POST-MORTEM CARE

-is the care provided to a patient - Most immediately

immediately after death understandable stage
“I just don’t know how my wife gets along
DEATH AND DYING after I’m gone”
DYING PROCESS- is often accompanied 5. ACCEPTANCE
by a myriad of psychological, spiritual, and -comes to terms with loss
physical needs, and nurses are in the ideal - May have deceased interest in
position to identify and address them surroundings and support persons
- May wish to begin making plans
KUBLER-ROSS STAGES OF DYING - Patient is recognizing reality
1. DENIAL
- Is not ready to deal with practical BODY SYSTEMS INDICATORS OF
problems IMMINENT DEATH
- May assume artificial
cheerfulness COGNITION/ORIENTATION
“This can’t be true” “I’ll be just fine after - May be agitated/ restless
surgery” - Cannot subjectively respond to
2. ANGER verbal stimuli
- Client and family have feelings CARDIOVASCULAR
of resentment, envy or anger - Tachycardia, irregular heart rate
directed at client, family, health - Low blood pressure or significant
care providers, God and others widening between systolic and
“Why me?” diastolic pressures
3. BARGAINING - Dehydration
- Seeks to bargain to avoid loss PULMONARY
- Client (or family) asks for more - Tachypnea, dyspnea
time to reach an important life - Acetone breath
event and may make promises to - Cheyne-stokes breathing
God and others - Pooling of secretions, or noisy
- Client is now cooperative respirations
because they want to bargain an GASTROINTESTINAL
extension for their life, they - Diminished appetite
begin to take medications with - Smaller amount of feces
full cooperation. - Incontinence
“I just want to see my daughter’s graduation, RENAL
then I’ll be ready” - Diminished urine output
4. DEPRESSION - Incontinence
- Grieves over what has happened - Concentrated urine
and what cannot be MOBILITY
- Limited mobility
 - Bedfound
DEATH WHAT IT IS..
TRADITIONAL VIEW: “heart-lung death”
Cessation of the apical pulse, respiration,
and blood pressure (blood pressure is now
palpable)
WORLD MEDICAL ASSEMBLY
- Total lack of response to external
stimuli
- No muscular movement
- No reflexes
- Flat encephalogram
CEREBRAL DEATH/HIGHER BRAIN
DEATH
CLINICAL SYNDROME:
- Absence of responsiveness
- Absence of cephalic reflexes
- Apnea
- Isoelectric encephalogram
DEVELOPMENT OF THE CONCEPT OF
DEATH
INFANCY (5 YEARS OLD)
- Does not understand concept of
death
- Infant’s sense of separation form
basis for later
- Believed is irreversible, a
temporary departure or sleep
- Emphasize immobility and
inactivity as attributes of death
5-9 YEARS OLD
- Understands that death is final
- Believes own death can be
avoided
- Associates death with
aggression/violence
9-12 YEARS OLD
- Understand death as the
inevitable end of life
- Begins to understand own
mortality, expressed an interest
in afterlife or as fear of death
- Expresses idea about death
gathered from parent or older
adults
12-18 YEARS OLD
- Fears a lingering death
- May fantasize tat death can be
defined, acting out defiance
through reckless behaviors
- Seldom thinks about death, but
views it in religious and
philosophic terms
- May seem to reach adult
perception o death but
emotionally unable to accept it
18-45 YEAR OLD
- Has attitude towards death
influenced by religious beliefs
45-65 YEARS OLD
- Accept own mortality
- Encounters death of parents or
peers
- Experiences peak of death
anxiety
- Death anxiety diminished with
emotional wellbeing
65 YEARS AND ABOVE
- Fear prolonged illness
- Encounters death of family and
peers
- Sees death as having multiple
meanings
PHYSIOLOGIC CHANGES
RIGOR MORTIS (stiff)
- Stiffening of the body occurs
about 2-4 hours after death
- Starts in involuntary muscles
- Lack of ATP causing muscle to
contract leading to
immobilization of muscles
ALGOR MORTIS (cold)
- Gradual decrease of temperature
after death
- Due to termination of blood flow
to the hypothalamus
 - Drop of 1 celsius per hour
- Skin looses elasticity
LIVOR MORTIS (bluish)
- Discoloration of tissues
- Appears in the lowermost,
dependent areas of the body
- Blood sits down in tissue & settle
at the bottom part of body
- Pulling of blood
- Begins at 2 hours of death and
becomes permanent at 8 hours

NOTE:

 Address psychological, physical and

spiritual needs of the patient
 2 identification card
- 1 on the right ankle
- Top of mortuary sheet
 Cleanse only soiled areas (Eg:
secretions)
 Change the patient’s clothes into
mortuary gown
 If there are valuables, endorse it
properly to the family
 Position the patient properly
- Close mouth
- Close eyes
- Insert CB in openings/entries
 Address the questions of the family
- Death certificate
- Hospital bills