Post mortem care

Specialties Hospice

Published

I have recently been present at two pt deaths where the Crisis Care nurse (yes, they were hospice nurses) did not make an attempt to wash the body. One told me "They just had a bath this morning", the other said "well, they're not dirty and besides, they'll wash them at the funeral home". This makes me crazy!!!! :banghead: I don't care if the patient was washed up 1/2 prior to death - you wash the body up due to any possible secretions present, and as a sign of respect and caring. Or am I wrong? I went ahead and washed the bodies up, anyway. The nurse looked at me like I was nuts.... Oh, and about powder. This one nurse just dumped powder all other the deceased man's chest "so he would smell good when his wife kissed him". How about smelling good 'cause he's clean!???? Is this too petty to report to someone??? (yes, I can be a bit anal, I know....:grn:

Thanks,

mc3:nurse:

Specializes in ER, CCU/ICU, Trauma, Hospice.

Thank you, Family appreciates it also as many don't think of "sending them out clean".

Up Vote Up Vote ×
Specializes in Acute Care.
I alwyas, pull the catheter, clean the body, change the gown, comb their hair and spray the room with air freshner (a small bottle I carry with me, has a nice fresh scent). I can not imagine someone thinking it is not okay or simply not doing it. One of our nurses actually got written up for not doing it when a funeral home complained. (I guess the man threw up on himself, etc and the new RN, a male nurse, never cleaned the body and just sent him on his way). I thought this was taught in nursing 101.

I learned nothing about post mortem care during nursing school.

I learned about it here and through research (I have a little obsession with medical examiners and death/dying.. not to sound morbid. I just find it very interesting)

Up Vote Up Vote ×
Specializes in hospice.

I usually ask the family what they would like me to do. Some families do not want me to do a complete bath. but I still wash the head, face, check the brief. With some families, I so everything including painting nails and fixing hair.I never take out the foley. The funeral homes actually prefer us not to take it out because during transport, urine usually leaks and it is cleaner for them to leave it in. I just empty the bag.

Up Vote Up Vote ×
Specializes in ER, CCU/ICU, Trauma, Hospice.

Since this is a Hospice thread in most cases the coroner may be notified but as the person is on hospice the death is "expected", therefore not a coroners case for investigation. As far as washing the body it is all about family preference. I ask the family if they would like to help in all cases, some prefer to do it all themselves. I always check the bottom and change briefs/depends and was hands and face at a minimum. Enbalming is not required in all states. Thanks you for the information on skin and embalming, I was not aware of the potential "problems" if skin is damaged.

As far as Nurses or CNA doing post mortem care, it was covered and expected to be done if a pt died in my first semester of nursing school.

Up Vote Up Vote ×
Specializes in ER, CCU/ICU, Trauma, Hospice.
I have never heard of a RN or CNA, or anyone doing postmotem care....except a Mortician. A dead human body has to be treated in a certain way. This is what Morticians learn in Mortuary College. Changing a person's clothes after death, washing the body, closing the eyes and mouth are a Mortician's job....not a Nurse!

If you pull too hard on an eyelid and break the skin it will leak for hours after the body is embalmed. A scratch to an arm after death will also leak after embalming. All sorts of dammage that can be done by a well meaning Nurse. Any dammage to the skin after death will be a problem after embalming. Running a brush through someone's hair will leave marks on the scalp....many problems will occur during and after embalming if the body was not cared for by someone who is trained to take care of the dead. Washing, drying, moving arms and legs, closing eyes and mouth are all things that will dammage the tissues.

sorry, in more than 30 years as a cna then a nurse i have never heard any of this... and in the "old days" we ALWAYS did complete post mortem care. I havent worked in Hospice so I cant speak to that; but as a nurse I know I would feel neglectful if I didnt do pm care.

The correct thing to do is to cover the body with a sheet and call the Funeral Home or the Coroner. You should never fuss with a Coroners Case because you'll destroy evidence.

????? evidence??/ like expelled feces and urine etc???

Since this is a Hospice thread in most cases the coroner may be notified but as the person is on hospice the death is "expected", therefore not a coroners case for investigation. As far as washing the body it is all about family preference. I ask the family if they would like to help in all cases, some prefer to do it all themselves. I always check the bottom and change briefs/depends and was hands and face at a minimum. Enbalming is not required in all states. Thanks you for the information on skin and embalming, I was not aware of the potential "problems" if skin is damaged.

As far as Nurses or CNA doing post mortem care, it was covered and expected to be done if a pt died in my first semester of nursing school.

Up Vote Up Vote ×
Specializes in Hospice.

re: coroner's cases ... it depends on state regulations.

Hospice pts. die of all sorts of things, including crimes ... it should be noted in the pts chart whether the death is to be reviewed by the medical examiner. In my state, any death following a fall or other accident within 6 weeks has to be called into the medical examiner ... usually they just want to review the chart, if anything ... but we still have to call.

When I worked in Massachusetts, any death of an inmate in custody was a medical examiner case.

It should have been covered in your hospice orientation ... if it wasn't, check with your state authorities.

BTW, we always clean the body unless the medical examiner takes jurisdiction, including changing any soiled linens. It's simple respect for the dignity of the pt. and feelings of the family - especially if they're saying goodbye at the bedside.

A rolled towel to keep the mouth closed works well. A little discreetly applied surgilube can help keep the eyes closed if there's been a lot of peri-orbital wasting.

I have yet to successfully place dentures after death ... any tips?

Up Vote Up Vote ×

Heron, I haven't had any luck with dentures either. Pt's gums have usually atrophied so they don't fit any longer. I always make sure they go to the funeral home with the pt. My only tip is don't use denture adhesive! One of our educators tells the story during orientation of the time she tried to put the dentures in and they wouldn't stay in place so she had the bright (or not so bright) idea to use the adhesive. After she got the dentures glued in, the patient's mouth wouldn't close properly and she couldn't get the dentures out because of the adhesive. She even went as far as to call the manufacturer for help! She always has us rolling on the floor when she tells this story and I always smile in the home thinking about it!

Up Vote Up Vote ×
Specializes in ICU, SDU, OR, RR, Ortho, Hospice RN.
heron, i haven't had any luck with dentures either. pt's gums have usually atrophied so they don't fit any longer. i always make sure they go to the funeral home with the pt. my only tip is don't use denture adhesive! one of our educators tells the story during orientation of the time she tried to put the dentures in and they wouldn't stay in place so she had the bright (or not so bright) idea to use the adhesive. after she got the dentures glued in, the patient's mouth wouldn't close properly and she couldn't get the dentures out because of the adhesive. she even went as far as to call the manufacturer for help! she always has us rolling on the floor when she tells this story and i always smile in the home thinking about it!

hi starr i always send the dentures with the body.

the gums are usually the first thing to atrophy when the person is losing weight.

they quite often say their teeth don't fit like they used to.

it amazes me with a morbid sense of interest just what they do to the body once it gets to the funeral home. i never knew they wired the mouth shut!

what heron suggested re the roller towel works well but i never thought of surgilube for the eyes excellent suggestion.

that was a funny story and a lesson learnt i would think lol :chuckle

Up Vote Up Vote ×
Specializes in hospice.
I have never heard of a RN or CNA, or anyone doing postmotem care....except a Mortician. A dead human body has to be treated in a certain way. This is what Morticians learn in Mortuary College. Changing a person's clothes after death, washing the body, closing the eyes and mouth are a Mortician's job....not a Nurse!

If you pull too hard on an eyelid and break the skin it will leak for hours after the body is embalmed. A scratch to an arm after death will also leak after embalming. All sorts of dammage that can be done by a well meaning Nurse. Any dammage to the skin after death will be a problem after embalming. Running a brush through someone's hair will leave marks on the scalp....many problems will occur during and after embalming if the body was not cared for by someone who is trained to take care of the dead. Washing, drying, moving arms and legs, closing eyes and mouth are all things that will dammage the tissues.

The correct thing to do is to cover the body with a sheet and call the Funeral Home or the Coroner. You should never fuss with a Coroners Case because you'll destroy evidence.

Nurses care for the sick and dying......Morticians care for the dead!

morticians have wonderful ways of fixing things up when they need to, and MY patients are MY patients until I walk the funeral home out the front door. They dont become the morticians until they are driving MY patients body down the road. SO...I applaud all of you who take pride in caring for the patients 5 minutes after they pass away...the exact same way you would care for them 5 minutes PRIOR to them passing!!!!!!:yeah:

Up Vote Up Vote ×
Specializes in ER, CCU/ICU, Trauma, Hospice.

Hi all, I just did some checking with our mortuaries about some of the "issues" discussed in this thread. Bathing a pt is something I will always do regardless unless family requests to do themselves or for whatever reason they don't want the person touched afterwards (family wishes). I have had mixed reviews on catheters left in vs. removed. SOme mortuaries prefer to leave it in as not having creats a big mess according to them, others say can remove if we want and are indifferent. I guess it's best to check with your mortuaries on their preference for this sort of thing.

Up Vote Up Vote ×

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

Up Vote Up Vote ×

I work in an ICU and I see a lot of pt death on my time and I always clean the patient up because most of the time the family is there. The only isse I have is we dont always have the time to clean them because my facility has just instituted this policy where the family and deceased must be out of the room within an hours time to make the room available for a new admission. This truly concerns me because where is the whole aspect of care going? Even if a pt has deceased they are still a pt until they leave that room and I still feel responsible for helping the mourners that are left behind. Sometimes families cant mourne properly in just an hour.

Up Vote Up Vote ×
+ Add a Comment