Death care nursing procedure

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DEATH CARE

• P.Meena,M.Sc.(N)

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INTRODUCTION OF DEATH

• Death has been considered as natural as birth
  ,as simply the last stage of life .Just as each
  person lives a unique life , each dies a unique
  death . Death may be sudden and unexpected .
  Death come quietly for the older person who
  dies during sleep.

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DEFINITION OF DEATH

• The end of life , the total and permanent
  cessation of all the vital functions of an
  organism known as death (e.g.-Heart beat ,
  Respiration ,Pulse etc.

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SIGNS OF CLINICAL DEATH

• Absence of pulse , heart beat and respirations
  , red blood cells rolling to a stop or forming
  rouleaux in the retinal vessels . Pupil of the
  eye becoming fixed and non reactive to light .
• LIVOR MORTIS - Dependant parts of body become
  discolored .

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• ALGOR MORTIS -Temperature decrease by a few
  degree each hour .
• RIGOR MORTIS -A stiffening of the body after
  death , is due to fixation of the muscles . It
  appears with a few minutes and hours . It first
  involves the muscles of the jaw and passes
  successfully down the neck , arms , trunks and
  legs .

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DEFINITION OF DEATH CARE

• The management of funerary arrangement ,
  including care of the dead and services offered
  to surviving family members .

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PRINCIPLES OF DEATH CARE

1. Reduces anxiety and tension of relatives .
2. Body should be kept in position before Rigor
   Mortis occurs .
3. Identification is necessary for legal purposes.
4. Prevent spread of infection.

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PURPOSES OF DEATH CARE

• - 1) To maintain normal body alignment before
  rigor mortis sets on .
• - 2) To reduce mental distress of family .
• - 3) To facilitate transportation to mortuary
  residence .

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ARTICLES

• ARTICLES

• RATIONALE

• 1) Tray lined with towel.
• 2)Long Artery clamp .
• 3) Bandage
• 4) Absorbent and non absorbent cotton.

• Prevent pooling of blood.
• Apply if autopsy is to be performed .
• Keep the mouth close .
• Cause release of urine feces and body fluids.

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• ARTICLES

• RATIONALE

• 5) Hospital gown or patients cloth .
• 6) Mackintosh
• 7)Mortuary cards in transparent plastic cover .

• - To prevent the exposure of body parts .
• - To protect the linen .
• - To avoid ink from spreading .

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• ARTICLES

• RATIONALE

• Keeps items safely secured .
• Prevent injury to skin and extremities .
• Body secretions may harbor infectious
  micro-organisms.

• Valuable envelop.
• Body bag /sheet
• Clean gloves .

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PROCEDURE-

• NURSING ACTION

• RATIONALE

• 1) Assess for presence of family or significant
  other and whether they have been informed of the
  patients death . Ask if they wish to view the
  body ,observe their response and offer them the
  opportunity to ask questions .

• - It is the physician to notify the family of
  patients death . Nurses provide emotional
  support and prepare body for viewing .

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• 2) Assess patients religious and cultural
  practices.
• Determine if family wishes to have a minister or
  priest at the bedside .

• - Specific religions dictate ceremonies at the
  time of death .

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• 3) Determine if patient was on isolation
  precaution for an infectious disease.
• 4) Wash hands .

• - Precautions must be taken to prevent spread of
  infection to other.
• -Reduce transmission of infection /
  micro-organisms .

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• 5) Done gloves and gown or protective devices
  as applicable .
• 6) Close room door or draw bedside curtains.
• 7) Identify the body according to agency policy .

• - Body secretions may harbor infectious
  micro-organisms .
• - Provide privacy for the deceased and family .
• - Ensure proper name use in labeling .

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• 8) Position body supine with arms at side ,
  palms down or arms across the abdomen . Do not
  place hands one on top of the other because
  bottom hands will become discolored .

• - Body appears in natural position .

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• 9) Place small pillow or folded towel under the
  head of bead
• 10-15 degree .
• 10) Gently place fingers over the closed eyelids
  for a few seconds .

• - Prevents pooling of blood in the face and
  subsequent discoloration .
• - Holds eyelids in place to create a natural
  appearance .

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• 11) Inserts dentures into mouth ( if applicable
  ) . If mouth fails to close , place a rolled
  towel under the chin .
• 12) Remove all bottles , bags or receptacles
  from urinary catheters , nasogastric tubes ,I.V.
  lines or drainage tubes .

• - It is difficult to insert dentures after rigor
  mortis occurs . Dentures maintain normal facial
  expression .
• - In case when autopsy is needed these need to be
  preserved .

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• 13) For tubes remaining in the body , either
  remove clamps or cut within one inch of the skin
  and top in place .
• 14) Remove soiled dressing and replace with
  clean gauze dressings .

• - Hospital policy dictates tube care, specific
  guidelines apply if an autopsy is to be
  performed .
• - Consider odor caused by micro-organisms .

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• 15) Wash body parts soiled with blood , urine ,
  feces or other drainage and put clean gown on .
• 16) Apply jaw bandage .

• - Prepare body for viewing and reduces odors .
• - Keep the mouth closed .

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• 17) Play body oriffices such as nose , mouth,
  vagina and rectum with absorbent cotton followed
  by non absorbent cotton . Nose to be packed in
  such a way that cotton is not visible .

• - Relaxation of sphincter muscles after death
  may cause release of urine ,feces and body
  fluids .

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• 18) Close eyes by keeping wet cotton balls on
  eyelids .
• 19) Fold hands as in praying position and the
  thumbs together .
• 20) Straighten legs ,bring feet together and tie
  big toes .

• - Eyelids remain closed with wet cotton on them.
• If fingers not tied it will make stiffing of the
  bone.

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• 21)Complete mortuary cards and place in plastic
  cover and to the big toes together .
• 22) Place an absorbent pad under the patient
  buttocks .

• - Use balls point pen to avoid ink from
  spreading .
• - Relaxation of sphincter muscles after death
  may cause release of urine or feces .

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• 23) Brush and comb patients hair ,remove any
  clips hairpins or rubber bands .
• 24) Remove all jewelery . Exception family may
  request wedding band be left in place . Place a
  small strip of tape around finger over the ring.

• - During viewing the patient should appear well
  groomed .Objects such as pin can damage or
  discolor the face and scalp .
• - Prevent loss of valuable

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• 25) Account for all valuable remaining in the
  patients room and label each item. prepare a
  valuable list to inventory all items . Return
  valuable to immediate family member when they
  arive or store in locked container, cup board

• -Nurse is responsible for safe keeping of
  personal valuable, such as jewellery , wallet
  ,eye glasses , or religious models .

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• 26) Place patients clothing and shoes in a
  labeled bag and return to family members.
• 27)Complete identification tags and attach one to
  the patients ankle. The remaining tag should
  saved in order to attach to the outside sheet/
  should after the body is covered.

• Keep item safely secured .
• Easy to identify the patient When its covered.

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• 28) If the family requests viewing , place a
  sheet or light blanket over the body with only
  the head and upper shoulder exposed .Provide soft
  lighting and offer chairs to the family.

• - Maintains dignity and respect for the patient
  and family and prevents exposure of body parts.

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• 29) After the family has left ,remove all linen
  and the patient s gown, then place body in body
  bag or apply the shroud .Be sure that the shroud
  completely encircles all body parts.

• Prevents injury to skinextremities,
• avoids unnecessary exposure of body parts .

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• 30) Secure shroud with tape wrapped over the
  shoulders ,waist and legs.
• 31) Attach second completed label to outside of
  the body bag or shroud.

• Keeps shroud secure ,protects body during
  transfer.
• Ensures proper identification of the body.

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• 32) If patient had a transmissible infection,
  special labeling may be used.
• 33) Arrange the transportation of the body to
  the morgue or mortuary.

• Protects health care workers who transport and
  store the body.
• The body should be cooled in the morgue to
  prevent further tissue damage.

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• 34) Carefully transfer the body to a stretcher
  keeping the body aligned . Cover with a clean
  sheet.
• 35) Close other patients room doors and arrange
  to transport the body.

• -Prevents damage to body tissues. A false bottom
  stretcher makes it appear there is no body lying
  on stretcher.
• -Appearance of a body can be emotionally
  upsetting to other patients.

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• 36) Record date and time of death, time physician
  was notified , consent from signed by family.
• 37) Document any marks, bruises or wounds on body
  before death or those observed during care of the
  body.
• 38) Document any infectious process that the
  patient had when death occurred and document
  procedure use to identify, the risk on body bag.

• -Ensures that patient death is recorded
  accurately and legally.
• - Reduces risk of liability for creating such
  marks in the care of the body after death.
• -Reduces the liability for in advertent
  contamination by person handling the body after
  transfer from the division or agency.

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NURSING RESPONSIBILITY-

• 1) Provide good and comfortable environment to
  family and patient.
• 2) Provide familiar and social support to the
  patient .
• 3)Provide nursing care to patient according to
  present problem.

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• Maintain respiratory status by good ventilation,
  o2 therapy.
• maintain nutritional status
• Maintain fluid electrolyte and balance.
• Maintain intake/output chart
• .

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• Provide diversional therapy I case of pain (music
  reading newspaper)
• For pain provide analgesic and sedatives.
• Maintain range of motion by assisting patient in
  light exercises ( change position for prevention
  of bed sore.)

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• Assist client in self care activities.
• Teach patient and f family member maintain
  personal hygiene.
• 5) Clear all the confusion and doubt of the
  patient
• 6) Provide death care in case death of client.

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• 6) Try to respond appropriately to patients
  needs by listening carefully to the complaints .
• 7) Proper recording and reporting is done .
• 8) Provide death certificate to family member and
  hand over the body.

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IDENTIFICATION TAG

• PATIENT NAME -_______________________
• AGE-_______ REGISTRATION NO-_________
• RELATIONS NAME-_____________
• ADDRESS-___________________________
• WARD-_______________ BED NO-______
• DATE AND TIME OF DEATH-_____________
• CAUSE OF DEATH-_____________________

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THANKU YOU