N109: Foundations in Nursing Practice

N109: Foundations in Nursing Practice Study Guide Following death, the nurse must be aware of whether or not an autopsy will be performed. This post- mortem exam may be required by law in certain circumstances, such as an unexpected death. During an autopsy, a medical examiner examines the body to establish the cause of death or to learn about the disease process that ended the individual’s life. In most cases following death, the nurse should position the body in as natural a position as possible with the head of the bed slightly elevated. If possible, the individual’s dentures should be inserted if they have been removed. Although the body can usually be cleaned and a fresh gown put on, all tubes should be left in place until the medical examiner or physician determines that an autopsy will not be conducted. The nurse should allow the family to see the body if they want to see it, and should respect their wishes as to whether they want to be alone or accompanied by the nurse. In all cases, the nurse should remain nearby in case a family member needs assistance. Any jewelry that has been removed should be documented and returned to the family. Most facilities have specific policies regarding the return of patient belongings. The nurse must be aware of these policies. After death, the body goes through several physical changes. Within two to four hours rigor mortis, or rigidness of the body, develops. The joints become immobilized and the body becomes difficult to position. After blood circulation stops, body temperature begins to drop (algor mortis) until it reaches room temperature. As hemoglobin is released, livor mortis develops. This discoloration of tissues appears in the lowest parts of the body and is the reason the nurse should slightly elevate the head of the bed. 4.8 The Nursing Process Assessment The nurse must be aware of where on the dying trajectory the patient might be. The nurse must also assess how the patient is coping, and must determine if there are coping mechanisms that have been used in the past that may be helpful now. It may also be helpful to know the state of awareness of the patient and his family. • Closed awareness is when the staff and perhaps the family are aware of the patient’s condition but the patient may not be. • Suspected awareness is when the patient suspects, but is uncertain, that the illness is fatal. • Mutual pretense is when everyone knows the terminal nature of the disease but no one talks about it. • Open awareness is when all parties know that death is imminent and are comfortable talking about it. When a patient is dying, the nurse must be aware of the physical condition of the patient, particularly for signs that the end of life may be near. These signs of impending death may include: • Loss of muscle tone as evidenced by sagging jaw or problems swallowing • Slowing of circulation with cooling and cyanosis of the hands and feet • Weakening pulse and decreased blood pressure • Respiratory changes, including slow, shallow, or irregular respirations • Impaired senses, especially blurred vision When a patient is dying, questions that should be asked of the patient and family members during the

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