care of dying client

UNIT-XV: Care of Terminally ill patient

SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA 1

Mrs. P. Vadivukkarasi Ramanadin, Professor, Dept. Of OBG (N), Shri Vinoba Bhave College of Nursing, Shri Vinoba Bhave Civil Hospital, Silvassa, DNH.

• Concepts of Loss, Grief, grieving process• Signs of clinical death• Care of dying patient;• special considerations• -Advance directives:• euthanasia will dying declaration , organ donation etc• Medico-legal issues• Care of dead body:• Equipment, procedure and care of unit• Autopsyo Embalming

2SHRI VINOBA BHAVE COLLEGE OF NURSINGH,

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Loss is an actual or potential situation in which something that is valued is changed or no longer available.

People can experience the loss of body image, a significant other, a sense of well-being, a job, personal possessions, or beliefs. Illness and hospitalization often produce losses.

Loss is an inevitable part of life


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Necessary loss, which is a part of life. They learn to expect that most necessary losses are eventually replaced by something different or better.

A maturational loss is a form of necessary loss and includes all normally expected life changes across the life span. A mother feels loss when her child leaves home for the first day of school.

Unwanted, or unexpected loss. Some losses seem unnecessary and are not part of expected.

Situational loss. For example, a person in an automobile accident sustains an injury with physical changes that make it impossible to return to work or school, leading to loss of function, income, life goals, and self-esteem.


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An actual loss occurs when a person can no longer feel, hear, see, or know a person or object.Examples include the loss of a body part, death of a family member, or loss of a job. Lost valued objects include those that wear out or are misplaced, stolen, or ruined by disaster. A child grieves the loss of a favorite toy washed away in a flood.

A perceived loss is uniquely defined by the person experiencing the loss and is less obvious to other people. For example, some people perceive rejection by a friend to be a loss, which creates a loss of confidence or changes their status in a group. How an individual interprets the meaning of the perceived loss affects the intensity of the grief response.


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Sudden versus Predictable Loss Sudden or shocking losses due to events like

crimes, accidents, or suicide can be traumatic. There is no way to prepare. They can challenge your sense of security and confidence in the predictability of life. You may experience symptoms such as sleep disturbance, nightmares, distressing thoughts, depressed mood, social isolation, or severe anxiety.

Predictable losses, like those due to terminal illness, sometimes allow more time to prepare for the loss. However, they create two layers of grief: the grief related to the anticipation of the loss and the grief related to the loss itself


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Grief is a natural part of the healing process. Grief is a strong, sometimes overwhelming emotion for people.

The reasons for grief are many, such as the loss of a loved one, the loss of health, or the letting go of a long-held dream. Dealing with a significant loss can be one of the most difficult times in a person's life.

Individual experiences of grief vary and are influenced by the nature of the loss.

Pattern of physical and emotional responses to bereavement may vary


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Grief is the emotional response to a loss, manifested in ways unique to an individual and based on personal experiences, cultural expectations, and spiritual beliefs (Walter and McCoyd, 2009)

Mourning: Coping with grief involves a period of mourning, the outward, social expressions of grief and the behavior associated with loss. Most mourning rituals are culturally influenced, learned behaviors.

A reaction activated by a person to assist in overcoming a great personal lossIt is the behavioral process through which grief is eventually resolved or altered; it is often influenced by culture, spiritual beliefs, and

Bereavement A common depressed reaction to the death of a loved one Encompasses both grief and mourning and includes the

emotional responses and outward behaviors of a person experiencing loss (AACN, 2008).

It is the subjective response experienced by the surviving loved ones. 8

SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

Normal Grief. Normal (uncomplicated) grief is a common, universal reaction characterized by complex emotional, cognitive, social, physical, behavioral, and spiritual responses to loss anddeath.

Anticipatory Grief. A person experiences anticipatory grief, The unconscious process of disengaging or “letting go” before the actual loss or death occurs, especially in situations of prolonged or predicted loss (Simon, 2008). When grief extends over a long period of time, people absorb loss gradually and begin to prepare for its inevitability. They experience intense responses togrief (e.g., shock, denial, and tearfulness) before the actual death occurs and often feel relief when it finally happens.


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Disenfranchised Grief. People experience disenfranchised grief, also Known as marginal or unsupported grief, when their relationship to the deceased person is not socially sanctioned, cannot be openly shared, or seems of lesser significance. The person’s loss and grief do not meet the norms of grief acknowledged by his or her culture.

Ambiguous Loss. Sometimes people experience losses that are marked by uncertainty. Ambiguous loss, a type of disenfranchised grief, occurs when the lost person is physically present but not psychologically available, as in cases of severe dementia or severe brain injury.

complicated grief a person has a prolonged orsignificantly difficult time moving forward after a loss. He or she experiences a chronic and disruptive yearning for the deceased; has trouble accepting the death and trusting others; and/or feels excessively bitter, emotionally numb, or anxious about the future.


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Exaggerated Grief: A person with an exaggerated grief response often exhibits self-destructive or maladaptive behavior, obsessions, or psychiatric disorders. Suicide is a risk for these people.

Delayed Grief: A person’s grief response is unusually delayed or postponed, often because the loss is so overwhelming that the person must avoid the full realization of the loss. A delayed grief response is frequently triggered by a second loss, sometimesseemingly not as significant as the first loss.

Masked Grief: Sometimes a grieving person behaves in ways that interfere with normal functioning but is unaware that he is in grief


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Whether the death is expected or unexpected.

The personality of the bereaved. The religious beliefs The age of the bereaved.


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According to Kübler-Ross’s there are five stages of normal grief that were first proposed by Elisabeth Kübler-Ross

Denial Anger Bargaining Depression AcceptanceDenial : It is a normal reaction to rationalize

overwhelming emotions. It is a defense mechanism that buffers the immediate shock. It is a conscious or unconscious refusal to accept facts, information, reality, etc.


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Anger: Anger can manifest in different ways. People dealing with emotional upset can be angry with themselves, and/or with others, especially those close to them.

Bargaining: The third stage involves the hope that the individual can somehow undo or avoid a cause of grief. The normal reaction to feelings of helplessness and vulnerability is often a need to regain control. This is a weaker line of defense to protect us from the painful reality.


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Depression: During the fourth stage, the grieving person begins to understand the certainty of death. It's natural to feel sadness and regret, fear, uncertainty, etc. It shows that the person has at least begun to accept the reality.

Acceptance: In this last stage, individuals begin to come to terms with their mortality or inevitable future, or that of a loved one, or other tragic event. This stage varies according to the person's situation. This phase is marked by withdrawal and calm. This is not a period of happiness and must be distinguished from depression.


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Feelings • Sorrow

• Fear• Anger• Guilt or self-reproach• Anxiety• Loneliness• Fatigue• Helplessness/hopelessness• Yearning

Cognitions (Thought Patterns) • Disbelief

• Confusion or memory problems• Problems with decision making• Inability to concentrate• Feeling the presence of the deceased


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Physical Sensations• Headaches• Nausea and appetite disturbances• Tightness in the chest and throat• Insomnia• Oversensitivity to noise• Sense of depersonalization (“Nothing seems real”)• Feeling short of breath, choking sensation• Muscle weakness• Lack of energy• Dry mouth

Behaviors • Crying and frequent sighing

• Distancing from people• Absentmindedness• Dreams of the deceased• Keeping the deceased’s room intact• Loss of interest in regular life events• Wearing objects that belonged to the deceased


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Frequent, intense, or prolonged exposure to grief and loss places nurses at risk for developing compassion fatigue. Compassion fatigue, described as physical, emotional, and spiritual exhaustion resulting from seeing patients suffer, leads to a decreasedcapacity to show compassion or empathize with suffering people


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Palliative Care: in Acute and Restorative Settings. Interventionsfor people who face chronic life-threatening illnesses or who are atthe end of life need palliative care. Palliative care focuses on theprevention, relief, reduction, or soothing of symptoms of diseaseor disorders throughout the entire course of an illness, includingcare of the dying and bereavement follow-up for the family. Theprimary goal of palliative care is to help patients and familiesachieve the best possible quality of life. Although it is especiallyimportant in advanced or chronic illness, it is appropriate for patients of any age, with any diagnosis, at any time, or in any setting.

Hospice Care. Hospice care is a philosophy and a model for thecare of terminally ill patients and their families. Hospice is not aplace but rather a patient- and family-centered approach to care.It gives priority to managing a patient’s pain and other symptoms;comfort; quality of life; and attention to physical, psychological,social, and spiritual needs and resources. Patients accepted into ahospice program usually have less than 6 to 12 months to live.Hospice services are available in home, hospital, extended care, ornursing home settings.


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Clinical death is the medical term for cessation of blood circulation and breathing, the two necessary criteria to sustain life.[1] It occurs when the heartstops beating in a regular rhythm, a condition calledcardiac arrest.

At the onset of clinical death, consciousness is lost within several seconds.

Measurable brain activity stops within 20 to 40 seconds.

Absence of pulse, heart beat and respirations

Pupil becoming fixed and not reacting to light Absence of all refluxes. Rigor mortis: Stiffing of the body after death.

The arms & legs cannot be bent or straightened while rigor mortis is present unless the tendons are torn


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http://en.wikipedia.org/wiki/Clinical_death

http://www.wikipedia.org/wiki/Heart

http://www.wikipedia.org/wiki/Cardiac_arrest

Sign of approaching death Respiration becomes irregular, rapid

and shallow breath or very slow Circulatory changes cause alterations in

the temperature, pulse and respirations. Radial pulse gradually fails

Usually the pulsations are seen even after the patient has stopped breathing

Hiccoughs, Nausea, Vomiting, abdominal distensions are seen. the patient feels the inability to swallow.

“DEATH RATTLE”-A rattling sound heard in throat caused by secretions that the patient cannot cough longer.


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The skin may become pale, cool and sweats lot (cold sweats).Ears and nose are cold to touch.

-Reflexes and pain are gradually lost. Patient may be restless due to lack of oxygen

CHANGES IN SIGHT, SPEECH, AND HEARING.- Sight gradually fail. The pupil’s fails to react to light. Eyes are sunken and half closed.


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Psychological support: The psychological need:

Relief from loneliness, fear and depression. Maintenance of security, self confidence and dignity. Maintenance of hope. Meeting the spiritual needs according to his religious

customs. SYMPTOMATIC MANAGEMENT Problem associated with breathing: The dying person who is restless, apprehensive

and short of breath may be given- Oxygen inhalation to remove his discomfort. Elevation of the patient’s head and shoulders

may make breathing easier. Keep the room well ventilated and keep

crowed away. Periodic suctioning is necessary.


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Problem associated with eating and drinking: Anorexia, nausea, and vomiting are commonly seen in dying patient person

The patient is unable to swallow even the sips of water poured in the mouth.

Most of them may require I.V fluids. If they can tolerate the oral fluids, sips of water is given with teaspoon.

That will help the patient to keep the mouth moist.

Give frequent oral hygiene. Apply emollients to the dry lips. The denture are removed and kept safely.


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Problem associated with elimination: Constipation, retention of urine and incontinence of urine and stool are some of problem faced by the patient.

Catheterization has to be done Through skin and Perineal care is to be

given, to keep the patient clean and to prevent skin breakdown.

Problem associated with immobility: Frequent skin care should be given with

particular attention to the pressure point. Patient should be comfortably placed

and their position frequently changed in the bed.


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Problem associated with sense organ:

Since the patient loses sight, before given any care to the patient, the nurse should touch the patient and say what she is going to do.

Since the hearing is retained longer, speak only what is appropriate.

Avoid whispering any think in patient room.

Speak distinctly so that patient may understand what is done for him.

Since the eyes are opened, protect the eyes from corneal ulceration with protective ointment.


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Problem associated with rest and sleep:

Patient may distressing symptoms in these patients.

Patient should not be disturbed while sleeping.

The visitors should be instructed not to disturbed the patient during his resting.

Maintain calm and quit environment. Problem associated with cleanliness

and grooming: Cleanliness and appearance are

important until the end. Cleanliness of the skin, hair, mouth, and

cloth has to be maintained.27


Cassen (1991) suggests seven essential features in the management of the dying patient:

Concern: Empathy, compassion, and involvement are essential.

Competence: Skill and knowledge can be as reassuring as warmth and concern.

Communication: Allow patients to speak their minds and get to know them.

Children: If children want to visit the dying, it is generally advisable; they bring consolation to dying patients.

Cohesion: Family cohesion reassures both the patient and family.

Cheerfulness: A gentle, appropriate sense of humor can be palliative; a somber or anxious demeanor should be avoided.

Consistency: Continuing, persistent attention is highly valued by patients who often fear that they are a burden and will be abandoned; consistent physician involvement mitigates these fears.


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The person who deals with the dying patient must commit (Schwartz and Karasu, 1997) to:

Deal with mental anguish and fear of death, Try to respond appropriately to patient’s needs by

listening carefully to the complaints and Be fully prepared to accept their own counter

transferences, as doubts, guilt and damage to their narcissism are encountered.

Management of the dying patient often elicits anxiety in nursing staff. Education and role playing can improve perspective taking and empathetic skills, respect each other’s point of view as well as appreciate the situation of patient and their families.

Developing a sense of control and efficacy. Encouraging peer groups for families coping with

bereavement. Developing increased resourcefulness in dealing with

death related situations. Recognizing that a moderate level of death anxiety is

acceptable. Improving our understanding of pain and suffering will

also improve communication and effective interactions.29


After the physician has pronounced death legally documented the death in the medical record, care of the body is usually performed by the nurse.

An autopsy consent may be requested & obtained if required.

If the patient is to be an organ donor arrangements will be made immediately.

The family often wishes to view the body before final preparations are made, they may be allowed.

If the patient had any valuables, they are handed over to the relatives


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Make body look as natural & beautiful as possible.

Perform his last duty tenderly. Protect other patients from unpleasant

sights and sounds which could frighten them

ARTICLES REQUIRED Articles for bath Extra bandages and cotton swabs Perineal pads Sheets Restraints for jaw, hands and legs. Pair of gloves Thumb forceps Patients own set of clothes.


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Rigor mortis is the stiffening of the body that occurs about 2 to 4 hours after death. Rigor mortis starts in the involuntary muscles (heart, bladder, and so on), then progresses to the head, neck, and trunk, and finally reaches the extremities.

Algor mortis is the gradual decrease of the body’s temperature after death. When blood circulation terminates and the hypothalamus ceases to function, body temperature falls about 1°C (1.8°F) per hour until it reaches room temperature. Simultaneously, the skin loses its elasticity and can easily be broken when removing dressings and adhesive tape.After blood circulation has ceased, the red blood cells break down, releasing hemoglobin, which discolors the surrounding tissues. This discoloration, referred to as livor mortis, appears in the lowermost or dependent areas of the body. Tissues after death become soft and eventually liquefied by bacterial fermentation. The hotter the temperature, the more rapid the change. Therefore, bodies are often stored in cool places to delay this process.


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Rigor Mortis: body becomes stiff within 4 hours after death as a result of decreased ATP production. ATP keeps muscles soft and supple.

Algor Mortis: Temperature decreases by a few degrees each hour. The skin loses its elasticity and will tear easily.

Livor Mortis: Dependant parts of body become discolored. The patient will likely be lying on their back, their backside being the 'dependant' body part. The discoloration is a result of blood pooling, as the hemoglobin breaks down.


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Remove all tubes and other devices from the patients body.

The patient looks more peaceful

Reduce the anxiety of the relatives

Comfort

consult close relatives before preparing the body for removal from the ward to the mortuary where the relatives will receive the body

To meet customs and wish of the relatives in caring for the body

Reduce the tension of relatives

If the relatives require, the nurse should help them to sponge the patient as necessary. brush and comb hair.

To reduce odor and for aesthetic sense for normal appearance

Appearance of the body after death should be presentable

Replace soiled dressing with cleaned ones

To avoid odor For better appearance

comfort35


Apply perineal pads and plug the rectum & vagina (in females) with cotton balls.).

To prevent soiling of bed and the patient cloth

After death there may be leaking of secretions form orifices

Safety

Provide clean cloths(own

For better appearance

Take care of valuables and personal belongings by handing over to members of family.

For legal considerations

Allow members of family to see the patient & remain in the room & remember that the body is still dear to someone.

Provide emotional support and helps grieving process by helping family to accept death

It allows them to ventilate their grief and feelings


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Advance Directive is a Scottish term, but in other parts of the UK these documents are also called Advance Decisions.

An advance directive tells the health care team what kind of care the patient would like to have if he is unable to make medical decisions (e.g., if in coma)

A good advance directive describes the kind of treatment the patient would want depending on the sickness

An Advance Directive allows you to make a refusal of treatment in advance of a time when you can’t communicate your wishes, or don’t have the capacity to make a decision. It only comes into effect if either of these situations occur.

You can use an Advance Directive to refuse any treatment, including life-sustaining treatment such as resuscitation, artificial nutrition and hydration, or breathing machines. An Advance Directive enables healthcare professionals to know what your wishes are even if you cannot tell them yourself, e.g. if you had severe dementia or were in a coma.

If you change your mind you can change your Advance Directive to reflect this. If you have mental capacity and can communicate your wishes then your Advance Directive will not apply.


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An Advance Health Care Directive (AHCD) is a generic term for a document that instructs others about your medical care should you be unable to make decisions on your own. It only becomes effective under the circumstances delineated in the document, and allows you to do either or both of the following:

Appoint a health care agent. The AHCD allows you to appoint a health care agent (also known as “Durable Power of Attorney for Health Care,” “Health Care Proxy,” or “attorney-in-fact”), who will have the legal authority to make health care decisions for you if you are no longer able to speak for yourself. This is typically a spouse, but can be another family member, close friend, or anyone else you feel will see that your wishes and expectations are met. The individual named will have authority to make decisions regarding artificial nutrition and hydration and any other measures that prolong life—or not.

Prepare instructions for health care. The AHCD allows you to make specific written instructions for your future health care in the event of any situation in which you can no longer speak for yourself. Otherwise known as a “Living Will,” it outlines your wishes about life-sustaining medical treatment if you are terminally ill or permanently unconscious, for example.

The Advance Health Care Directive provides a clear statement of wishes about your choice to prolong your life or to withhold or withdraw treatment. You can also choose to request relief from pain even if doing so hastens death. A standard advance directive form provides room to state additional wishes and directions and allows you to leave instructions about organ donations.


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While most people would prefer to die in their own homes, the norm is still for terminally-ill patients to die in the hospital, often receiving ineffective treatments that they may not really want. Their friends and family members can become embroiled in bitter arguments about the best way to care for the patient and consequently miss sharing the final stage of life with their loved one. Also, the opinions and wishes of the dying person are often lost in all the chaos.

It’s almost impossible to know what a dying person’s wishes truly are unless the issues have been discussed ahead of time. Planning ahead with an Advance Health Care Directive can give your principal caregiver, family members, and other loved ones peace of mind when it comes to making decisions about your future health care. It lets everyone know what is important to you, and what is not. Talking about death with those close to us is not about being ghoulish or giving up on life, but a way to ensure greater quality of life, even when faced with a life-limiting illness or tragic accident. When your loved ones are clear about your preferences for treatment, they’re free to devote their energy to care and compassion


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Euthanasia literally means “good death”. It is basically to bring about the death of a terminally ill patient or a disabled. Generally, the word euthanasia is defined as the act or practice of painlessly putting to death or withdrawing treatment from a person suffering an incurable disease. [3] From the definition, one can say that euthanasia is an unethical act as much as it is a great sin for those who strongly believe in God. Euthanasia is intentionally killing another person to relieve his or her suffering. [4] It is not the withdrawal or withholding of treatment that results in death, or necessary pain and symptom-relief treatment that might shorten life, if that is the only effective treatment. It is the intentional killing by act or omission of a dependent human being for his or her alleged benefits.


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http://www.lawteacher.net/free-law-essays/medical-law/legalization-of-euthanasia-in-india-law-essays.php

http://www.lawteacher.net/free-law-essays/medical-law/legalization-of-euthanasia-in-india-law-essays.php

Euthanasia can be classified in different ways, including: Active euthanasia (action)– where a person deliberately

intervenes to end someone’s life – for example, by injecting them with a large dose of sedatives

Passive euthanasia (ommission) – where a person causes death by withholding or withdrawing treatment that is necessary to maintain life, such as withholding antibiotics from someone withpneumonia

Voluntary euthanasia – where a person makes a conscious decision to die and asks for help to do this

Non-voluntary euthanasia – where a person is unable to give their consent (for example, because they are in a coma or are severely brain damaged) and another person takes the decision on their behalf, often because the ill person previously expressed a wish for their life to be ended in such circumstances

Involuntary euthanasia – where a person is killed against their expressed wishes 42


http://www.nhs.uk/conditions/Antibiotics-penicillins/Pages/Introduction.aspx

A will is a document by which a person regulates the rights of others over his property or family after death.

A statement by a person who is conscious and knows that death is imminent concerning what he or she believes to be the cause or circumstances of death that can be introduced into evidence during a trial in certain cases

A person who makes a dying declaration must, however, be competent at the time he or she makes a statement, otherwise, it is inadmissible.


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ORGAN DONATION A person 18 years or older and of sound mind can donate

all or any part of their own body for the following purposes: For medical or dental education Research Advancement of medical or dental science Therapy Transplantation

The request for organ donation should be done by patent in the presence of a physician or a nurse

Organs removed from the body following the death cannot be sold.

All organ donation are voluntary and there should not be any compulsion for the patient / family members

Organs usually donated :- kidney, heart, lungs, liver, bone, cornea

Organ donation should take place with in 2-6hrs after the death.


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Organ transplantation is truly one of the miracles of modern medicine, saving the lives of many patients and improving the quality of life for many more.

Given the ever-increasing gap between the number of organs needed and the supply, nurses have an ethical obligation to help ensure that the desires of people who want to donate organs are respected.

Nurses have to ensure that the consent process is informed and voluntary.

Information to the patient should consist of a balanced discussion of the available options and counseling to help patients or their families reach the choice that is best for them, including the provision of information about the urgent need for organs and the consolation that many families derive from knowing that their loved one was able to help others.


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· Abuse of children, elderly, and spouse · Drug-related injury · Unknown cause of death · Suicide · Violent death · Poisoning · Accidents · Suspicion of criminal action o Obtain death reports o Do investigation -the natural death and infant/child death o Conduct post mortem , sexual assault/child abuse

examinations o Collaborate with organ/tissue procurement agencies o Provide link between pathologists and lay investigative staff o Normally, only uniformed officers attend the natural death

scene o Understand subtle signs of abuse and neglect o Collaborate with pathologist to determine the appropriate

medical records o Review medical records once received o Obtain follow-up information


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Inform the nurse in charge and inform the medical staff of the patient’s death

In the case of an expected adult death, a registered nurse deemed competent by the Trust may confirm death

Confirmation of death must be recorded in the patient’s healthcare record

An unexpected death must be confirmed by the attending medical officer and if confirmed the service manager should be contacted or duty manager out of hours. Incident form to be completed


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Inform the patient’s relatives/next of kin of the patient’s death. Ensure that this is handled in a sensitive and appropriate manner with as much privacy as possible.

Ask if the relatives wish to see the chaplain or an appropriate religious leader or other appropriate person to the person’s faith or ethnic origins that need to be attended to immediately


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If relatives are in the hospital ask if they wish to assist with the last offices and/or if they have any particular wishes regarding the procedure

If the relatives are not in the hospital ask if they wish to view the body on the ward or at a later date

Assemble required equipment Wash hands and put on disposable

gloves and apron


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Any injuries sustained whilst carrying out the procedures on the deceased must be reported through the Trust risk system and follow the Trust Sharps and Inoculation Management Procedure

Lay the patient on their back with one pillow in place (adhere to the Moving and Handling Policy)

Straighten the patient’s limbs (if possible) and place their arms by their sides

Gently close the patient’s eyes if open by applying light pressure for 30 seconds. If corneal or eye donation to take place, close the eye with gauze moistened with normal saline


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Do not apply tape If syringe driver in situ, disconnect and

remove battery In cases where there is no referral to the coroner required infusions can be discontinued and infusion lines, cannulae, drainage and other tubes can be removed If referred to the coroner endo-tracheal tubes, catheters and infusion lines should remain in situ. (see section 3) Discard all sharps into a sharps bin as per Trust Sharps and Inoculation Management Procedure


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Place a receiver between the patient’s legs and drain the bladder by pressing on the lower abdomen. Pads and pants can be used to absorb any leakage

Exuding wounds should be covered with absorbent gauze and secured with an occlusive dressing

Wash the patient if necessary, unless requested not to do so for religious/cultural reasons or patient has died in suspicious circumstances


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It may be important to the family and carers to assist with washing, thereby continuing the care given to the patient in the period before death

Clean the patient’s teeth and gums using a moistened, soft small headed nylon toothbrush and or suction to remove any debris and secretions Clean any dentures and replace them in the mouth – a small pillow or rolled up towel placed under the patient’s chin may help to keep the jaw closed and teeth in situ


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Tidy the hair as soon as possible after death and arrange into the preferred style (if known)

Patients should not be shaved; usually a funeral director will do this. Some faiths prohibit shaving

Remove all jewellery, in the presence of another nurse, unless requested by the family to do otherwise. Any jewellery removed must be documented on a property form and placed in the hospital safe until collected by the family. Wedding rings may be left in situ and taped in place. Any jewellery remaining on the body should be documented on the identification card accompanying the patient to the mortuary or undertakers


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Record all property in the patient property book and pack in a labelled property bag, keeping secure until collected by the family. Pack personal property showing consideration for the feelings of those receiving it. Discuss the issues of soiled clothes sensitively with the family and ask whether they wish them to be disposed of or returned

Unless a specific request has been made by the family for alternative clothes the patient should be dressed in a hospital gown

If relatives are present at the time of death, or attend the hospital shortly after, staff should ensure that they are given the Trust Bereavement information copies of which are available on the ward.

Relatives should be told to contact the relevant Trust officer who supports bereavement or the patient’s GP to collect the death certificate


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Label one wrist and one ankle with an identification band containing the following information: Full name NHS Number Date of Birth

Complete patient identification cards and notification of death book clearly in capitals

If the patient has an implant device such as a pacemaker or an infectious disease is known or suspected – record this fact on both patient identification cards


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Tape one identification card to clothing or hospital gown Wrap the body in a sheet, ensuring that face to feet are covered and that all limbs are held securely in position

If the body may be infectious or there is a risk of leakage of body fluids place the body in a body bag and put the second identification card into the pocket of the body bag

If the deceased person has a known infectious disease Category 3 & 4 they must be placed in a heavy duty body bag and you must inform anyone else who comes in contact with this patient e.g. funeral directors, porters.


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Remove gloves and aprons. Dispose of equipment according to local policy and wash hands

If mortuary on site request porters to remove body from the ward to the mortuary

If no on site mortuary, contact local funeral directors or the funeral directors according to the relatives wishes Screen off the area where removal of the body will occur

Screen off the area where removal of the body will occur

Record all the details and actions in the nursing records Any property retained on the ward out of hours must be stored in a secure area and any valuables stored in the ward or hospital safe


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—it is also known as a post-mortem examination,

It is a highly specialized surgical procedure that consists of a thorough examination of a corpse to determine the cause and manner of death and to evaluate any disease or injury that may be present. It is usually performed by a specialized medical doctor called a pathologist.

Autopsies are performed for either legal or medical purposes.


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Autopsies are divided into 2 categories:

Medical, authorized by the decedent, decedent's family or healthcare surrogate

forensic, authorized by statute.


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AUTOPSY An autopsy or postmortem examination is an examination

of the body after death. It is performed in certain cases such as: o Committed suicide o Unknown cause of death o Unknown dead bodies o Homicide (The killing of one human being by another ) · The organs and tissues of the body are examined to

establish the exact cause of death , to learn more about a disease

· A consent should be obtain from the immediate relative :surviving spouse, adult children, parents, siblings.

· After an autopsy , hospitals cannot retain any tissues/ organs without the permission of the person who signed the consent form


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It is the art and science of preserving human remains by treating them (in its modern form with chemicals) to forestall decomposition.

The intention is to keep them suitable for public display at a funeral, for religious reasons, or for medical and scientific purposes such as their use as anatomical specimens.[1]

The three goals of embalming are sanitization, presentation and preservation (or restoration).

Embalming has a very long and cross cultural history, with many cultures giving the embalming processes a greater religious meaning.

Embalming prevents the process throughinjection of chemicals into the body to destroy the bacteria

It is the process of preserving dead body from decay Injection of chemicals into the body to destroy the

bacteria ; thereby prevents rapid decomposition of tissues.

Embalming fluid contains a mixture of formaldehyde, methanol, ethanol and other solvents


SILVASSA

Make sure the body is face up Remove any clothing that the

person is wearing. Disinfect the mouth, eyes, nose,

and other orifices Shave the body. Break the rigor mortis by

massaging the body. Setting the Features1.Close the eyes.2.Close the mouth and set it naturally3.Moisturize the features. A small

amount of creme should be used on the eyelids and lips

4.Casketing the Body63


Process of Embalming Embalming fluid is injected into the arteries of the deceased

during embalming. Many other body fluids may be drained or aspirated and replaced with the fluid as well. The process of embalming is designed to slow decomposition of the body.

The actual embalming process usually involves 4 parts:

Arterial embalming: which involves the injection of embalming chemicals into the blood vessels, usually via the right common carotid artery. Blood is drained from the right jugular vein.

Cavity embalming: The suction of the internal fluids of the corpse and the injection of embalming chemicals into the body cavities, using an aspirator and trocar.

Hypodermic embalming: The injection of embalming chemicals under the skin as needed.

Surface embalming: Which supplements the other methods especially for visible, injured body parts.


SILVASSA

care of dying client

Healthcare