Post-Mortem Care

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Well..I had my first experience with a patient dying on my shift last week. I was expecting her death was going to be in the next day or so since she was on hospice, not eating/drinking, and had bloody stools when I changed her the night before. So I thought to myself, "watch..she is going to pass on me tonight, knowing my luck and especially since I'm new and scared about it." Sure enough, I got there and as soon as I started my rounds..I got to her room and she had just passed (she was still pretty warm). I'm gonna have to say, I'm pretty good at dealing with death...I didn't feel sad, I didn't cry, and I didn't panic. However, I had a hard time doing post-mortem care! She died with her mouth open and there was dried up blood all on her tongue that I had to clean off. I couldn't do it. Her gown was soaked with all of her left over perspiration and I had to change that. I couldn't do that by myself. I had to pretend she was still alive to even be next to her. I guess I had the "heeby-jeebys" more than anything and I was feeling pretty grossed out. I am looking for any advice on doing and dealing with post-mortem care! I would also love to hear any and all of your experiences so that I can know a little more about what exactly happens when they pass and how you felt about it. Thanks!

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This is what scares the daylights out of me. Two of my clients are DNR's.

((((hugs)))))

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Get a second person to help you if you can, for physical AND emotional support.

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You are doing just fine. Nobody handles this perfectly. Post mortem care is different, but it is still care for the person. It is not something the average person deals with every day, so don't expect yourself to handle it without some akwardness. Ask for help, and do your best. I think you are expecting too much out of yourself. If you need to do this again, it will be a little easier since you now know what to expect from yourself. Just dont obsess about it. Consider that you did the best you could for this person and move on. You are going to be fine. I can tell you are a careing person, otherwise this would not really matter to you.

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Specializes in geriatrics, dementia, ortho.

I'm wondering about this too; 2 of my reasidents passed recently, though each happened on one of my days off. They were the first people I've cared for during the death process, so I learned a lot from that about what to do & expect (inability to eat or drink, no void, weakness & tiredness, need for very frequent oral care to remove mouth crusties, and at the very end, discoloration of extremeties as the heart stops pumping very hard).

What I'm specifically concerned about is getting them presentable before rigor mortis sets in. A coworker told me to use towels to keep their head in position so it doesn't get stuck at an awkward angle. Does anyone have a general time frame for when rigor mortis starts? And how firm will the person become? Like a contracture, or stiff like a board & immovable?

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"The onset of rigor mortis may range from 10 minutes to several hours, depending on factors including temperature (rapid cooling of a body can inhibit rigor mortis, but it occurs upon thawing). Maximum stiffness is reached around 12-24 hours post mortem." But the average time for rigor to set in is 3 hrs or so

I have worked in long term care since the age of 16, I can honestly say that NEVER have I had a resident go into rigor prior to me (or staff) getting the post-mort care done. I CAN tell you, if possible get the dentures in their mouths ASAP, it is very difficult to get dentures in once rigor starts.

I have had residents start going into rigor prior to the funeral home taking the body (family wanting to say with the body for a while, awaiting the doc's pronouncement etc) but post-mort care was done prior to all of that.

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I think you reacted intelligently to the situation, given that it was your very first time in dealing with it. Being honest about your feelings is a good way to start learning to handle things you are going to deal with on your job. As some of the other people commenting have said, yes it will get easier the more that you do it. I suppose the first thing to remember is that death is totally normal and natural. It is just a process in the cycle of life. Our bodies are very intelligent and they go through a 'system check' as they prepare to shut down. Call me morbid, but I think it's more interesting than frightening or creepy.

I'm a new CNA and I've had the opportunity to give 'comfort care' to a few of the hospice residents in the long-term care facility where I work. I have yet to perform post-mortem care, however, even though there have been a couple of them pass during my shift and other CNA's on duty were assigned to that task. I don't think it will bother me too much, other than that first initial experience. I have considered working full time for a hospice facility at some point, as I've found that I actually enjoy providing a comforting peaceful environment for a dying person, and giving emotional support and reassurance to their families.

:heartbeat

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Specializes in Neonatal.

My FIRST experience w/ post-mortem care is forever emblazoned in my memory. There's no easy way to be introduced to it, I think you handled yourself just fine :) deceased patients usually are slack-jawed like that, you could use a rolled up towel and stick it under their chin to close their mouths but that doesn't always work. Also, its gotten to the point for me where I actually still talk to the deceased like they're still alive (i.e. "ok, we're going to turn towards me now"...). Like "see, if you're still in the room I'm being nice to your body" kinda thing... sorry, hospice humor!

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Actually....talking to the deceased is not silly or crazy, it's right-on. :lol2: The ability to hear is not lost in the last moments of life. All of us have a spirit (at least I believe that), and no one knows when that spirit is no longer present with the body. It is possible that the person can even hear (or see!) or is somehow aware of what is happening to their body. Speaking to that person is really a wonderful, compassionate thing to do. :redbeathe

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Specializes in CNA/ ALF & Hospital.

Post mortom care is to be done within a 20 min., period because post mortum sets in real quick (HEAVY AS A BOLDER STIFF). You Have To Have Someone help you. When I did my first one,I treated them as this was my very own grandparent because I just lost my grandmother about 6 mo. back. I was ion total control and it did not scare me one bit bcuz I was at peace with it knowing what I knew about my grandmother.

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for a bad case of the heeby-jeebies, 2 recommendations:

- talk to the pt/body/deceased. seriously ! it helps you remember that it's a person in front of you and not a Scary Dead Body OMG.

- if taking care of them makes you sad, just try to remember that death is as important a part of life as being born. you're with someone at a momentous time, and the opportunity to perform care helps show respect for a life that has been lived. kind of like the first rec, this is part of remembering that you're still taking care of a person.

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One thing I wish someone had told me before my person Post-Mortem care?

There will likely still be some air left in the lungs, so when you roll them, they very well may sigh as the air is pushed out.

Nearly peed my pants the first time this happened, omg.

Other than that, I agree with others here: It helps to talk to them. I pretend that I'm cleaning up any regular living person, and after you do it a few times, it's not that different than giving a bedbath to anyone else.

I once had a lady pass away, and her daughters wanted to stay in the room and help clean her up with me. (I know this is probably not allowed by the state or at least frowned upon, but I would probably want the same thing if it were my mother, and the charge nurse didn't care). We sang to her while we cleaned her up. It was someone I'd taken care of a lot and it was sad, but at the same time, it was a really peaceful and personal experience that I'm glad I had.

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