POSTMORTEM CARE

DEFINITIONS AND SIGNS OF DEATH

CLINICAL SIGNS OF DEATH      Cessation of apical pulse, respirations and blood pressure. Total lack of response to the external stimuli. No muscular movement, especially breathing. No reflexes. Flat encephalogram for 24 hours.

CEREBRAL DEATH  Occurs when the higher brain center, the cerebral cortex, is irreversibly destroyed.  It is believed that the cerebral cortex, which holds the capacity for thought, voluntary action and movement, is the individual. SOMATIC DEATH  Determined by the absence of cardiac and pulmonary functions. MOLECULAR DEATH  Determined by the cessation of cellular function. Indications of death adopted by the World Medical Assembly  Total lack of response to the external stimuli  No muscular movement  No reflexes  Flat EEG BODY CHANGES: 1. Rigor Mortis  Stiffening of the body that occurs about 2 to 4 hours after death due to lack of Adenosine Triphosphate (ATP), which is not synthesized because of lack of glycogen in the body.  Starts in the involuntary muscles (heart, bladder, etc.) then progresses to the head , neck trunk and finally reaches the extremities.  Leaves the body about 96 hours after death.

2. Algor Mortis  Gradual decrease of the body s temperature after death.  When the blood circulation terminates and the hypothalamus ceases to function, body temperature falls about 1 degree Celsius per hour until it reaches room temperature. 3. Livor Mortis  Bluish discoloration of the skin after death.  After blood circulation has ceased, skin becomes discolored.  The RBC breakdown, releasing hemoglobin, which discolours the surrounding tissues.

Embalming  Injection of chemicals in the body to destroy the bacteria.  Tissues after death become soft and eventually liquefied by bacterial fermentation.  The hotter the temperature, the more rapid the change, therefore, bodies are often stored in cool places to delay the process.

CARE OF THE BODY

1. Placed in supine position with arms at the side, palms down, or across the abdomen ( to make the body look as natural and comfortable as possible). 2. Place a small pillow or folded towel under the head to prevent discoloration from body pooling. 3. Gently hold eyelids close for a few seconds to make it remain close. 4. Insert client s dentures to maintain the normal facial features. 5. Place a rolled-up towel under the chin to keep mouth closed. 6. Wash any soiled body parts, dress the body in a clean gown, and cover the body up to the shoulders with clean linen. 7. Place absorbent pads under the perineal and rectal area to collect any oozing feces or urine. 8. Remove all jewelries and present it and any valuables to the family. 9. If the wedding band is left in place, tape it securely to the finger. 10. Allow family members to enter the room when body is prepared. Never allow a single family member to enter the room alone (for emotional support). 11. Special tags containing the deceased s name, hospital number, and the name of the attending physician are placed on the wrist and ankles and on the outside of the shroud. 12. In the morgue, body is placed in a special cooling unit to slow decomposition. Nurses have a duty to handle the deceased with dignity and to label the corpse appropriately. Mishandling- cause emotional distress to the survivors Mislabelling- can create legal problems if inappropriately identified.

DEATH CERTIFICATE  Formal determination of death, or pronouncement, must be performed by a physician, coroner, nurse  The granting of the authority to nurse to pronounce death is regulated by the state or province.  This may be limited to nurses in long-term care, home health, hospice agencies, advanced practice nurses.  The family is given a copy to use for legal matters.

LABELING OF THE DECEASED

 If inappropriately identified and prepared incorrectly can create legal problems.  Placed on the wrist, ankle, and on the shroud.  Contains name of deceased, hospital number, and name of attending physician.

AUTOPSY OR POSTMORTEM EXAMINATION

 An examination of the body after death and is performed only in certain cases:  When the death is sudden or occurs within 48 hours of admission to a hospital , the organs and tissues of the body are examined to establish the exact cause of death.  To learn more about the disease.  To assist the accumulation of statistical data.  Consent should be obtained by the physician from the decent (before death) or by the next of kin (surviving spouse, adult children, parents, siblings).  Hospitals cannot retain any tissues or organs without permission of the person who consented to the autopsy.