Post mortem care

[mc3]

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!!!! 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:

[mike7evans]

Hello Chasing,

I agree with RNMI on his/her response. The nurse should tell you as they should know a little more.... BUT, not to say this is always the case as you may be a regular there and the nurse is an agency or whatever. In that case, consult the nursing supervisor.

BUT, FYI, the rule of thumb "typically" is:

If going to the funeral home, etc... pull all lines.

If going for an inquest (a Medical Examiner's investigation to determine if a full autopsy is necessary) then leave it all in.

Back when embalming, I doubt I would've known what to do with a foley.

Well, I really said nothing more than RNMI. LOL

Michael

[skybaby RN]

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.

You have very succintly worded the reason for the research in which I am currently and passionately engaged. It so clearly expresses what seems to be a rather common phenomena. Your example is exactly why I am doing this. I am afraid that nursing schools are not teaching much along this line based on the textbooks. Hopefully one day this will change since deceased patients deserve correct care every moment the patient is in our care.

Thanks for expressing your thoughts so well.

[rnboysmom]

Amen,Amen,Amen in whatever religion you want to be a part of. Post mortem care is about RESPECT to the family, the deceased and our profession!!!!!!! After asking the family their preferences or customs, I proceed with PM care. The family is always allowed to participate at their discretion weather it be as simple as picking out the clothing, or as complex as the bathing process. Nobody better ever send me out on my last ride with dirty underwear, dirty teeth and with my behind flapping in the wind!!!! Even if you do believe the bull malarky about causing damage to delicate tissues, I would much rather have a mark on my loved one's scalp as opposed to my last rememberance of them being lying dirty and exposed in a bed. Dying is like birthing, only you are birthing your own soul into another world instead of birthing someones soul into this world. Birthing is a hard and dirty task--you are sweaty at the end--and need a shower before the relatives arrive. PM care isn't any different!

[skybaby RN]

Very interesting analogy about the birthing process. I do, however, think it is possible to both provide excellent post-mortem care while preventing damage to delicate tissues which is a real possibility if not done correctly.

[OneThunder, BSN, RN]

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!

That is an interesting perspective. Food for thought.

[OneThunder, BSN, RN]

Excuse me, but cleaning a body (partially or otherwise), removing a foley cath, combing the hair of the deceased, putting on a clean dry gown is not as much for the deceased patient as it is for the family who wish to spend some time with thier loved one. It is also, in my opinion, a show of respect.

Pulling eyelids? never done it, never left a mark on a scalp, and never ever have I torn skin. Some patients with fragile skin and skin tears all ready there, have tegesorb or some dressing over them.

When the patient is taken to the funeral home, they are cleansed again, embalmed, dressed and prepared for showing. Their eyes are taken care of by the director as well as their mouths. Any wounds are usually redressed with transparent dressings before embalming.

I can't imagine NOT giving after death care.

Yes, I agree. I had not heard of "leaving marks, tearing skin" and the like. I have done 100's of post mortem care and never experienced that, but I suppose it is possible.

[OneThunder, BSN, RN]

Most families know why their loved one passed and don't request an autopsy.

Sometimes it's not the family that requests an autopsy. Sometimes it's the law. A fall that precedes death is one example. Regardless of whether they are on hospice or not.

[skybaby RN]

Possible? Only if done incorrectly.

[OneThunder, BSN, RN]

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

just recently had a tour of our local funeral home and he explained the very same things you did. one thing he also said that if the dentures are lost, they do have a prosthesis that can be used to make the mouth look as though the teeth are in.

[mike7evans]

Just recently had a tour of our local funeral home and he explained the very same things you did. One thing he also said that if the dentures are lost, they do have a prosthesis that can be used to make the mouth look as though the teeth are in.

To OneThunder:

Yes, I didn't cover dentures. Sorry. There is a prosthesis that CAN be used. However, it is my experience, that IF the dentures are not sent and the prosthesis or cotton is used by the embalmer....then typically, the day of visitation, the family will come in to view and ask, "here are his/her dentures, can you put them in?"

Well, the answer is: "we can put them IN THE CASKET." The full truth is, we DO put them at the foot of the casket. However, we cannot place them in the mouth. Embalming has already taken place. Formalin has firmed protein in the cells. The mouth cannot be taken apart unless one is willing to mess up what is already done and take a chance on a really bad looking deceased. (The setting of the mouth is a focal point of the survivors)

Now.... I have read the past few posts whereas several have talked about "pulling on the eye lids" and such. The procedure I described to be performed in post mortem nursing care doesn't invovled "pulling on the eye lids." It is a simple, "dry the eyes of moisture with a 4X4 or similar. Apply a small amount of vaseline to the bottom lid, and simply running the fingers over the top lids to bring them down to touch the bottom lids. The tackiness/sticky-ness of the vaseline will hold them together. Just asking for an attempt to get the lids closed before rigor sets in. This shouldn't invovle any "tugging" whatsoever. Plus the lids are delicate and will easily swell when a pressure is put on the system during embalming.

Here is an exception to this request: Occasionally, nurses get a dying case that just won't die. Their body actually dies before their system dies. Finally, after they are pronounced, rigor is already happening or has happened and continuing.

Therefore, IF there is resistance to the upper lids coming down, then just leave them alone as the embalmer will have to use the eye cap procedure anyway.

So, the way I described, actually may take 15 seconds of a nurses time in bringing the upper lids down.

Hope this helps.

Another thing you are correct on... messing up the hands can cause leakage after embalming. YES, correct. I saw a former post that said something to the effect of, "bullmalarky about delicate tissues... would rather have a mark on the head..." blah blah. Basically, it said to me, "I am such a hard headed nurse and I am not going to take suggestions." Nothing I can do with that.

Here is the full blown answer since my former simple answer got poo pooed on. WHEN tissue is damaged, even though it looks minor....then when decomposition sets it (which is nearly immediately and progressive), it is FURTHER damaged by the decomposition probably exponentially. Therefore, a simple skin tear on the hands/arms, turns into destroying the integumentary layer in that area. This allows fluid to escape out once a pressure of formalin is applied upon the system. We usually embalm at/about 3-4 pounds of pressure which I have calculated (years ago) to equal about 180mm/Hg...enough that in the living to cause a nose bleed to some. (I may need to recalculate as I have forgotten exactly).

(Embalming machines are not precise instruments)

Therefore, a simple bruise or maybe not even a bruise but just some very minor tissue damage turns into swelling once a pressure is placed on the system.

With all that said...don't get spooked and scared to give a little Post Mortem care. I have maximized it somewhat so that my point is made. So this is the entire reason I originally said, "simple post mortem care should be done such as clean the present feces, apply a diaper, close the lids with a little vaseline." And yes... as you have pointed out... locate the dentures and secure them with the deceased in whatever fashion.

Thanks.

Michael

[deecee474]

When attending to a death I always ask the family what they would have me do for post-mortem care. Some cultures do no allow you to bathe or clothe the patient. If they will allow a bath and dressing of patient in some ways it is a spiritual connection in preparation of body to leave the home. In my experience about 1/2 of the families will allow some part of care after death, the other half will not allow it.

[mike7evans]

When attending to a death I always ask the family what they would have me do for post-mortem care. Some cultures do no allow you to bathe or clothe the patient. If they will allow a bath and dressing of patient in some ways it is a spiritual connection in preparation of body to leave the home. In my experience about 1/2 of the families will allow some part of care after death, the other half will not allow it.

To DeeCee,

What culture do you have this 50% experience in?

Thanks

Michael