Funda

• Loss is an actual or potential situation in which something that is valued is changed or no longer available
• People can experience loss of body image, a loved one, well-being, a job, personal possessions, or beliefs
• Death is a loss for both the dying person and those who survive
• Grief is the total response to the emotional experience related to loss
• Bereavement is the subjective response experienced by the surviving loved ones
• Mourning is the behavioral process through which grief is eventually resolved or altered
• Autopsy/Post Mortem Examination: examination of the body after death
• DNR (Do Not Resuscitate): written when the client or proxy has expressed the wish for no resuscitation in the event of a respiratory or cardiac arrest
• Euthanasia: act of painlessly putting to death persons suffering from incurable or distressing disease
• Post Mortem Care: care of the body after death, aimed to provide dignity to the dead and sensitivity to the personal, religious, and cultural needs of the family
• Hospice Care focuses on support and care of the dying person's family, with the goal of facilitating a peaceful and dignified death
• Palliative Care focuses on symptom care of clients whom disease no longer responds to cure-focused treatment
• Physiologic Needs of a Dying Person include personal hygiene measures, controlling pain, and providing measures related to sensory changes
• Rigor Mortis (Post Mortem Rigidity) is the stiffening of the body that occurs about 2 to 4 hours after death due to lack of Adenosine Triphosphate (ATP)
• Post Mortem Care:

  • Autolysis (ATP) is not synthesized due to lack of glycogen in the body
  • Autolysis starts in involuntary muscles (heart, bladder, etc.) and progresses to the head, neck, trunk, and extremities
  • Autolysis leaves the body about 96 hours after death
• Algor Mortis (Post Mortem Cooling):

  • Gradual decrease of the body's temperature after death
  • Body temperature falls about 1 degree Celsius per hour until it reaches room temperature
• Livor Mortis (Post Mortem Lividity):

  • Bluish discoloration of the skin after death
  • Skin becomes discolored after blood circulation has ceased
  • RBC breakdown releases hemoglobin, which discolours surrounding tissues
• Putrefaction:

  • Destruction of a dead body by bacteria
  • Rate of changes depends on the environment
  • Hot, moist conditions favor putrefaction, while cold, dry air delays or prevents it
  • Deceased body should be placed in refrigeration in the morgue as soon as possible
• Embalming:

  • Used to chemically preserve the body
  • Solution introduced kills bacteria and prevents rapid decomposition of tissues
  • Tissues become soft and eventually liquefied by bacterial fermentation
  • Bodies are often stored in cool places to delay the process
• Purpose of Post Mortem Care:

  • Aid in preserving the physical appearance of the deceased
  • Prevent discoloration and damage of the corpse skin
  • Safeguard belongings of the deceased
  • Support family members during the initial hours of bereavement
  • Show respect for the deceased
• Signs of Impending Clinical Death:

  • Loss of Muscle Tone
  • Slowing of the Circulation
  • Changes in respiration
  • Sensory Impairment
• Dying Person's Bill of Rights:

  • Right to be treated as a living human being until death
  • Right to express feelings and emotions about approaching death
  • Right to participate in decisions concerning care
  • Right to expect continuing medical and nursing attention
  • Right not to die alone
  • Right to be free from pain
  • Right to have questions answered honestly
  • Right to die in peace and with dignity
• Guidelines of Post Mortem Care:

  • Show respect and preserve client's dignity
  • Maintain normal position with client in a supine position
  • Ensure none of the client's property or personal belongings is lost
  • Dispose soiled dressings, linens, and equipment properly
  • Observe standard precautions
  • Allow family to say goodbye through touching and talking
• Nursing Responsibilities Before, During, and After Post Mortem Care:

  • Before: Check for certification of death, gather necessary materials, provide privacy
  • During: Maintain body in supine position, remove supplies and personal belongings, bathe the body thoroughly
  • After: Transfer body to morgue, document the procedure
• Procedures Occurring After Death:

  • Pronouncement of Death and Death Certificate
  • Autopsy
• Autopsy or postmortem examination:

  • An examination of the body after death and is performed only in certain cases
  • Done when death is sudden or occurs within 48 hours of admission to a hospital to establish the exact cause of death
  • Done to learn more about the disease
  • Done to assist the accumulation of statistical data
• Consent for autopsy:

  • Should be obtained by the physician from the decedent (before death) or by the next of kin (surviving spouse, adult children, parents, siblings)
  • Hospitals cannot retain any tissues or organs without permission of the person who consented to the autopsy
• Inquest:

  • A legal inquiry into the cause or manner of death
  • Conducted under the jurisdiction of a coroner or medical examiner
  • Held when a death is the result of an accident to determine any blame
• Organ Donation:

  • People 18 years or older and of sound mind may donate all or any part of their bodies for various purposes
  • Donation can be made by a provision in a will or by signing a card-like form
  • Details regarding the process of requesting donation from family members and other legal aspects vary from country to country
• Nursing responsibilities of discharging a dead patient:

  • Evaluate nursing care for the grieving and dying client through communication and assessment
  • Evaluate the situation in clear and precise terms based on accurate database for nursing diagnosis
  • Document time of death, actions taken to prevent death, who pronounced the death, personal articles left on the body, personal items given to the family, time of discharge, destination of the body, and other relevant statements
  • Medical forms must be signed by a doctor or registered nurse
• Death Certificate:

  • Formal determination of death must be performed by a physician, coroner, or nurse
  • The authority to pronounce death may be regulated by the state or province
  • Family is given a copy of the death certificate for legal matters
• Labeling of the deceased:

  • Inappropriately identified and prepared incorrectly can create legal problems
  • Labels are placed on the wrist, ankle, and on the shroud
  • Contains name of deceased, hospital number, and name of attending physician
• Documentation:

  • Document reason for attending, who was present, circumstances of death, confirmation of death assessment, outcome of assessment, discussions with staff members or relatives, concerns, disposition of the body, and details of family members present or notified
  • Document all postmortem care given and belongings left on the patient