advance directives

1. ADVANCE
DIRECTIVES

2. ADVANCE DIRECTIVES
What kind of medical care the patient want if he were too
ill or hurt.
Advance directives are legal documents that allow him to
spell out his decision about end-of-life care ahead of time.

3. • An advance directive tells the health care team what kind of care the
patient would like to have if he is unable to make medical decisions (e.g., if
in coma)
• A good advance directive describes the kind of treatment the patient would
want depending on the sickness
• An Advance Directive allows you to make a refusal of treatment in advance
of a time when you can’t communicate your wishes, or don’t have the
capacity to make a decision. It only comes into effect if either of these
situations occur.

4.  You can use an Advance Directive to refuse any treatment,
including life-sustaining treatment such as resuscitation,
artificial nutrition and hydration, or breathing machines.
 If you change your mind you can change your Advance Directive
to reflect this. If you have mental capacity and can
communicate your wishes then your Advance Directive will not apply.
 An Advance Directive enables healthcare professionals to know whatyour
wishes are even if you cannot tell them yourself, e.g. if you had severe
dementia or were in a coma.

5. An Advance Health Care Directive (AHCD) is a generic term for a document
that instructs others about your medical care should be unable to make
decisions on your own. It only becomes effective under the circumstances
delineated in the document, and allows you to do either or both of the
following:
Appoint a health care agent. The AHCD allows you to appoint a health care
agent (also known as “Durable Power of Attorney for Health Care,” “Health
Care Proxy,” or “attorney-in-fact”), who will have the legal authority to make
health care decisions for you if you are no longer able to speak for yourself.
This is typically a spouse, but can be another family member, close friend, or
anyone else you feel will see that your wishes and expectations are met. The
individual named will have authority to make decisions regarding artificial
nutrition and hydration and any other measures that prolong life—or not.

6.  Prepare instructions for health care. The AHCD allows you to make specific
written instructions for your future health care in the event of any situation in which
you can no longer speak for yourself. Otherwise known as a “Living Will,” it
outlines your wishes about life-sustaining medical treatment if you are terminally ill
or permanently unconscious, for example.
 The Advance Health Care Directive provides a clear statement of wishes about
your choice to prolong your life or to withhold or withdraw treatment. You can also
choose to request relief from pain even if doing so hastens death. A standard
advance directive form provides room to state additional wishes and directions and
allows you to leave instructions about organ donations.

7. • While most people would prefer to die in their own homes, the norm is
still for terminally-ill patients to die in the hospital, often receiving
ineffective treatments that they may not really want. Their friends and
family members can become embroiled in bitter arguments about the
best way to care for the patient and consequently miss sharing the
final stage of life with their loved one. Also, the opinions and wishes
of the dying person are often lost in all the chaos.

8.  It’s almost impossible to know what a dying person’s wishes truly
are unless the issues have been discussed ahead of time. Planning
ahead with an Advance Health Care Directive can give your
principal caregiver, family members, and other loved ones peace of
mind when it comes to making decisions about your future health
care.

9.  Euthanasia literally means “good death”. It is basically
to bring about the death of a terminally ill patient or a
disabled. Generally, the word euthanasia is defined as
the act or practice of painlessly putting to death or
withdrawing treatment from a person suffering an
incurable disease.

10.  Euthanasia is an unethical act as much as it is a great sin for those
who strongly believe in God. Euthanasia is intentionally killing
another person to relieve his or her suffering. It is not the
withdrawal or withholding of treatment that results in death, or
necessary pain and symptom- relief treatment that might shorten
life, if that is the only effective treatment. It is the intentional killing
by act or omission of a dependent human being for his or her
alleged benefits.

11. Euthanasia can be classified in different
ways, including:
• Active euthanasia (action)– where a person
deliberately intervenes to end someone’s life – for
example, by injecting them with a large dose of
sedatives
• Passive euthanasia (omission) – where a person causes
death by withholding or withdrawing treatment that is
necessary to maintain life, such as withholding
antibiotics from someone with pneumonia

12.  Voluntary euthanasia – where a person makes a conscious decision
to die and asks for help to do this
 Non-voluntary euthanasia – where a person is unable to give their
consent (for example, because they are in a coma or are severely brain
damaged) and another person takes the decision on their behalf, often
because the ill person previously expressed a wish for their life to be
ended in such circumstances
 Involuntary euthanasia – where a person is killed against their
expressed wishes

13. • A will is a document by which a person regulates the
rights of others over his property or family after
death.
• A statement by a person who is conscious and knows
that death is imminent concerning what he or she
believes to be the cause or circumstances of death
that can be introduced into evidence during a trial in
certain cases
• A person who makes a dying declaration must,
however, be competent at the time he or she makes a
statement, otherwise, it is inadmissible.

14. ORGANDONATION
 A person 18 years or older and of sound mind can donate all or any part of
their own body for the following purposes:
 For medical or dental education
 Research
 Advancement of medical or dental science
 Therapy
 Transplantation
 The request for organ donation should be done by patent in the presence of
a physician or a nurse
 Organs removed from the body following the death cannot be sold.
 All organ donation are voluntary and there should not be any compulsion for
the patient / family members
 Organs usually donated :- kidney, heart, lungs, liver, bone,
cornea
 Organ donation should take place with in 2-6hrs after the death.
14

15.  Organ transplantation is truly one of the miracles of
modern medicine, saving the lives of many patients and
improving the quality of life for many more.
 Given the ever-increasing gap between the number of
organs needed and the supply, nurses have an ethical
obligation to help ensure that the desires of people who
want to donate organs are respected.
 Nurses have to ensure that the consent process is
informed and voluntary.

16.  Information to the patient should consist of a balanced discussion of
the available options and counselling to help patients or their
families reach the choice that is best for them, including the
provision of information about the urgent need for organs and the
consolation that many families derive from knowing that their loved
one was able to help others.

17. Inform the nurse in charge and inform the medical
staff of the patient’s death
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
Confirmation of death must be recorded in
the patient’s healthcare record
An unexpected death must be confirmed by
the attending medical officer and if confirmed the
service manager should be contacted or duty manager
out of hours. Incident form to be completed

18.  Inform the patient’s relatives/next of kin of
the patient’s death. Ensure that this is
handled in a sensitive and appropriate
manner with as much privacy as possible.
 Ask if the relatives wish to see the chaplain
or an appropriate religious leader or other
appropriate person to the person’s faith or
ethnic origins that need to be attended to
immediately

19.  If relatives are in the hospital ask if they wish to
assist with the last offices and/or if they have any
particular wishes regarding the procedure
 If the relatives are not in the hospital ask if they
wish to view the body on the ward or at a later
date
• Assemble required equipment
• Wash hands and put on disposable gloves and apron

20.  Any injuries sustained while carrying out the
procedures on the deceased must be reported through
the Trust risk system and follow the Trust Sharps
and Inoculation Management Procedure


Lay the patient on their back with one pillow in place
(adhere to the Moving and Handling Policy)
Straighten the patient’s limbs (if possible) and
place their arms by their sides
 Gently close the patient’s eyes if open by applying
light pressure for 30 seconds. If corneal or eye
donation to take place, close the eye with gauze
moistened with normal saline

21. Do not apply tape

 If syringe driver in situ, disconnect and remove battery
in cases where there is no referral to the coroner
required infusions can be discontinued and infusion
lines, cannulae, drainage and other tubes can be
removed, if referred to the coroner endo-tracheal tubes,
catheters and infusion lines should remain in situ.
Discard all sharps into a sharps bin.

22.  Place a receiver between the patient’s legs and drain
the bladder by pressing on the lower abdomen. Pads
and pants can be used to absorb any leakage
 Exuding wounds should be covered with
absorbent gauze and secured with an occlusive dressing
occlusive dressing
 Wash the patient if necessary, unless requested not to
do so for religious/cultural reasons or patient has died
in suspicious circumstances

23.  It may be important to the family and carers to assist
with washing, thereby continuing the care given to the
patient in the period before death
 Clean the patient’s teeth and gums using a
moistened, soft small headed nylon toothbrush and or
suction to remove any debris and secretions Clean any
dentures and replace them in the mouth – a small
pillow or rolled up towel placed under the patient’s
chin may help to keep the jaw closed and teeth in situ

24. Tidy the hair as soon as possible after death and
arrange into the preferred style (if known)
 Patients should not be shaved; usually a funeral
director will do this. Some faiths prohibit shaving.
Any jewellery removed must be documented on a
property form and placed in the hospital safe until
collected by the family. Any jewellery remaining on the
body should be documented on the identification card
accompanying the patient to the mortuary or
undertakers



25.  Record all property in the patient property book and
pack in a labelled property bag, keeping secure until
collected by the family. Pack personal property
showing consideration for the feelings of those
receiving it. Discuss the issues of soiled clothes
sensitively with the family and ask whether they wish
them to be disposed of or returned.



Unless a specific request has been made by the family
for alternative clothes the patient should be dressed in
a hospital gown
If relatives are present at the time of death, or attend
the hospital shortly after, staff should ensure that they
are given the Trust Bereavement information copies of
which are available on the ward.
Relatives should be told to contact the relevant Trust
officer who supports bereavement or the patient’s GP to
collect the death certificate

26.  Label one wrist and one ankle with an identification
band containing the following information: Full
name NHS Number Date of Birth
 Complete patient identification cards and

notification of death book clearly in capitals If the
patient has an implant device such as a pacemaker
or an infectious disease is known or suspected –
record this fact on both patient
identification cards

27.  Tape one identification card to clothing or hospital
gown. Wrap the body in a sheet, ensuring that face to
feet are covered and that all limbs are held securely in
position
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If the body may be infectious or there is a risk of
leakage of body fluids place the body in a body bag
and put the second identification card into the pocket
of the body bag
If the deceased person has a known infectious disease
Category 3 & 4 they must be placed in a heavy duty
body bag and you must inform anyone else who comes
in contact with this patient e.g. funeral directors,
porters.

28.  Remove gloves and aprons. Dispose of equipment
according to local policy and wash hands
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If mortuary on site request porters to remove body
from the ward to the mortuary
If no on site mortuary, contact local funeral directors or
the funeral directors according to the relatives wishes
Screen off the area where removal of the body will
occur
Screen off the area where removal of the body will
occur
Record all the details and actions in the nursing records
Any property retained on the ward out of hours must
be stored in a secure area and any valuables stored in
the ward or hospital safe

29. —it is also known as a post-mortem examination,


It is a highly specialized surgical procedure that
consists of a thorough examination of a corpse to
determine the cause and manner of death and to
evaluate any disease or injury that may be present. It is
usually performed by a specialized medical doctor
called a pathologist.
Autopsies are performed for either legal or
medical purposes.

30. Autopsies are divided into 2 categories:
 Medical, authorized by the decedent,
decedent's family or healthcare surrogate
 Forensic, authorized by statute.

31. AUTOPSY
An autopsy or postmortem examination is
an examination of the body after death.
It is performed in certain cases such as:
o Committed suicide
o Unknown cause of death
o Unknown dead bodies
o Homicide (The killing of one human being by another )
The organs and tissues of the body are examined to establish the
exact cause of death , to learn more about a disease
A consent should be obtain from the immediate relative
:surviving spouse, adult children, parents, siblings.
After an autopsy, hospitals cannot retain any tissues/ organs without
the permission of the person who signed the consent form

32. It is the art and science of preserving human remains by
treating them (in its modern form with chemicals) to
forestall decomposition.
The intention is to keep them suitable for public display at
a funeral, for religious reasons, or for medical and
scientific purposes such as their use as anatomical
specimens.[1]
The three goals of embalming are
• sanitization
• presentation
• restoration

33.  Embalming prevents the process through
injection of chemicals into the body to destroy the bacteria
 It is the process of preserving dead body from decay
 Injection of chemicals into the body to destroy the bacteria ;
thereby prevents rapid decomposition of tissues.
 Embalming fluid contains a mixture of formaldehyde,
methanol, ethanol and other solvents

34. • Make sure the body is face up
• Remove any clothing that the person is
wearing.
• Disinfect the mouth, eyes, nose, and other orifices
• Shave the body.
• Break the rigor mortis by massaging the body.
Setting the Features
1. Close the eyes.
2. Close the mouth and set it naturally
3. Moisturize the features. A small amount of creme
should be used on the eyelids and lips
4. Casketing the Body

35. Process of Embalming


Embalming fluid is injected into the arteries of the deceased during
embalming. Many other body fluids may be drained or aspirated and
replaced with the fluid as well. The process of embalming is designed
to slow decomposition of the body.
The actual embalming process usually involves 4 parts:
 Arterial embalming: which involves the injection of embalming chemicals
into the blood vessels, usually via the right common carotid artery. Blood is
drained from the right jugular vein.


Cavity embalming: The suction of the internal fluids of the corpse
and the injection of embalming chemicals into the body cavities, using
an aspirator and trocar.
Hypodermic embalming: The injection of embalming chemicals
under the skin as needed.
 Surface embalming: Which supplements the other methods especially
for visible, injured body parts.