Postmortem Care (Pediatric) - CE
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Immediately after death and before postmortem care activities, place the patient’s body in the supine position and elevate the head of the bed to decrease livor mortis.
Experiencing a pediatric patient’s death following a prolonged illness or a sudden trauma is emotionally and psychologically devastating for the family. Postmortem care that is handled with sensitivity and in a manner that is consistent with the family’s religious or cultural beliefs may help the family begin the grieving process. Assumptions that all individuals from the same ethnic group handle death in the same manner should be avoided. A health care team member should discuss with the family the desire to obtain mementos (e.g., lock of hair, handprint, photograph), who they would like present during postmortem care (e.g., family, friends, others), important postmortem rituals (e.g., bathing, dressing), and disposition of the body (e.g., funeral home, coroner, cremation center). The family’s unique needs must be considered when performing postmortem care.
After death, the body undergoes many physical changes, including loss of skin elasticity; algor mortis, which causes a drop in body temperature to room temperature; livor mortis, which causes a purple discoloration of the skin from blood pooling in dependent areas; and rigor mortis, which is the stiffening of the body. Postmortem care should be provided as soon as possible to prevent tissue damage or disfigurement. To prevent livor mortis of the face, the head of the bed should be elevated and a clean pillow placed under the head immediately after death before beginning other activities.
The 1986 Omnibus Budget Reconciliation Act (OBRA) requires that a patient’s survivors be made aware of the option of organ and tissue donation.undefined#ref1">1,2 In the case of a heart-beating organ donation (e.g., heart, lungs, liver, pancreas, kidneys), a patient must remain on the ventilator, and fluids and medications that maintain hemodynamic stability must be administered until the organs are surgically removed. The organ procurement process includes identifying potential organ donors, providing care for the donor’s body, and caring for the family throughout the donation process. In a nonheart-beating donation, tissues such as eyes, bone, and skin are retrieved from deceased patients either at the coroner’s office or mortuary. Because of the sensitive nature of making requests for organ donation, professionals from the organ procurement organization (OPO) may assume that responsibility. They inform family members of their options for donation, provide information about costs (there is no cost to the family), and inform them that donation does not delay funeral arrangements.
The donation request process involves notifying the OPO to determine whether a patient qualifies for organ donation. This conversation should be held in a private place with the custodial parent or legal guardian. Many donor families report that donating organs helped them in their grief and that they felt positive about the experience.
First-person consent does not require the family’s permission to procure certain organs, provided the patient documented the donation decision (e.g., donor card, driver’s license). This is only legal for pediatric patients who are mature minors or emancipated minors.1 The Donate Life Registry allows individuals to register for organ donation and is a supplement to existing state registries.2 An advance directive or living will may also be used to indicate donor status for the emancipated or mature minor. In these situations, the family may receive information about the recipient of the donated organ, if requested.
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. Individual state laws determine when autopsies are required, but they are usually performed in circumstances of unusual death, such as violent trauma, or unattended, unexpected death in the home. Some states have legislation that requires an autopsy if death occurs shortly after admission to a health care facility. If an autopsy is required, IV catheters and other indwelling tubes and lines should be capped and left in place. Autopsies normally do not delay burial or change the appearance of the deceased, but there may be a cost to families. The patient’s custodial parent or legal guardian and the practitioner or designated requester must sign a consent form. If appropriate, an explanation regarding the value that autopsies have for advancing medical knowledge may be necessary.
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Rationale: Removal of tubes and lines is contraindicated if an autopsy is planned.
Rationale: Positioning the mouth in a closed position may be less disturbing to family members.
Rationale: Some organizations require securing appendages to prevent tissue damage when the patient’s body is moved. Accumulation of fluid called hypostasis is a normal postmortem process caused by gravity.3 The condition is minimized if the affected body part is elevated.
Rationale: Paper tape minimizes skin damage when tape is removed. Rolled gauze can be wrapped around the limb, with no adhesive.
Rationale: Relaxation of the sphincter muscles at the time of death causes the release of urine and feces.
Rationale: Hard objects damage and discolor the face and scalp.
Rationale: The shroud protects against injury to the skin, avoids exposure of the body, and provides a barrier against potentially contaminated bodily fluids. Labeling ensures proper identification of the body. Marking a body reduces exposure of the morgue and mortuary staff to contamination.
Kukora, S. and others. (2019). Thematic analysis of interprofessional provider perceptions of pediatric death. Journal of Pediatric Nursing, 47, 92-99. doi:10.1016/j.pedn.2019.05.002
Medani, S., Brierley, J. (2021). End-of-life issues in the paediatric intensive care unit. Paediatrics and Child Health, 31(6), 245-249. doi:10.1016/j.paed.2021.03.004
*In these skills, a "classic" reference is a widely cited, standard work of established excellence that significantly affects current practice and may also represent the foundational research for practice.
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