Care of Death.pptx lecture notes fo nurses

useful for bsc nursing students

1. Unit:19 Care of D ead Body Mr Yogendra Mehta Assist. Professor TU,IOM, BNC

2. Introduction Death is the irreversible cessation of all biological functions that sustain an organism . Brain death is sometimes used as a legal definition of death. The remains of a former organism normally begin to decompose shortly after death.  The cerebral cortex is irreversibly destroyed. Causes: Many deaths are sudden and involves shock as well as normal grieving in the survivors. Death from the diseases, accidental death, violent death and suicide & Homicide.

3. Signs of Death Total Lack of response to external stimuli Absence of Vital sign Asystole ECG Absence of reflexes Like; pupillary Pallor, which happens in the 15-120 minutes after death. Liver mortis: a settling of the blood in the lower portion of the body. Gradual reduction of temperature. Stiffness of the body that occurs 2-4 hours after death. Unpleasant odor .

4. Meeting the Needs of Dying Patients Physiological Needs: It mainly focuses on meeting the physical needs such as respiratory care, maintaining personal hygiene, pain control, nutritional and fluid needs, movement, elimination care of environment and addressing sensory change. Respiratory care: keep the patient in semi fowler’s position. Provide oxygen and turn the head at lateral side to allow drainage . Perform suction if needed. teach patient for deep breathing and coughing exercise. Personal Hygiene: Cleanliness of the skin, hair , mouth, nose and eyes. Mouth and nose should be free of mucus and secretion. Discharge should be wiped from eyes. Frequent bath and linens changes may be essential.

5. Meeting the Needs of Dying Patients c. Pain Control: d. Nutritional and fluid needs: Administer antiemetics , appetizer to stimulate appetite. Encourage liquid food as tolerated. Maintain hydration and nutrition as needed. Movement: Assist to change the position regularly to prevent the pressure sore. Reposition the conscious patient in semi-fowler’s . Position the unconscious patient in semi prone position. Elimination Care of Environment: Ventilation should be maintained. Noise must be controlled. h. Sensory changes: check preference for a light room.

6. Meeting the Needs of Dying Patients Psychological Needs: Need for Intimacy Spiritual Needs

7. Meeting the Needs of Family - M eet the physical , emotional or spiritual needs of the members. Use the therapeutic communication to facilitate their expression of feelings. The reality of death can be made less painful by preparing the family ahead of time. As a nurse , after death of patient we should provide care for the family facing loss by listening to their concern. Ask to see the patient’s body too accept the death fully. Arrange the private area to begin their grieving. Guide the family in making plan and help in making decision. Ask family members for rest and to eat.

8. Bill of Rights of Dying Person H ave the right to be treated as a living human being until i die. I have the right to maintain a sense of hopefulness however changing its focus may be. I have the right to express my feelings and emotions about my approaching death in y own way. I have the right to participate in decisions concerning my care. I have the right to expect continuing medical and nursing care. I have the right to not to die alone. I have to right to be free from pain. I have the right to have my questions answered honestly. I have the right to have help from and for family in accepting death.

9. Purposes of Care of Dead Body To maintain normal body alignment before rigor mortis(stiffness of the body that occurs 2-4 hr after death). To ensure proper identification of the patient. To prepare the body after death with dignity and respect. To maintain hygiene and prepare the patient for viewing by family. To reduce mental distress of the family. To facilitate transportation for residence. To maintain vital organ if donation is planned.

10. Criteria for Death Declaration No respiration and no heart beat No movement .no response Flat ECG Pupil dilatation and fixed , non reactive Absence of all reflexes

11. Articles Needed A clean dry tray containing: Comb Towels and soap Dressing pad, guaze piece & cotton Gloves, adhesive bandages to cover wound or punctured area Identification tag Plastic bag Patient’s cloth and clean sheet Stretcher or morgue cart Morgue Cart

12. Nursing Intervention Attend with physician for certifying the death including time , dead, cause of death, therapy used and action taken. Notify appropriate people : Assess for presence of family or significant others. Visitors should be informed about the death of the patient. Ask the permission for CPR and prognosis Inform the police if the patient is medico-legal case. Provide emotional su pport to the family. Respect their wish to view the body. Observe their response, provide time and offer them opportunity to ask question. Assess patient’s religion and cultural practice. Allow family wishes to have a priest at the bedside. - Explain to the family that the body will first be cared by nurses before handover to the family.

13. Nursing Intervention Determine if the patient was on isolation precaution for an infectious diseases, precaution must be taken to prevent spread of disease to others. Wash and dry hands, assemble the articles and bring to the bed side. Use gloves and gown Close room door or draw bedside curtains or screen the patient to provide privacy . Position the body in good alignment in supine position. Place small pillow or folded towel under the head or elevate head of bed 10-15 inch. it helps in preventing pooling of blood in the face. After the family member viewed the body, remove all appliances used for the care of the patient. Remove all jewellery , handover to relatives and a signature should be taken in a register. Insert denture into mouth to maintain normal facial expression. Close the mouth. place the rolled towel under the chin.

14. Nursing Intervention Close the eyelid if opened by placing fingertip over each eyelid for a few seconds. If pacemaker implanted do not forget to inform to remove it. Remove soiled dressing and replace with clean guaze . Wash body parts soiled with blood , urine , faces or other drainage and put clean gown . Comb the patient’s hair neatly. Remove any clips and hair pin. Plug body orifices with absorbent cotton. Ear is plugged only if there is CSF leakage. Place absorbent pads under buttock. Wrap the body with the clothes as desired. Complete identification tag (name, age, sex, address, ward, bed number, diagnosis, date and time of death decleared )and attached to patient’s body.

15. Nursing Intervention Pack all remaining personal belongings and perform hand hygiene. Make sure for certificate of death. Send the patient chart with death certificate to the account section for clearance. Hand over the body to the relatives after the bill has been cleared and get relative to sign in death register. Arrange for transportation of the body to mortuary along with one copy of death certificate. Close other patient’s room or door and arrange the transport the body . Maintain the privacy and dignity when transfering .

16. Nursing Intervention Record and report writing should be done.(date 7 time of death, time of physician notified, name of physician, hand over body to family ). Document date and time of release of the body and before releasing record care given in the patient chart. Remove items that used to the patients and clean with antiseptic. Perform hand hygiene. Treat the bed and unit as in discharging the patients.

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