling refers to spots or blotches of different colors on the skin, usually associated with poor circulation near death.
- Palliative care is focused on providing comfort rather than trying to cure the disease.
- The Patient Care Self-Determination Act is a law requiring hospitals to give patients information about advance directives like living wills.
- Postmortem care is the physical care given to a body after death to prepare it with dignity and respect.
- A prognosis is a prediction about the probable course of a disease and the patient’s chances of recovery.
- Reminiscence involves remembering and talking about events and personal experiences from the past, which can comfort dying patients.
- Reincarnation is the belief that the soul is reborn into a new body after death, held by some religious traditions.
- Rigor mortis is the stiffening of the body that occurs several hours after death.
- A shroud is something that covers or wraps around a deceased person’s body.
- Terminal means there is no reasonable expectation of recovery from an illness or condition.
These sentences will help CNA students understand both the vocabulary terms and their practical application in end-of-life care situations.
Module 16: 5 CNA Dialogues: Death and Dying Vocabulary
Dialogue 1: Understanding Advanced Directives
Nurse Supervisor (Maria): Good morning, Sarah. Today we’ll discuss advanced directives with Mrs. Johnson’s family. Do you know what these are?
CNA Student (Sarah): I think they’re legal documents, but I’m not sure exactly what they include.
Maria: Exactly. Advanced directives include a living will and a durable power of attorney. The living will states the patient’s wishes about artificial hydration and nutrition if they can’t communicate.
Sarah: What about the Do Not Resuscitate order we saw on her chart?
Maria: That’s a DNR order. It means if Mrs. Johnson’s heart stops, we won’t perform CPR. This follows the Patient Care Self-Determination Act, which gives patients the right to make these decisions.
Sarah: It must be difficult for families to make these choices.
Maria: Yes, that’s why we provide emotional support and ensure they understand all options, including palliative care and hospice services.
Dialogue 2: Recognizing Physical Signs
CNA (David): I’m concerned about Mr. Wilson in room 302. His breathing seems different today.
Registered Nurse (Jennifer): Can you describe what you’re observing?
David: He has periods where he stops breathing completely – what we call apnea – then starts again. Is this normal?
Jennifer: You’re noticing Cheyne-Stokes respirations. This irregular breathing pattern is common as patients approach end of life. What else have you observed?
David: His skin looks patchy, especially on his legs. It’s darker in some spots.
Jennifer: That’s mottling – poor circulation causes this skin discoloration. These are signs his body is preparing for death. We need to keep him comfortable and notify his family.
David: Should we discuss his prognosis with them?
Jennifer: The doctor will handle that conversation. Our role is to provide compassionate care and observe any changes in his condition.
Dialogue 3: Supporting Family Through Grief
CNA (Lisa): Mrs. Garcia’s daughter seems very upset today. She keeps saying “This can’t be happening.”
Social Worker (Robert): She’s experiencing denial, which is the first stage of grief. People often refuse to accept their loved one’s terminal diagnosis initially.
Lisa: Yesterday she was shouting at the doctors, demanding they do more tests.
Robert: That sounds like anger – another grief stage. Sometimes families get angry at medical staff when they feel helpless.
Lisa: Now she’s asking if her mother will get better if she donates money to the hospital.
Robert: That’s bargaining – trying to make deals to change the outcome. Eventually, she may experience depression before reaching acceptance. Each person grieves differently.
Lisa: How can I help her?
Robert: Listen without judgment, offer tissues, and encourage her to share memories through reminiscence. Sometimes talking about happy times brings comfort.
Dialogue 4: End-of-Life Physical Changes
New CNA (Alex): I’ve never cared for someone who was dying before. What should I expect?
Experienced CNA (Carmen): End-of-life changes can be gradual. You might notice cachexia – severe weight loss and muscle wasting as the body shuts down.
Alex: Are there other physical signs I should watch for?
Carmen: Yes. Breathing may become irregular with apnea episodes. Skin temperature drops, and mottling appears on extremities. These are natural processes.
Alex: What happens after death?
Carmen: Rigor mortis begins – muscles stiffen gradually. We perform postmortem care, which includes cleaning and positioning the body with dignity. Sometimes families request an autopsy to determine exact cause of death.
Alex: Where does the body go afterward?
Carmen: Usually to the morgue until funeral arrangements are made. We wrap the body in a shroud – a special covering – before transport.
Dialogue 5: Cultural and Spiritual Considerations
CNA (Michael): The Patel family is asking about their father’s care after death. They mentioned something about reincarnation.
Chaplain (Susan): Many Hindu families believe in reincarnation – that the soul moves to a new body after death. This affects their funeral customs and timing.
Michael: They want to stay with him until he passes. Is that okay?
Susan: Absolutely. Family presence provides comfort and respects their spiritual beliefs. We support whatever brings peace during this difficult time.
Michael: What if they have specific requests about handling his body?
Susan: We honor cultural and religious preferences whenever possible. Some families have particular washing rituals or positioning requirements. Always ask respectfully about their traditions.
Michael: The daughter keeps talking about memories of her father’s childhood in India.
Susan: Reminiscence is healing. Sharing stories helps families process grief and celebrate their loved one’s life. Encourage these conversations – they’re part of the healing process.
Key Vocabulary Review
Legal Documents: Advanced directives, living will, durable power of attorney, DNR (Do Not Resuscitate), Patient Care Self-Determination Act
Physical Signs: Apnea, Cheyne-Stokes respirations, mottling, cachexia, rigor mortis
Grief Stages: Denial, anger, bargaining, depression, acceptance
Care Types: Palliative care, hospice, postmortem care
Medical Terms: Terminal, prognosis, autopsy, artificial hydration/nutrition
Cultural/Spiritual: Reincarnation, reminiscence, shroud, morgue
