Post Mortem Care
the mouth.
- Care given to patients body after death
Purpose:
To clean the patients body and prepare it for
removal from the hospital after death.
Preparing the patient for viewing by family
Ensuring proper identification of the patient prior to
transportation to the morgue or funeral home
Providing appropriate disposition of patients
belongings
Maintaining vital organs, if donation is planned
Key terms:
Algor mortis - Reduction of body temperature with
loss of skin elasticity.
Livor mortis - Discoloration of skin in dependent
areas. Begins 30 minutes after death.
Rigor mortis - Stiffening of the body, developing
within two to four hours of death.
Embalmation-involves the injection of chemicals
directly into the body through blood vessels for the
purposes of sanitation, preservation and
presentation.
Autopsy - also called a post-mortem examination, is a
detailed and careful medical examination of a
person's body and its organs after death to help
establish the cause of death. The word autopsy is
derived from a Greek word autopsia meaning
'seeing for oneself'
Pathologist - A physician who specializes in the study
of human diseases, performs the autopsy.
Morgue ( mortuary )-building for the storage of
human corpses awaiting identification or removal for
autopsy or disposal by burial , cremation etc.
Materials Needed
Gloves
ABD pads
Cotton balls
Adhesive bandages (to cover wounds or punctures)
Mortuary shroud bag
Responsibilities of the nurse
Care of the body
Post mortem care of the body is not rendered unless
the physician has pronounced the patient to be dead.
Indicate the chart time the patient was pronounced
dead and the physician pronouncing
Have the body cleaned and properly identified
If the patient is communicable the water used in
cleaning must be medicated
Inform medico legal Officer if accident, suicide,
homicide, or illegal therapeutic practices causes
death.
Prevent all means of distortion, discoloration, or
scarring of the body as it is distressful to the family.
Preparation for Viewing
Place the body in a supine position with arms on the
sides and head on a pillow. The head of the bed
should be slightly elevated.
Insert the patients dentures, if worn, and then close
The nurse should gently close the patients eyes; if
the eyes will not remain closed, moistened cotton
balls can be placed on the eyelids for several
minutes.
Place a folded towel under the chin to keep the
mouth closed. All catheters, tubes, and tape should
be removed, but adhesive bandages should be applied
to puncture sites.
At the time of death, offer comfort to the patients
survivors.
All patients belongings should be gathered for the
family to take. If a ring cannot be removed, cover the
ring with gauze, tape it securely, and tie the gauze to
the wrist to prevent loss.
Before the family views the patient, clean the body
with soap, water, and washcloths. To absorb any
rectal drainage, place one or more ABD pads between
the patients buttocks. Cover the body up to the chin
with a clean sheet, with arms placed outside of the
sheet if possible.
Fill out three identification tags with the deceased
name, room, and bed number; date and time of
death; and the physicians name. Tie one tag to the
big toe, hand, or foot, the other one on the shrouded
body, and the third, on the patients personal
belongings.
Care of the valuables
Valuable with the patient at the time of death should
be identified, accounted for and sent to the proper
department of the institution for safe keeping until
family claims for it.
Valuables taken or given to the patients family
should be voted on the form sheet specified by the
institution.
Accomplishment of necessary papers related to
death. Death certificate is sent to the local health
Department. It is accomplished by the physician and
signed by him and by pathologist if autopsy has been
performed.
Provide all means to comfort the family and relatives
who may be around.
Precautions
If organ donation is anticipated, respiratory and
circulatory support must be maintained until vital
organs can be harvested. It must be clearly
communicated to the family that the devices used to
maintain organ perfusion no longer keep the patient
alive, but are merely supporting the organs in
anticipation of transplant.
Vital Organs Requiring Support :
- Heart - Liver
- Lungs - Kidneys
- Pancreas
Other organs that does not require support after death:
- Cornea - Skin
- Long bones - Middle ear bones

INSULIN
A hormone produced on the pancreas by the islets of
Langerhans that regulates amount of glucose in the
blood.
The lack of insulin causes a form of diabetes
TYPES OF INSULIN FOR PEOPLE WITH DIABETES
- Rapid-acting: Usually taken before a meal to cover the
blood glucose elevation from eating. This type of insulin
is used with longer-acting insulin. (15 mins before
mealtime)
- Short-acting: Usually taken about 30 minutes before a
meal to cover the blood glucose elevation from
eating. This type of insulin is also called regular or
neutral insulin
- Intermediate-acting: Covers the blood
glucose elevations when rapid-acting insulins stop
working. This type of insulin is often combined with
rapid- or short-acting insulin and is usually taken twice a
day.(1 hour prior to a meal )
- Long-acting: This type of insulin is typically injected
once a day.
- One possible side effect is hypoglycemia
INSULIN ADMINISTRATION
To give an insulin injection, fill the right syringe with the
right amount of medicine, decide where to give the
injection, and know how to give the injection.
The type of insulin should match the type of syringe: U-
100, U-30,U-50 or U-500 available with 27-29 gauge
needle
Unopened vials of insulin should be stored in a
refrigerator.
Opened vials should be kept at room temperature and
should be discarded after 28 days.
Insulin should be given at room temperature. If you had it
in the refrigerator or cooler bag, take it out 30 minutes
before the injection.
Dont massage after injection
Rotate sites of injection
If client is allowed (NPO) for diagnostic tests , insulin
may be withheld depending on the time of the test and
the clients blood glucose level
Inspect before each use for changes (eg. Clumping
,frosting ,precipitation ,change in clarity or color ) that
may signify loss in potency
Before administering insulin , review serum glucose level,
blood glucose monitoring . Results may indicate need for
dosage adjustment
When a dose of insulin is being injected watch for signs of
hypo or hyperglycemia (weakness , shakiness , headache
, visual disturbance )
All individuals requiring insulin should carry at least 15g
CHO to be eaten or taken in liquid form :
- Half cup juice
- 1 cup skim milk
- 3 glucose tablets
- 4 sugar cubes
- 5-6 pcs. of hard candy
Administer mixed insulin (eg. Regular & NPH ) within 5
minutes of preparation . Regular insulin binds with NPH
which reduces the action of regular insulin
Regular insulin is the only insulin that may be
administered IV
Insulin dosage is individualized , balanced by medical
nutrition therapy & exercise
FILLING THE SYRINGE - ONE TYPE OF INSULIN
Wash your hands with soap and water.
Check the insulin bottle label. Make sure it is the right
insulin.
The insulin should not have any clumps on the sides of
the bottle. If it does, throw it out and get another bottle.
Intermediate-acting insulin is cloudy, and must be rolled
between your hands to mix it. DO NOT shake the bottle.
This can make the insulin clump.
Clear insulin does not need to be mixed.
If the insulin vial has a plastic cover, take it off. Wipe the
top of the bottle with an alcohol wipe. Let it dry.
Know the dose of insulin you want. Take the cap off the
needle, being careful not to touch the needle to keep it
sterile. Pull back the plunger of the syringe to put as
much air in the syringe as the dose of medicine you want.
Put the needle into and through the rubber top of the
insulin bottle. Push the plunger so the air goes into the
bottle.
Keep the needle in the bottle and turn the bottle upside
down.
With the tip of the needle in the liquid, pull back on the
plunger to get the right dose of insulin into the syringe.
Check the syringe for air bubbles. If there are bubbles,
hold both the bottle and syringe in one hand, and tap the
syringe with your other hand. The bubbles will float to
the top. Push the bubbles back into the insulin bottle,
then pull back to get the right dose.
When there are no bubbles, take the syringe out of the
bottle.
FILLING THE SYRINGE - TWO TYPES OF INSULIN
Never mix two types of insulin in one syringe unless you
are told to do this. You will also be told which insulin to
draw up first. Always do it in that order.
When mixing insulin be sure to inject sufficient air into
both vials before drawing up the dose
When mixing rapid or short-acting insulin with
intermediate or long acting insulin, the clear rapid or
short-acting insulin should be drawn into the syringe first
Clear insulin does not need to be mixed
Know the dose of each insulin you want. Take the cap off
the needle, being careful not to touch the needle to keep
it sterile. Pull back the plunger of the syringe to put as
 much air in the syringe as the dose of the longer-acting
insulin.
Put the needle into the rubber top of that insulin bottle.
Push the plunger so the air goes into the bottle. Remove
the needle from the bottle.
Put the air in the short-acting insulin bottle the same way
as the previous two steps above.Keep the needle in the
short-acting bottle and turn the bottle upside down.
With the tip of the needle in the liquid, pull back on the
plunger to get the right dose of insulin into the syringe.
Check the syringe for air bubbles. If there are bubbles,
hold both the bottle and syringe in one hand, and tap the
syringe with your other hand. The bubbles will float to
the top. Push the bubbles back into the insulin bottle,
then pull back to get the right dose.
Push the needle all the way into the skin. Let go ofthe
pinched skin. Inject the insulin slowly and steadily until it
is all in.
Leave the syringe in place for 5 seconds after injecting.
Pull the needle out at the same angle it went in. If insulin
tends to leak from your injection site, press the injection
site for a few seconds after the injection.Insulin
pen
IINSULIN PEN
ADVANTAGES of insulin pens:
Easy to use and carry
Looks like a pen for writing (discreet/not easily noticed)
No need to draw the insulin dose from a vial/bottle

When there are no bubbles, take the syringe out of the
bottle. Look at it again to make sure you have the right
dose.
Put the needle into the rubber top of the longer-acting
insulin bottle.
Turn the bottle upside down. With the tip of the needle
in the liquid, slowly pull back on the plunger to exactly
the right dose of long-acting insulin. DO NOT draw extra
insulin in the syringe, since you should not push the
mixed insulin back into the bottle.
Can be used for most insulin types
Doses can be easily dialed
Less waste of expired insulin if not much insulin is used
within time period designated (300 units in each pen)
To some people it may be less scary than a syringe
Before you give the shot, you will need the following:
Insulin pen
Alcohol swab, or cotton ball moistened with alcohol

Check the syringe for air bubbles. If there are bubbles,

hold both the bottle and syringe in one hand, and tap the
syringe with your other hand. The bubbles will float to
the top. Remove the needle from the bottle before you
push out
Pen needle (be sure your doctor writes your prescription
for the pen needles as well as the specific type of insulin
pen)
Hard plastic or metal container with a screw-on or
tightly-secured lid

GIVING THE INJECTION

PARTS OF AN
Choose where to give the injection. Keep a chart of INSULIN PEN
places you have used, so you do not put the insulin in the
same place all the time. Ask your doctor for a chart.
How to use:
Keep your shots 1 inch away from scars and 2 inches away
from your navel.
DO NOT put a shot in a spot that is bruised, swollen, or Wash your
tender. hands.
The site you choose for the injection should be clean and Check the drug
dry. DO NOT use an alcohol wipe on your injection site. label to be sure
it is what your
The insulin needs to go into the fat layer under the skin. doctor
Pinch the skin and put the needle in at a 45 angle.
If your tissues are thick enough, you may be able to
inject straight up and down (90 angle).
prescribed.
 Check the expiration date on the pen. Do not use a drug
that is past the expiration date. Also do not use if beyond
number of days listed in table at end of this document
once opened and in use.
Remove pen cap.
Look at the insulin.
Short or rapid-acting insulin (Regular, Humalog, NovoLog,
and Apidra) and Lantus or Levemir should appear clear.
Do not use it if the drug appears to have pieces in it or is
discolored.
Intermediate or mixed insulin (NPH, 75/25, 70/30, or
50/50) will appear cloudy and white. This type of insulin
should be gently mixed before use. To do this, roll the
pen between your hands. You must also turn the pen up
and down ten times as shown in picture (Fig. 2).
Look at the insulin to be sure it is evenly mixed (cloudy
white) with no clumping of particles.
Wipe the tip of the pen where the needle will attach with
an alcohol swab or a cotton ball moistened with alcohol.
Remove the protective pull tab form the needle and
screw it onto the pen until snug (but not too tight).
Remove both the plastic outer cap and inner needle cap.
Look at the dose window and turn the dosage knob to 2
units.
Holding the pen with the needle pointing upwards, press
the button until at least a drop of insulin appears. This is
the air shot or safety shot. Repeat this step if needed
until a drop
appears
(see figure
at right).
Dial the
number
of units
you need to
take.
To hold the pen, wrap your fingers around the pen with
your thumb free to reach the dosing knob.
With the other hand, gently pinch up the skin around
where you will give the shot and hold firmly (pinching is
most important when you are injecting in an area that
does not have a lot of fat).No need to pinch if giving into
a fatty area like the abdomen or if you are using a short
needle
Insert the needle at a 45 to 90 degree angle (longer
needles may require 45 degree angle, where shorter
needles may be given straight at a 90 degree angle).
While keeping needle under skin, press the button all the
way returning to zero, and keep pressing for six to ten
seconds (larger doses may require the whole ten
seconds). Withdraw from the skin.
If you bleed when the needle comes out, place an alcohol
swab over the skin right away. Press gently on the swab
until bleeding has stopped. Do not rub the skin.
Carefully replace outer needle cap over needle and
unscrew until loosened. Never leave needle on pen when
not in use.
Throw away the needle in a hard plastic or metal
container. Close the lid tightly.

Decide where on your body you will give the shot. Be sure
to give the shot in a different place each time. You can

stay in the same general area. Try to stay at least 1 inch

from the last shot, any scars, and your belly button. Keep
a diary to remember where your last shot was given (see
image at right).