Question

1. List in proper order the different elements of providing post-mortem care (in detail).

Answer 1

Post martom care :

After death, the body undergoes many physical changes, including loss of skin elasticity and change in body temperature (algor mortis), purple discoloration of the skin (livor mortis), and a stiffening of the body (rigor mortis). Postmortem care should be provided as soon as possible to prevent tissue damage or disfigurement. To prevent livor mortis of the face, the head of the bed should be elevated and a clean pillow placed under the head immediately after death before beginning other activities. The health care team member should provide a peaceful presentation of the patient for individuals who desire an opportunity to grieve and view the patient.

EDUCATION
• Explain the procedure and the reason for postmortem care to the family, as appropriate.
• Provide education as needed to protect the family and others from infectious diseases
from the patient. In many cases, this includes patients who were on respiratory or contact precautions. Explain to the family that minimal contact, limited to close family members, is necessary to prevent transmission of disease.
• Encourage questions and answer them as they arise.
ASSESSMENT AND PREPARATION
Assessment
1. Perform hand hygiene and don PPE as indicated for needed isolation precautions.
2. Verify the correct patient using two identifiers.
3. Introduce yourself to the family.
4. Ask the practitioner or other designated team member to establish the time of death and determine if the practitioner has requested an autopsy.
5. Determine if family members or significant others are present and if they have been informed of the death.
6. Identify the patient’s surrogate (next of kin or durable power of attorney).
7. Determine if the patient has first-person consent, is listed in the Donate Life Registry, or if his or her surrogate has been asked about organ and tissue donation. If so, ensure that the donation request form has been signed and notify the organ procurement team per the organization’s practice.
8. Give family members and friends a private place to gather. Allow them time to ask questions and to grieve.
9. Ask family members if they have requests for the preparation or viewing of the body (such as position of the body, special clothing, and shaving). Determine if they wish to be present or assist with care of the body.
10. Contact a spiritual care provider consistent with the family’s cultural beliefs or enlist a team member to stay with family members who are not helping prepare the body.
11. Consult the practitioner’s orders for special care directives or specimens to be collected.
Preparation
1. Provide privacy for the patient’s body, if possible. If the patient has a roommate, explain the situation to the roommate and move him or her to a temporary location.

PROCEDURE
1. Perform hand hygiene and don gloves, gown, mask, and eye protection.
2. Verify the correct patient using two identifiers.
3. Explain the procedure to the family and ensure that they agree to treatment.
4. Help family members notify others of the death. Per the organization’s practice, notify the morgue or mortuary chosen by the family to transfer the patient’s body. Discuss plans for postmortem care.

5. If organs or tissue are being donated, follow the organization’s practice for care of the body.
6. Identify and tag the patient’s body, leaving the identification on the body per the organization’s practice.
7. Assess the general condition of the body and note the presence of dressings, tubes, and medical equipment.
8. Remove indwelling devices (e.g., urinary catheter, endotracheal tube), if appropriate per the organization’s practice and circumstances.
9. If the patient has dentures that are not in his or her mouth, place them there. If the dentures do not stay securely in the mouth, place them in a labeled denture cup and ensure that they are transported with the patient’s body to the mortuary.
10. If culturally appropriate, use a rolled-up towel under the chin to close the patient’s mouth.

11. Place a small pillow under the patient’s head or position it according to cultural preferences.
12. Follow the organization’s practice regarding securing the hands and feet. Use only circular gauze bandaging on the body. Position the hands in an elevated position on the abdomen.
13. If culturally appropriate, close the patient’s eyes by gently pulling the eyelids over the eyes.
14. Shave male facial hair, unless doing so is prohibited by cultural practices or the patient wore a beard.

15. Wash soiled body parts. If family members are assisting with washing the body and providing postmortem care, instruct them to don gowns and gloves for protection from body fluids.
16. Remove soiled dressings and replace them with clean dressings, using paper tape or circular gauze.
17. Place an absorbent pad under the patient’s buttocks.
18. Place a clean gown on the patient’s body.
19. Brush and comb the patient’s hair. Remove any clips, hairpins, or rubber bands.
20. Identify which of the patient’s belongings are to stay with his or her body and which are to be given to the family.
21. If the patient’s family requests a viewing, prepare the patient’s body and room in a culturally sensitive manner per the organization’s practice.
22. Allow the family time alone with the patient’s body

DOCUMENTATION
• Time of death
• Description of any resuscitative measures (if applicable)
• Name of the professional certifying the death
• Any special preparation of the body for autopsy or organ and tissue donation