Post mortem care

Sabby_NC · Jan 11, 2009

i may be the most qualified to respond to this question as i am an rn plus a licensed funeral director and embalmer.
all the post mortem care we learned in nursing school... ie: tie the mouth/jaw closed, tie the hands together, etc.... please forget all of this.
i will explain: most set up rigor in the hours following and a process of desquamation can begin = "skin slip" or separation of the epidermis from the dermis. therefore, tying the scarf around the head to jaw technique closes the mouth and locks the mouth closed. it is much better for an embalmer to close the mouth than open it if/when rigor sets in. one embalmer in our company once broke a jaw opening it.
tying the hands together at the wrist often results in tearing the skin around the wrist. this is extremely difficult to cover with makeup. if a nurse is anal and just has to tie arms, then tie from above the elbow to the other elbow.
bowels relax and, most often, the deceased defecates...nothing new there. if cleaned, typically they will continue to defecate. simply clean them 1x and apply a diaper.
an overall bath is unnecessary for most cases unless unusually dirty such as confused feces eating elderly patients. an embalmer has a table that he/she will wash the skin in an easy fashion. a porcelain table with running water is necessary after embalming to clean his/her mess -- ie: blood, feces, etc. the only value a total nursing bath on the average patient can be would be if the nurses have taken care of this patient for a long term period and have some emotional vestment. it can help them work through their grief process.
now...something no one knows or does. the eye lids also set up rigor. if eyes are left open and rigor happens...i had to use "eye caps" to get closure. it is similar to a very large contact lens with barbs on the outside. then i pull the lids over with forceps or similar and the barbs stick into the posterior of the lids.
therefore, simply dry the eyes with a 4x4, apply a light coat of vaseline...and close the lids. bottom lid 1/3 up, top lid 2/3 down. the vaseline has a tacky-ness and the lids stick to one another.
in summary:
dry, close the lids.
clean up waste/secretions and apply a diaper.
those are the 2 most important.
if the family wishes to visit, then you may close the mouth (f it will stay closed) but then please open it back at least 1/2 way before sending out.
thanks,
michael

thankyou michael excellent post :)

skybaby RN · Jan 14, 2009

Michael

I especially appreciated your comments. I am currently conducting a grant funded research project on post-mortem care. Would you be willling to entertain a few questions as they arise? Knowing both the RN side and the FD side would be invaluable to the project.

Thanks,

Susan

talaxandra · Jan 14, 2009

Hi Susan,

I'm also conducting research into post-mortem care, specifically the way nursing and medical staff interact with the patient while performing death work (laying out the body, certification etc). What aspect are you investigating?

T

leslie :-D · Jan 14, 2009

i had never heard of tying hands together at the wrists...

has anyone else?

and michael, thank you.

wonderful input.

leslie

skybaby RN · Jan 15, 2009

Hi Susan,
I'm also conducting research into post-mortem care, specifically the way nursing and medical staff interact with the patient while performing death work (laying out the body, certification etc). What aspect are you investigating?
T

Our research is attempting to establish best practice. Nursing education does not really address these issues.

skybaby RN · Jan 15, 2009

i had never heard of tying hands together at the wrists...
has anyone else?
and michael, thank you.
wonderful input.
leslie

Oh yes, it's quite common in many areas. All the strings in those shroud bags should be thrown away to prevent the temptation to use them!

talaxandra · Jan 15, 2009

We usually gently bind the hands and wrists with bandages, wioth ID tags attached.

skybaby RN · Jan 17, 2009

Okay. What kind of bandages? Michael, could you also weigh in on this one?

mike7evans · Jan 17, 2009

Hello Skybaby,

Hey, did you receive my private message to you with my email address? I never got a reply from you. UNLESS, I thought something was spam and it got deleted. If so, sorry and please resend.

Still, with any bandages, I just cannot agree with around the wrist. If you could tear wet toilet paper with it, then don't use it. You have NO upfront idea of the time before embalming (if going to be a traditional funeral) Yes, what Talaxandra stated is MUCH better than the thin ties, still I can't go with it. The reason is... somewhere along the way we get a nurse that is thinking, "I don't have a kerlex(s) and we used to always just use these thin ties...etc.." After working at this place that we had several low functioning nurses, I just learned to attempt to fool proof things. So my opinion remains at:

(If you feel like you must bind the arms to prevent arms falling...then perhaps...) Tie from just above the elblow (distal), across the chest to the opposite arm with 3-4" wide Kerlex gauze.

As we advance in thoughts/ideas/concepts, more and more funerals are going to a less conversative approach. Therefore, it is more acceptable to display in casket a person in short sleeves when years ago the standard was a suit for a man and long sleeve dress for a woman.

Hope this helps. Just worked 3 13hour shifts so I am off to zzzzzz.

See you.

Michael

mike7evans · Jan 18, 2009

Correction to something.... I said "distal." I meant "proximal." Too many hours without sleep and then auto battery problems after the temp dipped to at/about 0 degrees F here in Tennessee. Something we are not used to.

Thanks,

Michael

chasingthedream · Jan 20, 2009

I have not started nursing school yet so I'm not sure exactly what is taught there but I have been working for a local hospital for about 2 months now as a PCT and recently just had my first experience with post-mortem care. Being new myself I wasn't really sure exactly what to do but it seemed that even when I asked others there was so much confusion in what needed to be done that nobody could help me. Nobody knew whether to leave the foley in/out, whether they should be gowned or nude, brief or no, bathed or not. It just seemed like a lot of confusion and ignorance of what the actual process entailed. Is this something that isn't really taught in school? I spoke with my father in law who is a funeral director and his response was very similar to the above response I was just curious why it is that no one seemed to know.

rnmi2004 · Jan 20, 2009

I have not started nursing school yet so I'm not sure exactly what is taught there but I have been working for a local hospital for about 2 months now as a PCT and recently just had my first experience with post-mortem care. Being new myself I wasn't really sure exactly what to do but it seemed that even when I asked others there was so much confusion in what needed to be done that nobody could help me. Nobody knew whether to leave the foley in/out, whether they should be gowned or nude, brief or no, bathed or not. It just seemed like a lot of confusion and ignorance of what the actual process entailed. Is this something that isn't really taught in school? I spoke with my father in law who is a funeral director and his response was very similar to the above response I was just curious why it is that no one seemed to know.

Post-mortem care in the hospital is going to be different than a hospice case.

I can't answer why no one in the hospital seemed to be able to answer your question other than deaths don't happen very often (which would be a good thing). Your hospital should have a policy outlining post-mortem care. Mine also supplies a post-mortem care pack, including the body bag, toe tag, and gown.

Ask the nurse if catheters, lines, etc. should be removed. If the ME determines that an autopsy will be performed these items must be left in.