Terminal illness 
   An illness in which death is expected within a limited space of time. 
 Meaning of death: 
        Death is a fundamental loss. It can be viewed as a dying person's final opportunity to experience life in ways that bring significance and fulfilment. 
Definition- the uniform definition of death act (1981) 
       An individual who has sustained either 
·        Irreversible cessation of all functions of circulatory and respiratory functions or 
·        Irreversible cessation of all functions of the entire brain, including brain stemIs dead 
       The traditional clinical signs of death were cessation of the apical pulse, respirations, and blood pressure, also referred to as heart-lung death. 
Signs of impending clinical death : 
       Loss of muscle tone: 
§  Relaxation of the facial muscles (sagging of face) 
§  Difficulty speaking 
§  Difficulty swallowing and gradual loss of the gag reflex 
§  Decreased activity of the gastrointestinal tract, with subsequent nausea, accumulation of flatus, abdominal distention, and retention of feces, especially if narcotics or tranquilizers are being administered 
§  Possible urinary and rectal incontinence due to decreased sphincter control 
§  Diminished body movement 
Slowing of the circulation: 
·        Diminished sensation 
·        Mottling and cyanosis of extremities 
·        Cold skin, first in the feet and later in the hands, ears and nose 
·        Slower and weaker pulse 
·        Decreased blood pressure 
Changes in respiration: 
§  Rapid, shallow, irregular or abnormally slow respirations 
§  Noisy breathing, referred to as "death rattle" 
§  Mouth breathing, dry oral mucus membrane. 
sensory impairment: 
·        Blurred vision 
·        Impaired sense of smell and taste. 
Signs of clinical death: 
(Medical criteria used to certify a death are) 
·        No muscular movement especially breathing 
·        No response to painful stimuli 
·        Lack of reflexes(such as gag or corneal reflex) and spontaneous movement 
·        Flat encephalogram 
·        Cerebral death or higher brain death 
·        Presence of cardiac activity, the permanent loss of cerebral function manifested clinically by the absenceof -Purposive responsiveness to external stimuli 
-         Absence of cephalic reflexes, 
-         Apnoea, 
-         Isoelectric encephalogram for at least 30 minutes, 
-         in the absence of hypothermia and poisoning by CNS depressants. 
Good death: 
       It is the one that allows a person to die on his or her own terms, relatively free of pain with dignity. 
Difference between clinical and biological death

Definition of clinical death:
                Clinical death is the cessation of breathing, followed by stopping of the heart. 
         Responses to dying and death: 
                 The reaction of any person-to another person's impending or real death, or to the potential   reality of his or her own death, depends on all the factors regarding loss and the development of the concept of death. 
·        Denial 
"They made a mistake in the diagnosis. May be they mixed up my records with someone else's" 
·        Anger 
                 "Why me? I quit smoking and I watched what I ate, Why did this happen to me? 
·        Bargaining 
 "If I can just make it to my son's graduation. I”ll be satisfied. Just let me live until then". 
·        Depression       
"I waited all these years to see my daughter getting married. And now I may not be there to see her walk down the aisle" 
·        Acceptance 
"l have tied up all the loose ends: made my will, made arrangements for my daughter to live with her grandparents. Now I can go in peace knowing everyone will be fine"



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item Death
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