Nursing Procedure 12.3
- Providing Postmortem Care
Provides proper preparation of body of deceased client, with minimum exposure of staff to body fluids and excrement, for viewing by family members and for transport to funeral home or morgue.
Nursing Procedure 12.3
Provides proper preparation of body of deceased client, with minimum exposure of staff to body fluids and excrement, for viewing by family members and for transport to funeral home or morgue.
Assessment should focus on the following:
Nursing diagnoses may include the following:
Outcome Identification and Planning
Sample desired outcomes include the following:
Special Considerations in Planning and Implementation
The bodies of deceased clients with known infections requiring blood and body fluid precautions or isolation (e.g., tuberculosis, AIDS) should be tagged accordingly, and there should be appropriate disposal of soiled items and cleaning of nondisposable items. In some states, death may be pronounced by someone other than a doctor (e.g., coroner, advanced practice nurse, home health nurse), particularly in out-of-hospital settings. Be familiar with agency and state policies and procedures related to pronouncement of death. Preferences regarding autopsy and organ harvesting vary widely among individuals, as well as cultures. Communication with the family on an individual basis is crucial, particularly if a living will is not in place. Current federal regulations mandate that for institutions receiving assistance through Medicare or Medicaid funding, permission must be sought to secure viable organs for harvesting in every case of death. Further, the Health Care Financing Administration (HCFA) mandates that a specially trained individual must seek permission from the family to do so.
The client must be pronounced dead before the body can be removed from the home (unless being taken to a hospital or health facility). Follow agency policy for recording the pronouncement on the client's chart. When an autopsy is required or requested, the body must be left basically undisturbed until transported to the morgue.
Staff should assist family members with emotional and spiritual needs before and at the time of death, such as summoning a spiritual advisor who shares the same faith or beliefs as the family members. Religious rites and practices differ with culture. Staff members should show respect for the deceased and should allow the family privacy. Before preparing the body, ask the family what postmortem practices are important; they may want to summon a priest, minister, rabbi, or other religious leader to the body.
| Action | Rationale | |
|---|---|---|
| 1 | Record on the client’s chart the time of death (cessation of heart function) and the time pronounced dead by a doctor or other appropriate authority. | Fulfills legal requirement for death certificate and all official records |
| 2 | Notify family members that client’s status has changed for the worse, and assist them to a private room until the doctor is available. | Provides privacy for family during initial grief; allows doctor to notify family of client’s death |
| 3 | Return to client’s room and close door. | Prevents exposure of body to other clients and visitors; prevents family from seeing body before it is prepared |
| 4 | Perform hand hygiene and don gloves and isolation gown. | Reduces microorganism transfer; protects nurse from body secretions |
| 5 | Hold eyelids closed until they remain closed. If they do not remain closed, place moist 4 × 4-in. gauze or cotton balls on lids until they remain closed on their own. | Fixes eyelids in a natural, closed position before rigor mortis sets in |
| 6 | Remove tubes, such as IV line, nasogastric (NG) catheter, or urinary catheter, if allowed and no autopsy is to be done. | Provides a more natural appearance |
| 7 | If unable to remove tubes: | Retains secretions while providing a clean and natural appearance |
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| 8 | Remove extra equipment from room to utility room. | Allows mobility around bed; improves appearance of room |
| 9 | Wash secretions from face and body. | Improves appearance of body; decreases odor |
| 10 | Replace soiled linens and gown with clean articles. | Provides clean appearance; decreases odor |
| 11 | Place linen savers under body and extremities, if needed. | Absorbs secretions and excrement |
| 12 | Put soiled linens and pads in bag (isolation bag, if appropriate) and remove from room. | Decreases exposure to body fluids; removes odor; improves appearance of room |
| 13 | Position client in a supine position with arms at side, palms down. | Provides a natural appearance |
| 14 | Place dentures (if present) in mouth, put a pillow under head, close mouth, and place rolled towel under chin. | Gives face a natural appearance; sets mouth closed before onset of rigor mortis |
| 15 | Remove all jewelry (except wedding band, unless it is requested by family members) and give to family with other personal belongings; record the name(s) of receiver(s). | Prevents loss of property during transfer of body; ensures proper disposal of belongings |
| 16 | Place clean top covering over body, leaving face exposed. | Allows family to view client while covering remaining tubes and dressings |
| 17 | Remove and discard gloves and perform hand hygiene. | Reduces microorganism transfer |
| 18 | Place chair at bedside. | Provides seat for family member unable to stand or if momentary weakness occurs |
| 19 | Dim lighting. | Makes atmosphere more soothing and minimizes abnormal appearance of body |
| 20 | After body has been viewed by family, tag client with appropriate identification. Some agencies require that the body be placed in a covering or shroud and that an outer covering identification tag be applied. | Ensures proper identification of body before transfer to funeral home or morgue |
| 21 | Send completed death certificate with body to funeral home or complete paperwork as required by hospital and send body to morgue. | Fulfills legal requirements for documentation of death |
| 22 | Close doors of clients in hall through which body is transported, if hospital policy. | Prevents distress to other clients and visitors |
| 23 | Restore or discard equipment, supplies, and linens properly; remove gown and gloves; and perform hand hygiene. | Reduces transfer of microorganisms among clients; prepares equipment for future use; reduces microorganism transfer; maintains clean and orderly environment |
| 24 | Have room cleaned: Use special cleaning supplies if client had infection (e.g., 1:10 bleach dilution for AIDS clients, special germicides for isolation situations). | Reduces microorganism transfer among clients |
Were desired outcomes achieved? Examples of evaluation include:
Transcultural