This document provides information on end of life care, including definitions of death, the stages of grief, and the physiological and psychological needs of a dying patient. It outlines the nursing responsibilities after a patient has died, such as preparing the body, caring for family members, documenting the death in medical records, and handling the deceased's belongings. The stages of rigor mortis are also discussed. The document provides detailed guidance on proper procedures for post-mortem care.

1. H. Deepani
RN, BN, Nursing Tutor
School of Nursing
Colombo

2. Irreversible cessation of circulatory
and respiratory functions
Irreversible cessation of all functions
of the entire brain, including the
brain stem

3. Denial/ isolation – refuse the
diagnosis
- go from one Dr. to
another
Anger -angry about sickness
Bargaining - makes negotiation
for cure
Depression – withdrawal, crying
Acceptance – ready for death

4. “They made wrong diagnosis. This is
not about me”

5. “why me? I’m such a nice person. Why
I was selected?”

6. “if I can wait until my son’s
graduation I will be satisfied. Please
god let me alive until then”
Fulfill bargaining as much as possible
to help the client to go to next stage

7. “ I waited so long to see my
daughter’s wedding and to cuddle
my grand children. I can’t bear the
thought of not being their for her
wedding”

8. “I’ve completed all my
responsibilities. Made my last will.
Everybody can live peacefully even
without me. So I’m happy to go to
last sleep”

9.  Inability to swallow
 Decreased GI tract and urinary tract activity
 Bowel & bladder incontinence
 Loss of sensation
 Loss of motion
 Slight elevation of body temperature
 Cold clammy skin
 Cyanosis
 Low BP
 Noisy & irregular respiration- cheyne stokes
respiration
 unconsciousness

10. Pain
Anxiety
Depression
Fear
Loss of dignity

11. Fulfill psychological needs according
to the stage of death
-keep relative with
-never leave alone
-answer questions
-encourage to cope
-allow religious practices
-no discussion about pt at his
presence

12. Fulfill physiological needs
1. Environment
-close to nurses station
-well ventilated
-pleasant
- provide privacy with screen
-adequate light
-equipment for manage emergency
-allow a relative

13. 2. Relieve pain
-give anelgesics
-keep in comfortable position
-explain every procedures
3. Positioning
-lateral
-semi prone
-supine with head turned to a side
( allows draining of secretion)
-semi fowler’s and O2 via mask if
dyspnoec

14. 4. Nutritional needs
-very small amount of oral feed at a
time if swallowing reflex present
-feed with a spoon
-sip of ice water
-NG feed as ordered if unconscious
or no swallowing reflex
-IV infusions

15. 5. Personal hygiene
-provide total hygeine care
6. Elimination
-catheterization for urinary
incontinence & retention
-incontinence pad for bowel
incontinence
-suppository for constipation

16. 7. Protect from injuries
-bar bed
-never leave client alone
8. Assist with last will
-inform Dr.
-inform relative if client wish
-arrange legal facilities
-nurse should stay away during
documentation of last will

17. 9. Facilitate organ donation
-provide informations
-can donate heart, lungs, liver ,
kidney and cornea
-help to fill up the consent form
-consent can be given by the
immediate relatives of the client

18. 10. Inform family members
-if relatives are present inform them
verbally
and get the signature
-if not inform over the phone or
telemail
usually this is done by the Dr. after
making records about pt’s condition
in the BHT

19. No pulse
No respiration
No heart sounds
BP unrecordable
Flat ECG wave
Fixed & dialated pupils
No reflexes
Flat EEG

20. Examination of the organ & tissues of a
human body after death.
Consent - before death by the person
- after death by immediate
relative
-taken by physician
Contribute to the advancement of
medical science

21.  Autopsy which doesn’t require consent of
person or guardian
1. Death occurred by within 24 hours of the
admission to the hospital
2. Death due to accidents
3. Suicide
4. Homicide
5. Illegal therapeutic practice
 Dr. writes in the BHT “inquest
ordered”
 These deaths should inform to the
coroner &Judicial Medical Officer
(JMO)
 Coroner decides the need of autopsy

22. Rigor mortis – stiffness of the body
within 2-4 hours after death
Algor mortis – decreasing
temperature
-loss of elasticity of the skin
Livor mortis – discoloration of
dependant body parts due to blood
pooling (back)

23. Caring for dead body
Caring for family members
Legal responsibilities
Care of patient’s valuables
Issuing and signing of death
certificate
Labeling the body
Review organ donation arrangements

24. After written confirmation of death
by the Dr. nurse should prepare the
dead body to discharge
Keep body in normal anatomical
position
Close eyes
Remove soiled garments

25. Remove every attached devices
(cannula, catheters, NG tube, drain
tubes, POP casts etc.) do not
remove if autopsy(inquest) is
required
If necessary wash the body
(controversial ideas)
Cover any wounds with tight
dressing

26. Pack every orifice with cotton swabs
For female cover perineum with a
pad
Replace dentures
Dress with light color or white dress
Keep hands interlaced over the
chest
Tie both thumbs, both knees and
both big toes together with a cotton
bandage
Apply barrel bandage to jaw
Attach identification tags to the
dress and big toes

27. Keep another tag attached to the
death record book
Cover whole body with a white cloth
If relatives want to stay with body
allow them for grieving
If relatives want to stay with body
allow them for grieving
Keep the unit screened
Inform the mortuary about the time
of death
Keep the body in the ward for 2
hours

28. Listen them
Allow them to express feelings,
grief, loss and helplessness
Provide them to sit
Give First aid for fainting attacks
of relatives
Reassure them
Review them their dedication for
care, optimal care given at the
hospital

29. Explain the need of keeping body 2
hours at the ward
Help them in legal aspects
Participate for the funeral
Refer for appropriate services if
family not coping well

30.  Name of the client
 BHT No
 Ward No
 Age
 Sex
 Race
 Religion
 Address of the guardian
 Date & time of admission
 Date & time of death
 Diagnosis
 Signature of ward sister & date

31. Prepare 3 cards
Attach 2 to the body and send the
remaining card to the mortuary with
person accompanying the body
If inquest ordered write “inquest
ordered” in the cards

32. Once the death is confirmed by the Dr.
Get the death certificate filled
Inform director- BHT to director’s
office
Inform relatives- BHT to inquiry office
If inquest ordered send the BHT to the
police post for necessary action
Get the permission of the hospital
director
Police will inform to the coroner,
police of the dead person’s area

33. Coroner, Dr., relevant police officer
& relative will discuss about the
death
If no suspicion cause of death will be
mentioned
If suspicious post mortem is held

34. If the cause of death is uncertain
post mortem is held
Done by Judicial Medical Officer
(JMO)
Usually conducted for death
followed by
Assault, accidents, poisoning, gunshot
injury, stab and any suspicious
deaths

35. Prepare a list of valuables
Record it in the BHT and hand over to
the relatives
Get the signature of guardian
If relatives not available hand over
valuables to ward sister with a list
If its difficult to remove the wedding
ring or relatives want to keep the
wedding ring, cover it with an adhesive
plaster & make note in the BHT

36.  Admission register- patient expired at 2.40
am on 22/12/2014
 In the death register
 In the day report/ night report
{condition of the client, how the situation
occurred, treatment and care given, and the
time of death in red ink “pt. expired at 2.40
am on 22/12/2015”
 If death certified by the Dr. “death certified
by the doctor”
 If inquest ordered “inquest ordered”
 Giving over book

37. Get the death confirmed by a doctor
Inform the G.S. in the area
Inform the registrar of the area
If any suicide or homicide occur
inform the police