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Admission, Dismissal and Transfers and Post mortem Care

Admission, Dismissal and Transfers and Post mortem Care. NURS 1510 Nancy Pares, RN, MSN. Dimensions of Health and Ilness. Culture Religion and spirituality Environment Finances Work that is meaningful. Biologic—at risk Nutrition Physical activity Sleep and rest Lifestyle choices

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Admission, Dismissal and Transfers and Post mortem Care

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  1. Admission, Dismissal and Transfers and Post mortem Care NURS 1510 Nancy Pares, RN, MSN

  2. Dimensions of Health and Ilness • Culture • Religion and spirituality • Environment • Finances • Work that is meaningful • Biologic—at risk • Nutrition • Physical activity • Sleep and rest • Lifestyle choices • Family relationships

  3. What factors disrupt health? • Competing demands • The unknown • Imbalance • isolation • Physical disease • Injury • Mental illness • Loss • Impending death

  4. Five stages of illness behavior • Experiencing symptoms • Sick role behavior • Seeking professional care • Dependence on others • recovery

  5. Factors that influence illness behavior • Age • Family patterns • Culture • Nature of the illness • Hardiness • Intensity, duration, and complications of the disruption

  6. Relating nursing process • 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

  7. How can I honor each client’s unique experience? • Examine life’s uncertainties • Envision wellness for yourself and your client • Establish trust at your first client contact • Provide a healing presence.

  8. Preparing for admission • Prepare the room • Neat, clean, well lit, temperature appropriate • All equipment in the room

  9. Admission of client • Provide privacy • Provide for safety • Initiate nurse/client relationship • Greet by name • Orient to room • Explain hospital routine

  10. Record/forms initiated • Items done at registration • Financial agreement • Release of information • Advanced directives • Pg 273 • Medical record • Nursing record • Physical assessment • Clothing/personal item inventory

  11. Think discharge at time of admission!!!

  12. Nursing responsibilities at transfer • Provide complete report to new nurse • Record condition and means of transfer • Assure that other depts know about transfer. • Check for the order • Inform client and family • Notify receiving unit • Gather client belongings • Introduce client and family to new nurse

  13. Nursing responsibilities at discharge • 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 • Written order • If no order, AMA form • Notify ride home • Verify client understands d/c instructions • Check clothing/valuable list

  14. AMA (against medical advice) • 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.

  15. Postmortem Care • 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

  16. 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

  17. 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 Physiologic care

  18. Rigor mortis • 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

  19. Care of body • 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

  20. Care of body..cont • Obtain mortuary information • ID tag on toe and wrist • Shroud body and tag shroud • Follow facility policy for moving to morgue

  21. Care of the Family • Sensitive, compassionate interpersonal skills are required • Nurses provide invaluable support • Bring other disciplines as needed • Clergy • Social services

  22. Therapeutic communication • 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

  23. It is normal for the nurse to feel grief when a client dies. • You must also take care of yourself.

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