rle finals 7

• Post mortem care


  Care provided to a patient immediately after death
• Dying process


  • Often accompanied by a myriad of psychological, spiritual, and physical needs, and nurses are in the ideal position to identify and address them
• Kubler-Ross Stages of Dying (Loss and Grief)

  • Denial
  • Anger
  • Bargaining
  • Depression
  • Acceptance
• Denial


  A conscious or unconscious decision to refuse to admit that something is true
• Anger


  When the individual recognizes that denial cannot continue, they become frustrated especially at proximate individuals
• Bargaining


  The third stage involves the hope that the individual can avoid a cause of grief. Usually, the negotiation for an extended life is made in exchange for a reformed lifestyle
• Depression


  During the fourth stage, the individual despairs at the recognition of their mortality. In this state, the individual may become silent, refuse visitors and spend much of the time mournful and sullen
• Acceptance


  In this last stage, individuals embrace mortality or inevitable future, or that of a loved one, or another tragic event
• Body System Indicator of Imminent Death

  • Cognition/Orientation
  • Cardiovascular
  • Pulmonary
  • Gastrointestinal
  • Renal
  • Mobility
• Traditional View of Death


  Cessation of the apical pulse, respiration, and blood pressure
• Cerebral death/Higher Brain Death

  • Absence of responsiveness
  • Absence of cephalic reflexes
  • Apnea
  • Isoelectric encephalogram
• World Medical Assembly definition of death


  • Total lack of response to external stimuli
  • No muscular movement
  • No reflexes
  • Flat encephalogram
• Development of the concept of death

  • Infancy - 5 years old
  • 5-9 years old
  • 9-12 years old
  • 12-18 years old
  • 18-45 years old
  • 45-65 years old
  • 65 years and above
• Rigor Mortis


  Stiffening of the body OCCURS ABOUT 2 TO 4 HOURS after death, starts in the involuntary muscle
• Algor Mortis


  Gradual decrease of temperature after death, due to termination of blood flow to the hypothalamus, drop of 1° Celsius per hour, skin loses elasticity
• Livor Mortis


  Discoloration of tissues, appears in the lowermost, dependent areas of the body
• Post mortem care (manual)

  Care given to the body after death
• Equipment for post mortem care

  • Basin half-filled with water
  • Towel and wash cloth
  • Cotton balls
  • Identification tags (2)
  • Safety pins
  • Forceps
  • Mortuary gown
  • Plastic bag for soiled equipment
  • Working gloves
  • Plaster if not using shroud kit
• Post mortem care procedures

  1. Let the doctor pronounce the patient's death and note the exact time of death

  2. Screen the bed in the ward or close the door in the private room

  3. Wash hands

  4. Assemble the equipment

  5. Put on working gloves

  6. Place the body supine with the arms extended at the side or folded over the abdomen

  7. Close the eyelids by applying gentle pressure

  8. Replace or retain dentures within the mouth

  9. Place a small towel under the chin to close an open mouth

  10. Remove soiled dressings, venipuncture devices, indwelling catheter, etc. and dispose all contaminated and soiled items to appropriate containers

  11. Pack all body orifices with cotton using forceps

  12. Cleanse any obviously soiled areas of the body and provide grooming and hygiene to the person's face and hair

  13. Remove and make inventory of the valuables still attached to the body

  14. Endorse valuables to the family

  15. Dress the deceased with the mortuary gown, if any. Attach identification tag to the right great toe or right ankle

  16. Cover the body with a clean mortuary sheet and zip it. Attach the second identification tag at the top of the sheet

  17. Remove gloves and dispose of properly. Wash hands

  18. Complete charting
• Nasogastric Tube (NGT) Feeding Procedure

  1. Prepare materials

  2. Inform and position patient

  3. Measure and lubricate NGT

  4. Insert NGT

  5. Confirm placement

  6. Secure NGT

  7. Document procedure
• Nasogastric Tube (NGT)


  Tube inserted through the nose and into the stomach to provide feeding, medication, or decompression
• Nasogastric Tube (NGT)


  • Has holes to allow flow of medications/feeding to stomach
  • Colored part remains outside the body
• Purposes of NGT


  • Provide feeding (gastric gavage)
  • Irrigate stomach (gastric lavage)
  • Decompress stomach (drainage of gastric content)
  • Administer prescribed medication
  • Administer supplemental fluid
• Enteric pills should not be crushed and added to NGT
• Effervescent medications should not be added to NGT as they may cause clogging
• NGT Sizes


  • Fr 4-6 for newborns
  • Fr 8-12 for children
  • Fr 14-16 for teens/adults
• Nurses are not allowed to insert NGT as it is an invasive procedure
• Confirming NGT Placement


  1. Auscultate over stomach

  2. Aspirate gastric contents

  3. Introduce air and auscultate for gurgling sound (borborygmi)

  4. Obtain X-ray if concerns about placement
• Residual


  Backflow when aspirating from NGT
• Purposes of NGT/OGT Administration

  • Improve or maintain nutritional status
  • Administer prescribed medication
• Principles of NGT/OGT Feeding

  1. Elevate head of bed 30-90 degrees before and after feeding

  2. Keep head of bed elevated at least 30 degrees during continuous feeding

  3. Assess bowel sounds at least once per 8 hours

  4. Assess abdomen for distension

  5. Check tube position before each feeding

  6. Check gastric residual before each feeding
• Common Problems with NGT/OGT Feeding

  • Vomiting
  • Aspiration
  • Diarrhea
  • Constipation
  • Hyperglycemia
  • Abdominal distension
• Administering Tube Feeding


  1. Assist patient to semi-Fowler's or elevated right side position

  2. Assess tube placement and patency

  3. Assess residual feeding contents

  4. Introduce feeding slowly

  5. Maintain feeding height 6-12 inches above tube insertion

  6. Follow feeding with water flush

  7. Clamp tube before all water is instilled

  8. Keep patient elevated for 30 mins after feeding

  9. Perform aftercare of equipment

  10. Document procedure
• Performing Gastric Lavage


  1. Introduce water into NGT using asepto syringe

  2. Allow drainage to flow by gravity