POSTMORTEM CARE Table of Contents Definition etiology pathophysiology
POST-MORTEM CARE
Table of Contents �Definition, etiology, pathophysiology �Manifestations evident in nursing assessment �Diagnostic �Procedure/preparation �Patient problems/interventions �NCLEX Questions �References KAD
What is postmortem care? �Definition: The care provided to a patient and family directly after death (physical, emotional, and/or religious). KD
Physical Changes After Death � Algor Mortis � Post-Mortem Decomposition � Rigor Mortis � Defecation or release of bodily fluids (purge fluid) � Livor Mortis (see picture) MB
Cultural differences � Jewish � Muslim � Jehovahs Witness � Catholic KD
Nursing Responsibilities When Death is foreseeable �Be prepared � Religious, Spiritual, Cultural issues � Don’t wait �Keep supervisor informed �Keep family informed SR
Nursing Responsibilities When Death is Sudden �Reallocate �Certify �Paperwork �Remove devices �Infectious �Coroner or Police �Notify SR
Nursing Responsibilities In Case of All Deaths �Notify � Resident � Consulting and Attending Physicians � Charge Nurse, Charge Nurse Manager, Supervisor � Chaplain/Clergy � Possibly Family �Report to: Coroners Office, Donor Referral Hotline �Important! � Nurse cannot recommend funeral home, advise on cremation vs burial, or act as a legal witness for any paper work TS
Critical Procedure Points � Don’t ask for Organs � Know the Rules! � Autopsy, Specimens, Special Order? � Coroner? � Tags/Bands? YF
Procedures / Equipment � � � Gauze or soft string ties Gloves Chin straps Abdominal pads Cotton balls Plastic shroud or body wrap, Plastic bag or biohazard bags Three identification tags Adhesive bandages Water-filled basin, Soap, Towels, Washcloths Stretcher Optional: tape, personal protective equipment TS
Potential Nursing Diagnosis �Ineffective family coping �Spiritual Distress �Death Anxiety �Complicated Grieving �Hopelessness RI
Patient/Family Problem Interventions �Presence/therapeutic communication �Discuss spiritual beliefs and needs with family members �Educate family members prior to death and after about symptoms the patient may experience. RI
Charting and Documentation � Actions related to death � Physician � Organ/Tissue Donation � Religious, Spiritual, Cultural issues � Medical Devices � Document personal articles left on the patient � Personal items � Location of body identification tags � Time of body transfer and who transferred � Any other relevant information or family requests MB
Considerations ❏ Special Considerations ❏ Spiritual, Religious, Cultural ❏ Personal belongings ❏ Viewing ❏ Patient Teaching: ❏ Important people ❏ Discussion YF
NCLEX question When performing a nursing assessment, which of these observations would be the most significant finding of a client who is dying? a. b. c. d. Temperature of 96. 8 degrees F Pain level of 5 Cheyne-Stokes respirations Urinary incontinence DV
NCLEX Questions A Nurse is is preparing to perform a postmortem procedure on a deceased client. Which of the following equipment is essential for completing this task? A. Sterile Gloves B. Trash Bags C. Identification D. Clean Sheets TS
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. References National End of Life Care Programme and National Nurse Consultant Group (Palliative Care). (2011). "Guidance for staff responsible for care after death (last offices)" [Online]. Accessed March 2016 via the Web at http: //www. nhsiq. nhs. uk/media/2426968/care_after_death___guidance. pdf Centers for Medicare & Medicaid Services, Department of Health and Human Services. (2015). Condition of participation: Organ, tissue, and eye procurement. 42 C. F. R. § 482. 45. American Osteopathic Association. (2014). Standard 14. 00. 01. Healthcare Facilities Accreditation Program: Accreditation requirements for acute care hospitals. Chicago, IL: American Osteopathic Association. (Level VII) DNV GL-Healthcare USA, Inc. (2014). TO. 1. SR. 1. NIAHO® accreditation requirements: Interpretive guidelines & surveyor guidance (version 11). Milford, OH: DNV GL-Healthcare USA, Inc. (Level VII) American Osteopathic Association. (2014). Standard 15. 01. 16. Healthcare Facilities Accreditation Program: Accreditation requirements for acute care hospitals. Chicago, IL: American Osteopathic Association. (Level VII) Centers for Medicare and Medicaid Services, Department of Health and Human Services. (2015). Condition of participation: Patient's rights. 42 C. F. R. § 482. 13(c)(1). The Joint Commission. (2016). Standard RI. 01. 01. Comprehensive accreditation manual for hospitals. Oakbrook Terrace, IL: The Joint Commission. (Level VII) DNV GL-Healthcare USA, Inc. (2014). PR. 1. SR. 5. NIAHO® accreditation requirements: Interpretive guidelines & surveyor guidance (version 11). Milford, OH: DNV GL-Healthcare USA, Inc. (Level VII) Centers for Disease Control and Prevention. (2002). Guideline for hand hygiene in health-care settings: Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. MMWR Recommendations and Reports, 51(RR-16), 1– 45. Accessed March 2016 via the Web at http: //www. cdc. gov/mmwr/pdf/rr/rr 5116. pdf (Level II) Centers for Medicare & Medicaid Services, Department of Health and Human Services. (2015). Condition of participation: Infection control. 42 C. F. R. § 482. 42. American Osteopathic Association. (2014). Standard 07. 01. 21. Healthcare Facilities Accreditation Program: Accreditation requirements for acute care hospitals. Chicago, IL: American Osteopathic Association. (Level VII) World Health Organization. (2009). "WHO guidelines on hand hygiene in health care: First global patient safety challenge, clean care is safer care" [Online]. Accessed March 2016 via the Web at http: //whqlibdoc. who. int/publications/2009/9789241597906_eng. pdf (Level IV) The Joint Commission. (2016). Standard NPSG. 07. 01. Comprehensive accreditation manual for hospitals. Oakbrook Terrace, IL: The Joint Commission. (Level VII) DNV GL-Healthcare USA, Inc. (2014). IC. 1. SR. 1. NIAHO® accreditation requirements: Interpretive guidelines & surveyor guidance (version 11). Milford, OH: DNV GL-Healthcare USA, Inc. (Level VII)
References 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. American Osteopathic Association. (2014). Standard 07. 01. 21. Healthcare Facilities Accreditation Program: Accreditation requirements for acute care hospitals. Chicago, IL: American Osteopathic Association. (Level VII) World Health Organization. (2009). "WHO guidelines on hand hygiene in health care: First global patient safety challenge, clean care is safer care" [Online]. Accessed March 2016 via the Web at http: //whqlibdoc. who. int/publications/2009/9789241597906_eng. pdf (Level IV) The Joint Commission. (2016). Standard NPSG. 07. 01. Comprehensive accreditation manual for hospitals. Oakbrook Terrace, IL: The Joint Commission. (Level VII) DNV GL-Healthcare USA, Inc. (2014). IC. 1. SR. 1. NIAHO® accreditation requirements: Interpretive guidelines & surveyor guidance (version 11). Milford, OH: DNV GLHealthcare USA, Inc. (Level VII) American Osteopathic Association. (2014). Standard 07. 01. 10. Healthcare Facilities Accreditation Program: Accreditation requirements for acute care hospitals. Chicago, IL: American Osteopathic Association. (Level VII) Siegel, J. D. , et al. (2007). "2007 guideline for isolation precautions: Preventing transmission of infectious agents in healthcare settings" [Online]. Accessed March 2016 via the Web at http: //www. cdc. gov/hicpac/pdf/isolation/Isolation 2007. pdf (Level II) National Institute on Aging. (2015). "Things to do after someone dies" [Online]. Accessed March 2016 via the Web at http: //www. nia. nih. gov/health/publication/end-lifehelping-comfort-and-care/things-do-after-someone-dies The Joint Commission. (2016). Standard RC. 01. 03. 01. Comprehensive accreditation manual for hospitals. Oakbrook Terrace, IL: The Joint Commission. (Level VII) Centers for Medicare & Medicaid Services, Department of Health and Human Services. (2015). Condition of participation: Medical record services. 42 C. F. R. § 482. 24(b). American Osteopathic Association. (2014). Standard 10. 03. Healthcare Facilities Accreditation Program: Accreditation requirements for acute care hospitals. Chicago, IL: American Osteopathic Association. (Level VII) DNV GL-Healthcare USA, Inc. (2014). MR. 2. SR. 1. NIAHO® accreditation requirements: Interpretive guidelines & surveyor guidance (version 11). Milford, OH: DNV GLHealthcare USA, Inc. (Level VII) Hand, M. W. (2014) Lasting impressions: Using the perspective of the funeral director to guide post mortem nursing care practice. Medsurg Matters Newsletter, 13(6), 4 – 6. Perry, Anne Griffin, & Potter, Patricia A. (2017). Fundamentals of Nursing: 9 th edition. St. Louis, Missouri: Elsevier Inc.
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