time of death

Moved to the general nursing discussion forum

I just post time of death and that no apical pulse or respirations noted for 2 mins. A lot will depend if the facility has their own definition on how you write

if i wasn't present: pt found w/o respirations, pulses, and bp at ______am/pm.

skin warm/cool to touch. no rigor mortis present. md and pt's spouse/dtr/poa notified and aware.

if i am present: pt noted with cheyne-stokes respirations x 45 mins; non-reactive to writer's/family's voices; extremities purple and mottled. at 4:15 am, pt noted to have apnea x 60 secs, over 1/2 hr., when respirations completely ceased at 4:45am. no pulses, no bp, pupils fixed/non-reactive. md notified...etc.

leslie

First consult your facility policy. If no policy exists then consult your Board of Nursing, different states have different requirements for nurses to call th time of death.

My state wants the following to be assessed and charted; no respers, unable to auscultate or palpate pulse, hypothermia, livor mortis, no pupilary response, practitioner/family notified.

if i wasn't present: pt found w/o respirations, pulses, and bp at ______am/pm.

skin warm/cool to touch. no rigor mortis present. md and pt's spouse/dtr/poa notified and aware.

if i am present: pt noted with cheyne-stokes respirations x 45 mins; non-reactive to writer's/family's voices; extremities purple and mottled. at 4:15 am, pt noted to have apnea x 60 secs, over 1/2 hr., when respirations completely ceased at 4:45am. no pulses, no bp, pupils fixed/non-reactive. md notified...etc.

leslie

It always made me nervous when I was a new hospice RN pronouncing death (I worked in an inpt facility). Esp. when apnea lasted >1 min, then pt would start breathing again.

the first time I observed the 'funeral man' put a body on the stretcher and pulled the lap belt across, the "whoosh" sound coming out of the lungs was enough to almost make me pass out.

I'm better with it now. But it certainly isn't easy. And never will be.

It always made me nervous when I was a new hospice RN pronouncing death (I worked in an inpt facility). Esp. when apnea lasted >1 min, then pt would start breathing again.

the first time I observed the 'funeral man' put a body on the stretcher and pulled the lap belt across, the "whoosh" sound coming out of the lungs was enough to almost make me pass out.

I'm better with it now. But it certainly isn't easy. And never will be.

i so understand, di.

one time i pronounced a pt and told her dtr, who was present.

well, guess what?

pt wasn't dead.

the perceived death, was a loooooong period of apnea...

and when she started breathing again, i jumped through the ceiling.

i ran out and got the nm- the nm said "oh yeah, she's gone"...

and i whispered back, "don't be so sure".

but this time, she really was...as i still remained standing behind the nm, holding onto her shirt.

awakening from the dead, is an event no one ever gets used to.:uhoh21:

leslie

I know when my father in law passed, he had a pacemaker and although his breathing was Cheyene Stokes for a long time, and then he become agonal and was breathing 2-3 times per minute and then eventually he was breathing once per minute until he took his last breath, but the nurse couldn't call his time of death 1601 because his pacemaker was still firing and she needed a strip that showed no heart activity. She couldn't get the pacemaker to deactivate with the magnet and it took her until 1614 to finally get her strip needed to confirm death, even though she heard no breath sounds and there was no pulse. I helped with post mortem care on him, and being a new grad had never done this. He had a trach and the nurse and the respiratory therapist warned me about what may happen when they remove his trach, and sure enough, lots of secretions started coming out the hole. Glad they prepared me first... it's that kind of stuff they don't teach well nursing school... in fact we never had any discussion on postmortem care...

I am sad and sorry he is gone, but I am thankful to him that he gave me the opportunities to learn more to help my career, and I can only hope that he knows that, I tried to tell him many times that I was grateful he allowed me to be involved in his care.

According to our policy, we chart final v/s, temp/look of skin, pupil reaction, resps, pulses, notification of MD/family/AOD, and who pronounced pt.

Oh my gosh, I am so glad that I am not the only person who has said someone is dead when they are not! I had a patient not breath for over 3 minutes, no heartbeat, nothing. I went down to call the doc and the son ran down yelling, he is breathing again! Sure enough! Lived another hour or so. Family told me he was alway a practical joker and they saw this as his one last prank. They sat and chuckled about it up until the real time of death. Then they leaned close and asked him if he was sure this time, lol.