1. NURS 1510 Nancy Pares, RN, MSN

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

3.  Physical disease  Injury  Mental illness  Loss  Impending death  Competing demands  The unknown  Imbalance  isolation

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

5.  Age  Family patterns  Culture  Nature of the illness  Hardiness  Intensity, duration, and complications of the disruption

6.  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.  Examine life’s uncertainties  Envision wellness for yourself and your client  Establish trust at your first client contact  Provide a healing presence.

8.  Prepare the room ◦ Neat, clean, well lit, temperature appropriate  All equipment in the room

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

10.  Medical record  Nursing record  Physical assessment  Clothing/personal item inventory  Items done at registration ◦ Financial agreement ◦ Release of information ◦ Advanced directives  Pg 273

12.  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.

13.  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

14.  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.  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.  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

18.  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.  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.  Obtain mortuary information  ID tag on toe and wrist  Shroud body and tag shroud  Follow facility policy for moving to morgue

21.  Sensitive, compassionate interpersonal skills are required  Nurses provide invaluable support  Bring other disciplines as needed ◦ Clergy ◦ Social services

22.  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.