HHC Health & Home Care Clinical Policy And

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HHC HEALTH & HOME CARE Section: 14-29 Emergency: Stroke __RN PURPOSE: To identify signs/symptoms of stroke and take appropriate action in order to maintain life. CONSIDERATIONS: Signs and symptoms of stroke are: Partial/total paralysis (unilateral or bilateral) Loss of consciousness Aphasia Headache Hyper or hypotonia Sensory impairment (touch, visual) Convulsions Lack of coordination Incontinence Lethargy Nausea and/or vomiting EQUIPMENT: Manometer Stethoscope Otoscope (optional) PROCEDURE: 1. Adhere to Universal Precautions. 2. Check for patent airway -- initiate cardiopulmonary resuscitation, if indicated. (See Cardiopulmonary Resuscitation, No. 15.07.) *If there is fluid or vomit in victim’s mouth, position on side to allow fluids to drain out. May have to use “finger sweep” to clear material from mouth. 3. Determine level of consciousness. 4. Measure and assess patient's response to commands. Determine loss of impaired vision, speech, and motor ability. 5. Obtain vital signs. 6. Call 911, as indicated. 7. Reassure and calm the patient and family. AFTER CARE: 1. Document in patient's record: a. Incident, signs and symptoms of stroke present, and vital signs. b. Treatment provided. c. Patient's response to treatment. d. Identity and location of emergency facility, if indicated. e. Condition of patient at time of transportation, if indicated. f. Communication with patient’s physician and nursing supervisor. 336
HHC HEALTH & HOME CARE Section: 14-30 Emergency: Unexpected Death In The Home __RN PURPOSE: Ensure proper and timely reporting of death in the home to appropriate legal/medical personnel. CONSIDERATIONS: 1. State and/or local regulations supersede any procedure identified here. 2. All home deaths must be reported to the coroner. 3. The coroner makes a decision to visit/not visit the home based on information they receive regarding the death. 4. All information that can be given to the coroner to reassure him/her that there was no evidence of foul play, etc., will be helpful in facilitating the timely removal of the body from the home with minimal trauma to the family. 5. Although this is a function usually performed by the mortuary or cremation society, anyone may make the initial contact with the coroner's office -- physician, agency staff member or family member. 6. The coroner must be notified and approval given before a body can be removed from the home. 7. Check on regulations and policies for pronouncements with your agency. 8. Regardless of who makes the initial contact, the coroner will need to speak to at least one other party to corroborate information regarding the death. This may mean that the coroner will speak with either a family member or preferably an agency staff member, if present. 9. Follow your state’s reporting requirements that refer to communicable diseases. EQUIPMENT: Personal Protective Equipment PROCEDURE: Unwitnessed death with obvious signs that there has been a great length of time elapsed since death occurs and rigor mortis is present: 1. Adhere to Universal Precautions. 2. Contact coroner and physician. Await further instructions from coroner. 3. Instruct family to select mortuary, if arrangements not already made. 4. Contact mortuary for removal of body when authorization received from coroner. 5. Remain in the home until final arrangements made, body removed, and responsible family member present. 6. Notify nursing supervisor of patient's death. Unwitnessed death when time of death is unknown and no rigor mortis is present: 1. Adhere to Universal Precautions. 2. Initiate cardiopulmonary resuscitation, unless a Do Not Resuscitate order is in place. (See Cardiopulmonary Resuscitation, No. 15.07. and Section 1 “Rights and Ethics” of the Administrative Policy & Procedure Manual.) The general rule- is to always resuscitate a body that feels warm and a victim of extreme cold. However, some victims may have Advanced Directives or a Community DNR order. Hospital DNRs are not sufficient for use in home care (community). In most instances, you should honor the wishes of the victim expressed in writing. State and local laws may vary – if you are in doubt about validity of advanced directives, attempt to resuscitate. 3. Call 911. 4. Notify physician. 5. Remain in home; provide support to family until further instructions received from medical personnel. 6. Notify nursing supervisor of home situation. AFTER CARE: 1. Document in patient's record: a. Name, telephone number of coroner, and physician notified, in situation of obvious death. b. Disposition of body, in situation of obvious death. c. Emergency medical care, if cardiopulmonary resuscitation is initiated. d. Contact the physician. 2. Submit a written incident report for all patient deaths at home (whether or not the death was expected). Recommended Reportable Deaths to Coroner: 1. No physician in attendance. 2. The deceased has not been attended by a physician in the 20 days prior to death. 3. Physician unable to state the cause of death. 4. Known or suspected suicide. 5. Known or suspected homicide. 6. Involving any criminal action or suspicion of a criminal act. 7. Related to, or following known or suspected selfinduced or criminal abortion. 8. Associated with known or alleged rape or crime against nature. 9. Following an accident or injury (primary or contributory, occurring immediately or at some remote time). 10. Drowning, fire, hanging, gunshot, stabbing, cutting, starvation, exposure, alcoholism, drug addiction, strangulation, or aspiration. 337
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