LAST OFFICES POWER POINT PRESEANTATION 123

LAST OFFICES

1. Last office/Death care

2. Definition, Meaning The last offices, or laying out, is the procedures performed, usually by a nurse, to the body of a dead person shortly after death has been confirmed. The term last offices relates to the care given to a body after death. It is a process that demonstrates respect for the deceased and is focused on respecting their religious and cultural beliefs, as well as health and safety and legal requirements

3. Care of the dead Body Care of the dead and dying is one of the most complex and challenging responsibilities of the nurse. The attitude of the nurse about death and dying affect their ability to provide care. Dead body care should be carried according to hospital policy. Because care may be influenced by religious law, it should be taken into consideration. Care can be delegated immediately except for organ donation and autopsy request. To release the dead body to the relatives with respect and dignity To maintain hygiene - Bath towels , Wash clothes , Shroud , Kit with name tags , Bed linen , Documentation forms , Cotton swabs , comb

4. Care of the dead Body Physician and other designated health care providers certify death, document time of death, action taken. Physician request an autopsy in case necessary Validates state for organ donation. Maintain sensitivity to personal, religious and cultural beliefs Provide sensitive and dignified nursing care to the client and family Note if you need to collect any specimen. Ask if the family wishes to participate in the preparation of the body. Ask about family request for body preparation such as wearing of special clothing, shaving of beard in male according to cultural practices. All the equipment, soiled linen and supplies should be removed from the bedside.

5. Care of the dead Body Body should be placed in supine position with arms on either side, palms down or across the abdomen. One pillow is placed under the head and shoulders to prevent blood from discoloring the face. The eyelids are closed and held in place for few seconds so that they remain closed. Dentures are usually inserted to help give the face a natural appearance. Then the mouth is closed Soiled part of the body are washed, however, complete bath is not necessary Absorbent are placed under the buttocks to take of any feces and urine released because of the relaxation of the sphincter muscles. Clean gown placed on the client, hair brushed and combed.

6. Care of the dead Body All jewelry should be removed except for those which family wishes to keep. The top bed linen are adjusted neatly to cover the client to the shoulders. Cotton swabs are kept in nose and ears. Soft lighting and chairs are provided for the family. Offer family member to view the body. Encourage to say goodbye in their own way. Provide privacy After body viewed by family, the deceased identification tag is applied. Body wrapped in shroud. Identification tag should be applied in shroud. Then body is taken to morgue Nurses have to handle the deceased with dignity and label the corpse appropriately Nurses provide support and reinforce explanation to grieving family members who often need clarification of what they are told during the request process If life support is being continued for organ donation even though the client with brain death has been declared legally dead, they need to be explained that life supports only preserving vital organs.

7. Care of the dead Body Take consent from family members for autopsy in case when death is due to foul play, homicide, suicide, accidental cases e.g. trauma, crashes, fall, poisoning, death within 24 hours of hospital admission : Documentation of death for legal record. Follow agency policy and protocol. Documentation should include the following Time and date of death and all action taken to respond the impending death Name and designation of health care provider certifying death, persons notified of death Request for organ donation Special preparation of the body Medical tubes and lines left inside the body

8. Care of the dead Body Personal articles given to the family with description, date time and given to whom. Location of identification tag. Time of body transfer and destination Any other relevant information or family request that help clarify special circumstances Send the patient’s file to billing counter for account clearance. In case of medico-legal cases, notify it to concerned/ legal authorities before handing over to the relatives or sending it to mortuary. The patient’s body may have to be placed in the hospital morgue refrigerator if mortuary arrangements were not made before patient’s death. If patient died of communicable disease the body may require special handling to prevent spread of disease. After removing dead body from ward clean the bed and room thoroughly and disinfect all the articles used and replace it in proper place.

9. Counseling and Supporting Grieving relatives Goals of Grief Counseling 1. Accepting the loss and talking about it 2. Identifying and expressing feelings related to the loss (anger,guilt,anxiety, helplessness,sadness) 3. Living without the deceased and making decisions alone 4. Separating emotionally and forming new relationships 5.Identifying ways of coping that suit the bereaved

10. Autopsy An autopsy, also known as a post-mortem examination, is a specialized surgical procedure used to determine the cause and manner of death. The cause of death is the medical reason explaining why a patient passed. The manner of death is the circumstances surrounding the death. Complete autopsy is defined to include a detailed external examination of the entire body, and an internal examination to include the removal and dissection of all thoraco-abdominal and neck organs, opening the head with the removal and examination of the brain.

11. The objective of an autopsy Establish the identity of the body if unknown. Ascertain the time of death. Ascertain the cause of death. Whether the death was natural or unnatural. If death was unnatural, whether it was homicidal, suicidal, or accidental. In the case of newborn infants, determine whether it was live birth and its viability. The manner of death such as kind of injury, wound, or impact. Whether there was any psychological disturbance or derangement resulting in a cause of death such as asphyxia, coma, or syncope.

12. Classification of Autopsy 1. Forensic : This is done for medical legal purpose. No family permisssion is required to complete this type of autopsy This is carried out when the cause of death may be criminal matter such as accidents, burns etc

13. Classification of Autopsy 2. Clinical/ Academic : This is usually performed in hospital for research and study purpose For a clinical autopsy to take place, a c a use of death must have already been established and a death certificate should be present to complete this type of autopsy and permission is required

14. Classification of Autopsy 3. Coroner's : This type of autopsy involves cases where no medical cause of death is readily available and the cause, manner and mechanism of death are in the question. Eventually, the prospectors will identify

15. Stages of Autopsy Examination 1.Physical examination of clothes and collection of evidence in them. 2. Physical examination of body surfaces and collection of any evidence. 3. Opening of the body cavities. 4. Scrutiny of internal contents of cavities and vital systems. 5. Collection of specimens. 6. Closure of body/reconstruction. 7. Disposal of dead body- Relatives or Police

16. Nursing Responsibilities 1.Obtain the consent for autopsy. 2.Inform the family members that an autopsy doesn’t deform the body and that all the organs are replaced in the body. 3.Explain the patient relatives that an autopsy may contribute to advances in medical science. 4.Answer the family member’s doubts and support the family as necessary. 5.Respect and honour family wishes and final decisions regarding tissue or organ donation.

17. Embalming Embalming is the art and science of preserving human body by treating them with chemicals to prevent decomposition. Embalming is meant to temporarily preserve the body of a deceased person. Embalming is the process where a body is preserved by using preservatives to slow down the effects of natural deterioration Typically, it will preserve the body for around a week, but factors such as condition of the body and temperature conditions may affect this.

18. Purpose : To keep the body suitable for public display at a funeral. For medical and scientific purposes such as their use as anatomical specimens Goals : Sanitization Presentation Preservation

19. Chemicals used for Embalming : Formaldehyde Glutaraldehyde Ethanol Steps : Arterial embalming Cavity embalming Hypodermic embalming Surface embalming

20. Arterial embalming The body is laid on the left lateral Recumbency. The right common carotid artery is exposed through incising the right jugular furrow and by cleaning the fascia of the the artery to allow movement and space for the canula, which is inserted into it. When the carotid artery is raised with aneurism hooks, two (10”) pieces of ligature are placed around the artery with forceps to hold the canula in place while embalming. ( This is done to help avoid leakage or release of the tube due to pressure exerted by the embalming apparatus.) The common carotid artery is then incised about 4 mm long and any blood clots present are removed with forceps. A canula is inserted in the same slit made into the artery for effective bleeding

21. Arterial embalming An L-shaped canula is then inserted into the carotid artery via the slit and tied securely with a string. The other end of L-shaped canula is connected to polyethylene tubing which is connected to the gravity embalming tank located above the calf. Before embalming fluid is injected, air is removed from the connecting tube to avoid any possible airlocks produced by the vessels of the cadaver during the injection of the fluid. Injection periods vary in each case taking 8 to 24 hours. This variability is due to the ability of the body to accept the fluid at its own rate.

22. Arterial embalming Instruments Container containing embalming fluid When all preparatory procedures have been completed, the petcock is turned on to allow the embalming fluid to flow through the tubing, canula and into the common carotid artery, thus dispersing the fluid into the vascular system. During embalming a number of small whitish splotches appear on the skin in the region most effectively embalmed and then spread peripherally. This splotching effect of embalming can be used to determine the effectiveness of the embalming condition at any given time.

23. Cavity embalming Cavity embalming refers to the replacement of internal fluids inside body cavities with embalming chemicals via the use of an aspirator and trocar. The embalmer makes a small incision just above the navel (two inches superior and two inches to the right) and pushes the trocar in the chest and stomach cavities to puncture the hollow organs and aspirate their contents. The cavities are filled with concentrated chemicals that contain formaldehyde. The incision is either sutured closed or a "trocar button" is secured into place.

24. Hypodermic embalming Hypodermic embalming is a supplemental method. It is refers to the injection of embalming chemicals into tissue with a hypodermic needle and syringe, which is generally used as needed on a case by case basis to treat areas where arterial fluid has not been successfully distributed during the main arterial injection.

25. Surface embalming Surfac embalming chemicals use to preserve and restore areas directly on the skin surface and other superficial areas. A lso use for areas of damage such as from accident, decomposition, cancerous growth or skin donation. Specimen made available for dissection within 48 - 72 hours. Widely used for preparation of specimen for dissection. Suitable method for long time preservation of the cadaver/ organ / tissue. 10 % formalin solution is routinely used and prepared from formaldehyde solution that easily available in the market.

26. Legal aspects of Practice of Embalming 1.Prior identification of body by near relative is done before procedure 2. Consent for the procedure 3. No objection certificate from police should be obtained 4. Death certificate should be referred before embalming 5. In case of foreigner, embassy clearance should be obtained 6. In medico-legal cases, it should be done after autopsy 7. Death certificate/post mortem report should be accompanied with the dead body 8. On completion of embalming, embalmer/competent authority should issue certificate (for local transport 3 copies and for international transport 5 copies) 9. In case of embalming of dead bosy who suffered from notifiable disease, concern authority should be informed

27. Placing body in Mortuary 1. Dead body should be kept in a body bag or wrapped in a sheet before storage 2. All dead bodies should be identified and correctly labeled with identity labels and category tags. 3. Dead body which is found soiled with blood or body fluids should be placed in a disposable plastic bag instead of linen 4. Dead body should be stored in cold chambers maintained at approximately 4 degree C 5. Pathologists and other support staffs should observe standard precautions in the performance of autopsy since it is potential source of infection 6. Bodies that cannot be recognized by visual means, shoild be properly stored until forensic specialists can investigate

28. Releasing body from mortuary 1. A dead body should only be released when identification is certain 2. Visual recognition should be confirmedby other information such as identification of clothing or personal effects 3. Information collected about missing people can be used to cross-check visual recognition. A body should only be released by the responsible authority, which must also provide documentation of the release 4. Record the name and contact details of the person or relatives who claimed the body together with the body's unique reference number