Admission, Dismissal, Transfer, Post Mortem

By: Diana Blum MSNNURS 1950

Assessment

• Systematic and continuous collection of data• 4 types:– Initial> done with in __________ hours– Problem focused> ongoing– Emergency > A.B.C– Time lapsed> reassess after a period of time compare

to baseline• Should include client’s needs, health problems,

lifestyle, values, practices• Start at the head and work to the feet

DATA

• Subjective: what you are told• Objective: what you observe

• Sources: client, family, records, other healthcare workers

• Collection methods: observe, interview, examine

Organizing Data

• Conceptual model: Gordon, orem, roy, etc.• Wellness model• Body system model• Maslow’s hierarchy of needs

http://dinamehta.com/blog/wp-content/uploads/2007/10/800px-maslows_hierarchy_of_needssvg.png

Validating

• Def: double check to confirm actuality• Cues• Inferences

• At the end:

• DOCUMENT, DOCUMENT, DOCUMENT!

Concerns of the client

• being a burdon• Loss of control• Overall fear of the unknown

Ways to help adjust

• Spend time with client• Orient to room and surroundings• Be respectful• Develop a rapport with the client– Ask open ended vs close ended questions– Stay on top of pain control– Use layman terms– Be accomodating

• Offer support/services available

observations

• Use your senses– Sight– Smell– Auditory be attentive, speak slow – tactile

• When you first enter room– Look for signs of distress– Look for threats to safety– Who is present in the room– Be prepared

Responsibility and Assisting the doctor

• Know your scope of practice• DO NOT WORK OUT OF YOUR SCOPE• Be prepared

Positions for examination

semifowler trendelenberg

What to do with clients belongings

• Send home with family• Lock up in security• Closet• Lock up in med drawer

Transferring a Client

• Check order • Gather patients belongings• Call report to the receiving floor• Prepare the client and family for the transfer• Transfer to floor meds and dressing etc face to

face with the receiving nurse.

Discharging without a doctor order

• AMA

definitions

• LOSS is related to an actual or potential event occuring– Actual– Perceived– anticipatory

• DEATH is a fundamental loss – Inevitable– People search for reasons

Grief

• Total response to emotions related to loss• Mourning is the behavior• Types: anticipatory, disenfranchising,

unhealthy• Stages: Denial, Anger, Bargaining, Depression,

Acceptance• Influences: age,culture, spiritual beliefs,

gender, socioeconomic status, support system, cause of death

Management • Assess

– Look at history, coping, resources available, and do an assessment• Diagnosis

– Grieving, interrupted family process, loneliness, anticipatory grieving, ineffective coping

• Plan– Goal: remembrance without pain

• Assist planning of home care• Implement

– Clarify statement made, open ended questions, active listening, do not advice or analyze, do not offer false hope, or reassurance

– Facilitate grief work– Provide emotions support– Provide resources

• Evaluate– Did you meet your goals

• If not how would you modify to meet goals

Dying Process • Heart/Lung Death

– Cessation of pulse, lack of blood pressure, cessation of respirations– Lack of response to external stimuli– No muscle movements (breathing)– No reflexes– Flat encephalogram (no brain waves)

• On vent: no brain waves for 24 hours

• Brain Death– Cerebral cortex destroyed– Loss of brain stem function

• Unresponsive• Absent cephalic reflexes• Apnea• Isoelectric EEG for 30 minutes if no hypothermia present or poisoning by depressants

Cultural Practices

• Peaceful death at home• Not to reveal prognosis to client– Last days free of worry

• Family member told diagnosis so patient is told in stages or not at all

• Bad death vs Good death• Preparation of body, autopsy, donation,

cremation are based on religion• Rituals

• Closed awareness• Mutual pretense• Open awareness

• Implementation– Help clients die with dignity – Explain hospice vs palliative care – Provide spiritual support– Support the family during difficult time

Post mortem

• Stages of rigor– Rigor mortis:stiffening of the body that occurs 2-4

hours after death• Leaves in 96 hours

– Algor mortis: decrease in body temperature– Livor mortis: dependent discoloration of the skin

Post Mortem Care• Per hospital policy• Comply with religious law• Clean environment so family and friends may view• Make the body appear natural and comfortable. • Place dentures in mouth. • Change linens• Tube removal if allowed• Close eyelids• Wash the body if need , clean gown placed, comb hair• All jewlry removed except wedding band (tape to finger) and given to

family. Glasses are returned to family• Position the body