Admission Dismissal and Transfers and Post mortem Care NURS 1510 Nancy Pares RN MSN Biologicat risk Nutrition Physical activity Sleep and rest Lifestyle choices Family relationships Culture Religion and spirituality ID: 771829
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Admission, Dismissal and Transfers and Post mortem Care NURS 1510 Nancy Pares, RN, MSN
Biologic—at risk Nutrition Physical activitySleep and restLifestyle choicesFamily relationships CultureReligion and spiritualityEnvironmentFinancesWork that is meaningful Dimensions of Health and Ilness
Physical disease Injury Mental illnessLossImpending death Competing demandsThe unknownImbalanceisolation What factors disrupt health?
Experiencing symptomsSick role behavior Seeking professional care Dependence on othersrecovery Five stages of illness behavior
AgeFamily patterns Culture Nature of the illnessHardinessIntensity, duration, and complications of the disruption Factors that influence illness behavior
Diagnosis (NANDA)Planning outcomes Envision acceptable outcomes, set goals Planning interventionsEnvision strengths and potential in clients when they are too overwhelmed to identify on their own Relating nursing process
Examine life’s uncertaintiesEnvision wellness for yourself and your client Establish trust at your first client contact Provide a healing presence. How can I honor each client’s unique experience?
Prepare the roomNeat, clean, well lit, temperature appropriate All equipment in the room Preparing for admission
Greet by name Orient to room Explain hospital routine Provide privacy Provide for safetyInitiate nurse/client relationshipAdmission of client
Medical record Nursing record Physical assessmentClothing/personal item inventory Items done at registrationFinancial agreementRelease of informationAdvanced directivesPg 273 Record/forms initiated
Think discharge at time of admission!!!
Check for the order Inform client and family Notify receiving unitGather client belongingsIntroduce client and family to new nurse Provide complete report to new nurseRecord condition and means of transferAssure that other depts know about transfer. Nursing responsibilities at transfer
Written order If no order, AMA form Notify ride homeVerify client understands d/c instructions Check clothing/valuable listTransfer 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 Nursing responsibilities at discharge
Client leaving without MD orderClient 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. AMA (against medical advice)
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 Postmortem Care
Organizations are required to have specific policies related to referral for organ donation When family consents, nurse notifies donor team Time is essentialPostmortem care
Physiologic care Algor mortis When circulation stops Temp decreases to room temp (1.8 degrees/hr)Skin is fragile—caution removal of tapeLiver mortisOccurs 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 voluntaryDisappears in 96 hours Nursing interventionsClose eyelidsInsert dentures Close mouthPosition body in natural postion Rigor mortis
Bath body ( Vol 2, technique 15.3 and 15.4.pg 168-170) Place supine covered with clean sheet Allow family to touch deceasedAllow privacy and time for familyReturn deceased personal possessions to family Care of body
Obtain mortuary informationID tag on toe and wrist Shroud body and tag shroud Follow facility policy for moving to morgue Care of body..cont
Sensitive, compassionate interpersonal skills are requiredNurses provide invaluable support Bring other disciplines as needed ClergySocial services Care of the Family
Perfect your listening skillsEncourage and accept expression of feelings Reassure that it is not wrong to feel anger, relief, or other ‘unacceptable’ feelings Increase your self awareness Therapeutic communication
It is normal for the nurse to feel grief when a client dies. You must also take care of yourself.