Post Mortem Care 2

NCM 102R-18
Fundamentals of Nursing Practice
Post Mortem Care

Learning Outcomes
After completion of this module, the student will be able to:

1. Identify the purposes of the procedure.
2. Recall the signs of impending death.
3. Justify the Nursing Diagnosis applicable to dying patient.
4. Discuss the steps and the rationale.
5. Explain significant psycho-spiritual & cultural nursing considerations in the
care of dead patient.
6. Demonstrate appropriate documentation and reporting of dead/ expired
patient.
NCM 102 Fundamentals of Nursing

Second Semester, AY 2021-22
@ Dr. Lambert F. Valera, Jr.
Historical Notes
❑ Death and the changes that follow have
been ingrained in society since the
dawn of history. Ancient Egyptians took
extraordinary measures to slow
decomposition, with some good
results.
❑ Later societies recognized the need to
sequester the dead from the living to
contain the spread of disease.
❑ In modern times, bereaved families
must choose between cremation and
embalmment for their dearly departed.
❑ Death is a part of life, and
decomposition is a part of death.

Introduction
❑ Care of the body after death (post-
mortem care) is an essential
component of the total care of the
patient and surviving family members
and friends.
❑ Postmortem care should be provided
as soon as possible to prevent tissue
damage or disfigurement.
❑ Specific policies and procedures for
post mortem care are a matter of
agency policy, local customs, and
cultural and religious ritual.

Post Mortem Changes
❑ After death, a sequence of changes
naturally occurs in the human body.
Although these changes proceed in
a relatively orderly fashion, a variety
of external factors and intrinsic
characteristics may accelerate or
retard decomposition.

Post Mortem Changes
❑ Putrefaction involves the action of
bacteria on the tissues of the body.
This process, prevalent in moist
climates, is associated with green
discoloration of the body; gas
production with associated bloating;
skin slippage; and a foul odor.

Post Mortem Changes
❑ Autolysis is the breakdown of the
body by endogenous substances. It
proceeds most rapidly in organs
such as the pancreas and stomach.
It may predominate in more arid
conditions and can eventually result
in mummification.

Post Mortem Changes
❑ In most circumstances, autolysis
and putrefaction occur in tandem
(decomposition).
❑ In temperate climatic conditions,
they can result in rapid degradation
of the tissues. These alterations
may eventually produce great
distortion of the body after death.

Post Mortem Changes
1. Rigor mortis: The stiffening of the
body that occurs about 2 to 4 hours
after death. Rigor mortis starts in the
involuntary muscles (heart, bladder,
and so on), then progresses to the
head, neck, and trunk, and finally
reaches the extremities. Rigor mortis
usually leaves the body about 96
hours after death.

Post Mortem Changes
2. Algor Mortis: The gradual decrease
of the body’s temperature after death.
When blood circulation terminates and
the hypothalamus ceases to function,
body temperature falls about 1°C
(1.8°F) per hour until it reaches room
temperature. Simultaneously, the skin
loses its elasticity and can easily be
broken when removing dressings and
adhesive tape.
Cooling takes place only if the ambient
temperature is cooler than the body
temperature at the time of death.

Post Mortem Changes
3. Livor Mortis: A discoloration after
blood circulation has ceased, the red
blood cells break down, releasing
hemoglobin, which discolors the
surrounding tissues.
Purple-red coloration appears on
dependent portions of the body other
than areas exposed to pressure after
the heart ceases to beat. It results
from the settling of the blood under
the force of gravity

Other Post Mortem Changes
Tardieu spots are petechiae and purpuric hemorrhages that Tache noire is the dark, red-brown stripe that develops
develop in areas of dependency secondary to the rupture of horizontally across the eyes when the eyelids are not closed
degenerating vessels under the influence of increased pressure after death. It is a drying artifact that may mimic trauma
from gravity

Clinical Death
Clinical death is the cessation of blood
flow and/or respiratory arrest. It
implies loss of consciousness which is
reversible

Biological Death
Biological Death is the irreversible
destruction of brain tissue ischemia

Clinical Signs of Biological Death
• cessation of the apical pulse,
respirations, and blood pressure,
• Total lack of response to
external stimuli / unreactive pupil
• No muscular movement,
especially breathing
• No reflexes (dilatedpupils)
• Flat encephalogram (brain
waves) / Flat ECG rhythm

Death Pronouncement
Hospital Setting:
As soon as possible, the death must
be officially pronounced by someone
in authority like a doctor in a hospital
or nursing facility or a hospice nurse.
This physician also fills out the forms
certifying the cause, time, and place of
death.

Death Pronouncement
Home Setting:
Get a doctor that lives nearby (or call
for one from a hospital nearby) to
come and confirm the death. It would
be a good idea to find this doctor
beforehand and inform them that you
have a dying relative at home.

Legal Considerations
1. Organ Donation Act of 1991 or RA ▪ Person Who May Execute a
7170 - AN ACT AUTHORIZING Donation. –
THE LEGACY OR DONATION OF
ALL OR PART OF A HUMAN (1) Spouse;
BODY AFTER DEATH FOR (2) Son or daughter of legal age;
SPECIFIED PURPOSES
(3) Either parent;
▪ Person Who May Execute A Legacy.
– Any individual, at least eighteen (4) Brother or sister of legal age; or
(18) years of age and of sound (5) Guardian over the person of the
mind, may give by way of legacy, to
take effect after his death, all or part decedent at the time of his death.
of his body for any purpose.

▪ Transplantable organs or parts of
the body:
• Cornea/ eyes • intestine
• Heart • tissue
• Liver • body fluids (including sperm
cell)
• lungs
• arteries
• kidney
• blood

2. An autopsy, the surgical dissection
of a body after death, helps determine
the exact cause and circumstances of
death, discover the pathway of a
disease, or provide data for research
purposes.
▪ An autopsy is not performed in
every death.
▪ The patient’s legal representative
and the practitioner or designated
requester must sign a consent form.

Death-related Religious & Cultural Practices
💧In some cultures, people prefer a peaceful death at home rather than in
the hospital.
💧Members of certain ethnic groups may request that health professionals

not reveal the prognosis to dying clients.
💧Beliefs about preparation of the body, autopsy, organ donation, cremation,

and prolonging life are closely allied to the person’s religion:

💧Autopsy, for example, may be prohibited, opposed, or discouraged by Eastern
Orthodox religions, Muslims, Jehovah’s Witnesses, and Orthodox Jews. Some
groups, such as Hindus, may oppose autopsy based on not wanting non-Hindus to
touch the body (Carpenter et al., 2011).
💧Some religions prohibit the removal of body parts or dictate that all body parts be
given appropriate burial.
💧Organ donation is prohibited by Jehovah’s Witnesses and Muslims, whereas
Buddhists in America consider it an act of mercy and encourage it. (Ashkenazi &
Klein, 2012).
💧Cremation is discouraged, opposed, or prohibited by the Church of Christ (INC),
Baha’i, Mormon, Eastern Orthodox & Islam. Hindus, in contrast, prefer cremation
and cast the ashes in a holy river.

💧Autopsy, for example, may be prohibited, opposed, or discouraged by Eastern
Orthodox religions, Muslims, Jehovah’s Witnesses, and Orthodox Jews. Some
groups, such as Hindus, may oppose autopsy based on not wanting non-Hindus to
touch the body (Carpenter et al., 2011).
💧Some religions prohibit the removal of body parts or dictate that all body parts be
given appropriate burial.
💧Organ donation is prohibited by Jehovah’s Witnesses and Muslims, whereas
Buddhists in America consider it an act of mercy and encourage it. (Ashkenazi &
Klein, 2012).
💧Cremation is discouraged, opposed, or prohibited by the Church of Christ (INC),
Baha’i, Mormon, Eastern Orthodox & Islam. Hindus, in contrast, prefer cremation
and cast the ashes in a holy river.

💧Nurses also need to be knowledgeable about the client’s death related
rituals, such as last rites like chanting at the bedside, and other practices,
such as special procedures for washing (should be members of the family of
same sex), dressing, positioning, shrouding, and attending the dead.
💧Nurses need to ask family members about their preference and verify who
will carry out these activities. The nurse must ensure that any ritual items
present in the health care agency are returned to the family or to the funeral
home.

The Dying Patient’s Bill of Rights (Barbus, 1975)
• I have the right not to die alone.
• I have the right to be free from pain.
• I have the right to have my questions answered honestly.
• I have the right not to be deceived. I have the right to have help from
and for my family in accepting my death.
• I have the right to die in peace and with dignity.

• I have the right to be treated as a living human being until I die.
• I have the right to maintain a sense of hopefulness however changing
its focus may be.
• I have the right to express my feelings and emotions about my
approaching death in my own way.
• I have the right to participate in decisions concerning my care.
• I have the right to expect continuing medical and nursing attention
even

• I have the right to retain my individuality and not be judged for my
decisions which may be contrary to the beliefs of others.
• I have the right to be cared for by caring, sensitive, knowledgeable
people who will attempt to understand my needs and will be able to gain
some satisfaction in helping me face my death.

General Assessment: State of Awareness
• In closed awareness, the client is
not made aware of impending death. The
family may choose this because they do
not completely understand why the client
is ill or they believe the client will recover.
The primary care provider may believe it is
best not to communicate a diagnosis or
prognosis to the client. Nursing personnel
may experience an ethical problem in this
situation.

• In mutual pre-tense, the client,
family, and health care personnel know that
the prognosis is terminal but do not talk
about it and make an effort not to raise the
subject. Sometimes the client refrains from
discussing death to protect the family from
distress.

• In open awareness, the client and
others know about the impending death
and feel comfortable discussing it, even
though it is difficult. This awareness
provides the client an opportunity to
finalize affairs and even participate in
planning funeral arrangements.

Nursing Diagnoses
• Grieving include denial, guilt, anger, despair, feelings of
worthlessness, crying, and inability to concentrate. They may extend to
thoughts of suicide, delusions, and hallucinations.
• Fear, the feeling of disruption related to an identifiable source (in this

case someone’s death), may also be present.
• Hopelessness occurs when the person perceives no solutions to a

problem—when the death becomes inevitable and the person cannot see
how to move beyond the death.

Nursing Diagnoses
• Powerlessness. This loss of control may be manifested by anger,
violence, acting out, or depression and passive behavior.
• Interrupted Family Processes. In this situation, the family may be

unable to meet the physical, emotional, or spiritual needs of the members
and may have difficulty communicating and problem solving.

Nursing Considerations
• Verify that the patient has been pronounced dead by the physician
• Document exact date and time
• The nurse first needs to recognize the states of awareness
manifested by the client and family members.
• Review Dying Patients’ Bill of Rights
• Identify cadaver and collect his/her belongings for labeling
• Recheck patients religious and cultural background
• Assess for the need for autopsy or organ donation

Materials/ Articles
1. Articles for bath ( wash cloth, basin, dry cloth, wipes)
2. Cotton swabs and cotton for plugging
3. Body sheets
4. Restraints materials for jaw , hands and legs
5. Clean gloves
6. Thumb forceps
7. Clean gown
8. Identification tags
9. Cadaver bag

Clinical Alert!
Don appropriate PPE based on
indications for isolation precautions.
Turning a recently deceased body to the

side sometimes causes the flow of
exhaled air. This is a normal event and
not a sign of life.

Preparation
Provide privacy for the patient’s body, if
possible. If the patient has a roommate,
explain the situation to the roommate
and move him or her to a temporary
location.

Procedure
PROCEDURE RATIONALE
1. States the purpose of the procedure. The relatives have the right to be
informed about any procedure to
be done to their patient for better
understanding and cooperation.
2. Identifies client using two identifiers. To prevent mistakes and ensures
the right patient receive the right
procedure.

Procedure
3. Performs hand hygiene. To prevent transfer of infection
4. Introduces self to the client’s family. To establish rapport and gain

cooperation
5. Explains the procedure to the client's To reduce fear and anxiety of
family and asks them to temporarily leave family members and ensure
the room if possible. efficiency of post mortem care

Procedure
6. Gathers and assembles equipment. To provide ease in the execution

of the procedure
7. Dons clean gloves. To prevent cross
infection/contamination
8. Maintains the proper alignment of the To ensure efficiency & ease of
body of the client. post mortem care

Procedure
9. Places a pillow under the head of the
client.
Rationale: To stabilize body position and

prevents livor mortis of the face.

Procedure
10. Closes the client's eyes, place hand
on his /her abdomen.
Rationale: To ensure proper face & body

position before rigor mortis sets in.

Procedure
11. Places the client's prosthetics if
there is any (dentures, artificial eye, etc.)
Rationale: To re-establish normal mouth

shape & contour.

Procedure
12. Removes any objects causing
pressure or injury to the skin.
Rationale: To preserve dead patient’s

skin integrity.

Procedure
13. Removes all contraptions attached to
patient following hospital protocol.
Rationale: To ensure efficiency & ease of

post mortem care.
If the body will be autopsied or sent to the medical examiner:

a. Leave all of the tubes in the client’s body intact according to facility policy.
b. Ensure that the original chart and consent forms remain with the client.
c. Ensure that client identifications and all documentation remain with the client. This prevents misidentification
of the body in the morgue or medical examiner’s office.

Procedure
14. Applies dressing if necessary.
Rationale: To stop small bleeding and

prevent other fluid secretions from
draining

Procedure
15. Cleanses the body taking into
consideration the cultural orientation of
the family. (head to toe).
Rationale: To preserve body integrity of

the dead patient.

Procedure
16. Places protective incontinent
pad/diaper.
Rationale: To catch blood and other fluid

secretions.

Procedure
17. Dresses the client with a clean
gown.
18. Covers the client with clean linen.
Rationale: To preserve body integrity of

the dead patient

Procedure
19. Disposes the soiled materials used To prevent spread of infection

according to hospital protocol. and cross contamination
20. Provides ample time for the family to To demonstrate respect and
be with the client. courtesy to the grieving process
of patient’s relatives

Procedure
21. Labels the body according to the
hospital protocol (attaches ID tags to
one foot/ankle/ big toe, wrist and
shroud).
Rationale: For correct identification of

patient’s body

Procedure
22. Places body in the shroud or in the
cadaver bag.
Rationale: For correct identification of

patient’s body

Procedure
23. Labels all personal belongings of the
client following hospital protocol.
Rationale: To provide security and easy

identification of patient’s belongings.
Place jewelry or other valuables in a secure bag. If the
family prefers that the client’s wedding ring remain on the
finger, tape it gently in place (Matzo & Hill, 2015). (Note: Some
facilities require placing valuables in a safe until they can be
signed out by the family.)

Procedure
24. Disposes material used gloves observing To prevent spread of infection and
hospital protocol. cross contamination
25. Performs hand hygiene.

26. Document the procedure. Documentation provides on-going
data collection and coordination of
care

Sample Post Mortem Documentation
05/11/2022 9:30 AM- Called to room by client’s daughter, Helen Garcia, stating
her mother Auring Garcia is not breathing. Found unresponsive in bed at 8:45
AM, no respirations, no pulse, no heart or breath sounds auscultated. No code
called per advance directive and signed DNR order in chart. Death pronounced
by Dr. Carl Balita at 9:10 AM. NG tube, indwelling urinary catheter, and I.V.
access device in left forearm removed and dressing applied. Post-mortem care
performed and dentures placed in mouth. Belongings checked off on belongings
list and signed by Ms. Helen Garcia, who will take them home with her. Body sent
to morgue at 9:27 AM . L. Valera, RN

Hospice VS Palliative Care
❑ While the objective of both hospice and
palliative care is pain and symptom
relief, the prognosis and goals of care
tend to be different.
❑ Hospice is comfort care without curative
intent; the patient no longer has curative
options or has chosen not to pursue
treatment because the side effects
outweigh the benefits while palliative
care is comfort care with or without
curative intent.

References
A. J. Barbus, (1975) “The Dying Person’s Bill of Rights”, created at the workshop
The Terminally Ill Patient and the Helping Person, Lansing, MI: South
Western Michigan
Barbus, A. J. (1975). The dying person’s bill of rights. Created at the Terminally Ill
Patient and the Helping Person Workshop, Lansing, MI, South Western
Michigan In-service Education Council.
Bickley, L. S., & Bates, B. (2017). Bates’ Nursing Guide to Physical Examination
and history taking. Pp. 290 – 297 Philadelphia: Wolters Kluwer Health /Lippincott Williams &
Wilkins
Brown, H., Johnston, B., & Östlund, U. (2011). Identifying care actions to
conserve dignity in end-of-life care. British Journal of Community Nursing,
15, 238–245.
California Healthcare Foundation. (2012). Final chapter: Californians’ attitudes
and experiences with death and dying. Retrieved from:
http://www.chcf.org/publications/2012/02/ final-chapter-death-dying
Kozier & Erb’s (2016) Fundamentals of Nursing : Concepts, Process, and
Practice. Pp. 717-723 Upper Saddle River, N.J.:Pearson Prentice Hall.


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NCM 102R-18

Fundamentals of Nursing Practice

Post Mortem Care

After completion of this module, the student will be able to:

NCM 102 Fundamentals of Nursing

NCM 102 Fundamentals of Nursing

NCM 102 Fundamentals of Nursing

NCM 102 Fundamentals of Nursing

NCM 102 Fundamentals of Nursing

NCM 102 Fundamentals of Nursing

NCM 102 Fundamentals of Nursing

NCM 102 Fundamentals of Nursing

NCM 102 Fundamentals of Nursing

NCM 102 Fundamentals of Nursing

NCM 102 Fundamentals of Nursing

NCM 102 Fundamentals of Nursing

NCM 102 Fundamentals of Nursing

NCM 102 Fundamentals of Nursing

NCM 102 Fundamentals of Nursing

NCM 102 Fundamentals of Nursing

NCM 102 Fundamentals of Nursing

NCM 102 Fundamentals of Nursing

NCM 102 Fundamentals of Nursing

💧Members of certain ethnic groups may request that health professionals

💧Beliefs about preparation of the body, autopsy, organ donation, cremation,

NCM 102 Fundamentals of Nursing

NCM 102 Fundamentals of Nursing

NCM 102 Fundamentals of Nursing

NCM 102 Fundamentals of Nursing

NCM 102 Fundamentals of Nursing

NCM 102 Fundamentals of Nursing

NCM 102 Fundamentals of Nursing

NCM 102 Fundamentals of Nursing

NCM 102 Fundamentals of Nursing

NCM 102 Fundamentals of Nursing

• Fear, the feeling of disruption related to an identifiable source (in this

• Hopelessness occurs when the person perceives no solutions to a

NCM 102 Fundamentals of Nursing

• Interrupted Family Processes. In this situation, the family may be

NCM 102 Fundamentals of Nursing

NCM 102 Fundamentals of Nursing

NCM 102 Fundamentals of Nursing

Turning a recently deceased body to the

NCM 102 Fundamentals of Nursing

NCM 102 Fundamentals of Nursing

NCM 102 Fundamentals of Nursing

4. Introduces self to the client’s family. To establish rapport and gain

NCM 102 Fundamentals of Nursing

6. Gathers and assembles equipment. To provide ease in the execution

NCM 102 Fundamentals of Nursing

Rationale: To stabilize body position and

NCM 102 Fundamentals of Nursing

Rationale: To ensure proper face & body

NCM 102 Fundamentals of Nursing

Rationale: To re-establish normal mouth

NCM 102 Fundamentals of Nursing

Rationale: To preserve dead patient’s

NCM 102 Fundamentals of Nursing

Rationale: To ensure efficiency & ease of

If the body will be autopsied or sent to the medical examiner:

NCM 102 Fundamentals of Nursing

Rationale: To stop small bleeding and

NCM 102 Fundamentals of Nursing