Admission, Dismissal and Transfers and Post mortem

CareNURS 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

Dimensions of Health and Ilness

Physical disease Injury Mental illness Loss Impending death

Competing demands

The unknown Imbalance isolation

What factors disrupt health?

Experiencing symptoms Sick role behavior Seeking professional care Dependence on others recovery

Five stages of illness behavior

Age Family patterns Culture Nature of the illness Hardiness Intensity, duration, and complications of the

disruption

Factors that influence illness behavior

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

Relating nursing process

Examine life’s uncertainties Envision 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 room◦ Neat, 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 safety Initiate

nurse/client relationship

Admission of client

Medical record Nursing record Physical

assessment Clothing/personal

item inventory

Items done at registration◦ Financial agreement◦ Release of

information◦ Advanced directives

Pg 273

Record/forms initiated

Think discharge at time of admission!!!

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.

Nursing responsibilities at 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

Nursing responsibilities at discharge

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.

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 essential

Postmortem care

Physiologic care

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

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 deceased Allow privacy and time for family Return deceased personal possessions to

family

Care of body

Obtain mortuary information ID 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 required

Nurses provide invaluable support Bring other disciplines as needed

◦ Clergy◦ Social services

Care of the Family

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

Therapeutic communication

It is normal for the nurse to feel grief when a client dies.

You must also take care of yourself.