NURS 1510 Nancy Pares, RN, MSN Biologic—at risk Nutrition Physical activity Sleep and rest Lifestyle choices Family relationships Culture Religion and spirituality Environment Finances Work that is meaningful Physical disease Injury Mental illness Loss Impending death Competing demands The unknown Imbalance isolation Experiencing symptoms Sick role behavior Seeking professional care Dependence on others recovery Age Family patterns Culture Nature of the illness Hardiness Intensity, duration, and complications of the disruption Diagnosis (NANDA) Planning outcomes ◦ Envision acceptable outcomes, set goals Planning interventions ◦ Envision strengths and potential in clients when they are too overwhelmed to identify on their own Examine life’s uncertainties Envision wellness for yourself and your client Establish trust at your first client contact Provide a healing presence. Prepare the room ◦ Neat, clean, well lit, temperature appropriate All equipment in the room Greet by name Orient to room Explain hospital routine Provide privacy Provide for safety Initiate nurse/client relationship Medical record Nursing record Physical assessment Clothing/personal item inventory Items done at registration ◦ Financial agreement ◦ Release of information ◦ Advanced directives Pg 273 Check for the order Inform client and family Notify receiving unit Gather client belongings Introduce client and family to new nurse Provide complete report to new nurse Record condition and means of transfer Assure that other depts know about transfer. Written order If no order, AMA form Notify ride home Verify client understands d/c instructions Check clothing/valuable list Transfer client per w/chair to vehicle Chart entire procedure.. ◦ ‘discharged per w/c to home in stable condition. Nurse and wife in attendance’ Arrange for cleaning of room Client leaving without MD order Client must sign form acknowledging understanding and will not hold institution, MD, personnel responsible Unless held by court order or police hold, CANNOT be physically detained. Legal pronouncement of death ◦ Usually by MD—some states allow RN May need autopsy ◦ Family must give consent unless death is unusual, unexpected or violent—then body goes to coroner Organizations are required to have specific policies related to referral for organ donation ◦ When family consents, nurse notifies donor team ◦ Time is essential Algor mortis ◦ When circulation stops ◦ Temp decreases to room temp (1.8 degrees/hr) ◦ Skin is fragile—caution removal of tape Liver mortis ◦ Occurs with algor mortis ◦ Discoloration due to RBC breakdown ◦ Mostly in dependent body parts ◦ Raise head slightly to prevent pooling Occurs 2-4 hours after death Body stiffens ◦ Involuntary muscles----then voluntary ◦ Disappears in 96 hours Nursing interventions ◦ ◦ ◦ ◦ Close eyelids Insert dentures Close mouth Position body in natural postion Bath body ◦ ( Vol 2, technique 15.3 and 15.4.pg 168-170) ◦ Place supine covered with clean sheet Allow family to touch deceased Allow privacy and time for family Return deceased personal possessions to family Obtain mortuary information ID tag on toe and wrist Shroud body and tag shroud Follow facility policy for moving to morgue Sensitive, compassionate interpersonal skills are required Nurses provide invaluable support Bring other disciplines as needed ◦ Clergy ◦ Social services Perfect your listening skills Encourage and accept expression of feelings Reassure that it is not wrong to feel anger, relief, or other ‘unacceptable’ feelings Increase your self awareness It is normal for the nurse to feel grief when a client dies. You must also take care of yourself.