CARE OF THE DECEASED POSTMORTEM CARE

Key Terms Deceased Postmortem Morgue Autopsy Rigor mortis Shroud Coroner

Signs of Impending Death Decreased urine output Changes in vital signs Respirations become shallow and irregular Inability to clear secretions “Death rattle” Circumoral cyanosis Pallor

What Role Does the Nurse Play when Death is Expected A very difficult and challenging role with an opportunity to provide and receive the most rewarding aspect of being a nurse

What About Unexpected Death? Work with the rest of the health team Provide comfort for the grieving family

POSTMORTEM CARE Death – occurs when the heart stops beating MD pronounces pt dead in hospital or nursing home & signs the death certificate (documents time of death & cause of death) RN, coroner, or undertaker may pronounce pt dead if dies at home & is not unexpected

CORONER determines cause of death if suspicious or unexpected (injury, homicide, accident, suicide) Any death within 24 hr of hospital admission & death of person not under MD care must be reported to coroner

AUTOPSY POSTMORTEM EXAM CORONER’S CASE Examination of the body by a pathologist to determine the cause of death may be requested by family, MD, or required by law if death unexpected or suspicious Need consent from next of kin unless a coroner’s case

AUTOPSY CASE Body must be kept as it was at time of death (leave in IVs, catheters, etc., by cutting tubings, removing drainage bags)

CARING FOR THE FAMILY May need time to sit with the body Assist them with their grief, provide a quiet place Be available to listen & be supportive

CARING FOR THE FAMILY Many factors influence how they cope (personalities of family members, value of the deceased, relationship with deceased, family stability & unity, culture & ethnic practices & customs, religious beliefs, age of deceased, suddenness of death, length of illness, manner of death)

CARING FOR YOURSELF In order to provide good support as a nurse for the families of patients who have died, it is most important to have dealt with your own feelings about death & dying You need to have a support system as well

POSTMORTEM CARE Prepare the body for family to see if wish to Be sure body is clean Prepare body so deceased appears comfortable Turn off monitors, etc. Check if autopsy to be performed, if so, DO NOT remove any lines or tubes

POSTMORTEM CARE CONT. Allow family members to stay as long as wish Offer to call chaplain, clergy, friends, other family members Determine whether pt is an organ donor prior to clinical death (pt needs to be kept alive until organs are harvested)

ORGAN DONATION Federal legislation requires hospitals to identify & refer potential donors to procurement agencies Discussion of donation should be performed in a sensitive & caring manner (no pressure) by a physician or specially trained nurse Can allow for something good to come out of a personal tragedy

ORGAN DONATION Tissues & organs used for transplant: Vital organs = heart, liver, lungs, kidneys, pancreas Non-vital organs: corneas, skin, long bones, middle ear bones

ORGAN DONATION The organs &/or tissue are recovered after the pt is pronounced dead. Circulatory & ventilatory support is maintained to perfuse the organs before removal.

CHANGES THAT OCCUR AFTER DEATH Decomposition of blood cells after death causes appearance of bruising & mottling of skin. ATP production stops, myosin heads become stuck to actin, and rigor mortis sets in, making the body stiff. PM care should be done as soon as possible after death to prevent tissue damage or disfigurement

POSTMORTEM CARE After family has left, the nurse prepares the body for transport to the morgue or pick up by funeral director Check if family wants to assist in caring for the body

Procedure Assessment: –Verify identity –Notification of family and/or clergy –Determine if autopsy is to be done –Determine if family would like to assist in bathing the deceased

Planning: –Gather equipment – bathing supplies, clean linens, gown, postmortem kit –Assist roommate out of room –Provide privacy –Plan to handle the body with dignity & care.

Implementation Close door & curtains for privacy Treat body with dignity & sensitivity Try to perform PM care ASAP to prevent tissue damage or disfigurement of body parts

POSTMORTEM CARE 1. Wash hands & don gloves. 2. Position pt in supine position w/ small pillow under head (prevents lividity - discoloration of face from blood pooling) 3.Replace dentures (maintains normal facial features). Close eyes & mouth (place a rolled towel under chin).

POSTMORTEM CARE 4. Remove jewelry & clothing. Give to family & document. 5. Wash all areas soiled with blood, feces, urine, or drainage. Place pads under rectum & between legs. After death, sphincter muscles relax, allowing leakage of stool, urine, or body fluids

POSTMORTEM CARE 6. Comb hair & arrange neatly. 7. Remove all tubes, IVs, catheters, etc. if no autopsy to be performed. 8. Change soiled dressings & remove adhesive marks with solvent.

POSTMORTEM CARE 9. Dress body in clean gown if family to view. Remove gown before placing in shroud. 10. Attach ID tags on big toe or ankle & wrist 11. Place padded ties around ankles, criss- cross wrists over abdomen & secure with padded ties. Place a gauze tie or chin strap under jaw to keep mouth closed.

POSTMORTEM CARE 12. Place body in shroud & check for placement of drainage pads. Fold shroud. Secure shroud at chest, waist, & knees. Place ID tag on outside of shroud. 13. Transfer body to stretcher or morgue cart. Transport to morgue per facility policy. Use discretion, respect deceased & needs of other pts.

DOCUMENTATION Must be objective, complete, legible, & accurate Legal proof of nursing care provided Record who was present at time of death Last entry should state where & to whom the body was transferred

DOCUMENTATION 10/12/ Pt. stopped breathing No apical pulse detected. Dr. Miller in to pronounce pt Family present & assisted in washing & preparing the body for transport to morgue. Foley catheter removed. ID tags attached to Rt. toe, Rt. wrist, & zipper outside of shroud. Transported to morgue at 11:20 AM C. DeMatteo, RN