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Admission, Dismissal and Transfers and Post mortem
CareNURS 1510
Nancy Pares, RN, MSN
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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
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Physical disease Injury Mental illness Loss Impending death
Competing demands
The unknown Imbalance isolation
What factors disrupt health?
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Experiencing symptoms Sick role behavior Seeking professional care Dependence on others recovery
Five stages of illness behavior
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Age Family patterns Culture Nature of the illness Hardiness Intensity, duration, and complications of the
disruption
Factors that influence illness behavior
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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
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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?
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Prepare the room◦ Neat, clean, well lit, temperature appropriate
All equipment in the room
Preparing for admission
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Greet by name Orient to room Explain hospital
routine
Provide privacy Provide for safety Initiate
nurse/client relationship
Admission of client
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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
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Think discharge at time of admission!!!
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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
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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
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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)
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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
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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
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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
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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
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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
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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
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Sensitive, compassionate interpersonal skills are required
Nurses provide invaluable support Bring other disciplines as needed
◦ Clergy◦ Social services
Care of the Family
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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
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It is normal for the nurse to feel grief when a client dies.
You must also take care of yourself.