Unit -IV

Care Of Terminally Ill

Patient

Prepared by
Mrs. Silpa Jose T
Asst. Professor
St .Thomas College of Nursing,
Kattanam
• 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
• Autopsy
o Embalming

Care of terminally ill patient 2

 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

 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 loss
It 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
ones.
loved 8
 Normal Grief. Normal (uncomplicated) grief is a
common, universal reaction characterized by
complex emotional, cognitive, social, physical,
behavioral, and spiritual responses to loss and
death.

 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 to grief (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 or significantly

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, sometimes
seemingly 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
proposed by Elisabeth Kübler-Ross first
 Denial
 Anger
 Bargaining
 Depression
 Acceptance

Denial : It is a normal reaction to rationalize

overwhelming emotions. It is a defense
mechanism that buffers the
shock. It is a conscious or unconscious refusal
immediate
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 decreased
capacity to show compassion or empathize
with suffering people

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 Palliative Care: in Acute and Restorative Settings. Interventions for
people who face chronic life-threatening illnesses or who are at the
end of life need palliative care. Palliative care focuses on the
prevention, relief, reduction, or soothing of symptoms of disease or
disorders throughout the entire course of an illness, including care of
the dying and bereavement follow-up for the family. The primary goal
of palliative care is to help patients and families achieve the best
possible quality of life. Although it is especially important 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 the care of
terminally ill patients and their families. Hospice is not a place 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 a hospice
program usually have less than 6 to 12 months to live. Hospice services
are available in home, hospital, extended care, or nursing 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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 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 elimination:
with
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.

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Cassen (1991) suggests seven features in
essential management of the dying the
 patient:
Concern: Empathy, compassion,
and essential. involvement are
 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.

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 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
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Changes in body after death
There are a number of changes that
happen to a body after death. These
changes are the result of physical and
chemical shifts happening to the body as
it begins to decay. There are discernible
postmortem changes that occur in the first
24 to 72 hours after death: pallor mortis,
algor mortis ,rigor mortis, and livor
mortis.
Cont…..
Pallor mortis: paleness which happens in the first 15–120 minutes after death
Algor mortis: the second stage of death, is the change in body temperature
post mortem, until the ambient temperature is matched. This is generally a
steady decline, although if the ambient temperature is above the body
temperature (such as in a hot desert) the change in temperature will be
positive, as the (relatively) cooler body acclimates to the warmer
environment. External factors can have a significant influence.
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
Livor mortis is the fourth postmortem sign of death. It is the appearance of a
reddish or purple discoloration of the skin. This lividity appears about 2
hours after death and becomes fixed
Putrefaction the beginning signs of decomposition
Nursing action Rationale Scientific Nursing

principles principl
es
Wash hands and put Helps prevent Prevents direct Safety
on gloves cross infection contact with
infection
Soon the death is Keeping the The body after Comfort
pronounced, patient in a supine death should
remove the position prevents look as normal
backrest, extra post mortem as possible
pillows and gently hypostasis of
put the patient in a blood.
supine position
with the head
elevated on the
pillow.
Positioning is Rigor mortis sets Body should be workma
important after in shortly after kept in nship
death, because of death.to give a position before
rigor mortis. close normal rigor mortis
Remove all tubes and The patient looks Reduce the Comfort
other devices from more peaceful anxiety of
the patients body. the relatives
consult close To meet customs Reduce the
relatives before and wish of the tension of
preparing the body relatives in caring relatives
for removal from the for the body
ward to the mortuary
where the relatives
will receive the body
If the relatives To reduce odor Appearance
require, the nurse and for aesthetic of the
should help them to sense for body after
sponge the patient as normal death
necessary. brush and appearance should be
comb hair. presentable
Replace soiled To avoid odor For better comfort
dressing with cleaned appearance
ones

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Apply perineal pads To prevent soiling After death Safety
and plug the rectum & of bed and the there may
vagina (in females) patient cloth be leaking
with cotton balls.). of
secretions
form
orifices
Provide clean For better
cloths(own appearance
Take care of valuables For legal
and personal considerations
belongings by handing
over to members of
family.
Allow members of Provide emotional It allows
family to see the support and helps them to
patient & remain in grieving process by ventilate
the room & remember helping family to their grief
that the body is still accept death and feelings
dear to someone.
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Close the body from side Hospital policy is Legal
to side and head to foot for relatives to aspects of
with the sheet. claim the body from nursing
the mortuary
Prepare the identification Helps to identify the It is for legal
slip and attach it to the patient purpose
patients pack sheet. .
Attach a special label if Protect those who Infection
the patient had a handle the body may spread
contagious disease. if proper
precautions
are not
taken
Transfer the body to the They will get
mortuary another certificate
according to hospital
policy
Remove contaminated Prevent Prevent
articles from room. contamination of spread of
others from
body fluids infection
3
7
 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 to make a refusal of treatment in
advance of a time when the patieent can’t communicate thier
wishes, or don’t have the capacity to make a decision. It only
comes into effect if either of these situations occur.
Person 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. 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. 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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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 or withdrawing treatment that is necessary to
withholding such as withholding antibiotics from someone
maintain life,
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
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 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 kn

ows 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 ma
kes a statement, otherwise, it is inadmissible.

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ORGAN
DONATI
 A person 18 years or older and of sound
ON 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
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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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 · 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
 AUTOPSY
 An autopsy or postmortem examination is an examination of
 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 through injection 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

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 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 Features

1. Close the eyes.

2. Close the mouth and set it naturally
3. Moisturize the features. A small
amount of creme should be used on the
eyelids and lips
4. Casketing the Body

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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.

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