| Symptoms |
Comforts |
| Patient has decreased need for food and drink
as the bodily functions begin to slow down. |
Know that the patient is not hungry or in discomfort
from lack of nourishment. |
| There may be difficulty in swallowing. |
The mouth may be dry and should be kept moist. |
| Gradually, the patient spends more time sleeping
during the day and at times is difficult to arouse. This occurs through
changes in the body’s metabolism. |
Permit rest. |
| It is common for the dying person to become restless
and to pull at the bed linens. |
Soft music may be calming. Keep the side rails
of the bed up for safety. |
| The patient may become increasingly confused about
time and place, and have trouble identifying familiar people. |
It may be comforting to be reminded about what
day it is, what time it is, and who is in the room. |
| The patient may have visions of people and things
not visible to others. |
Don’t become alarmed. Often, these visions
are comforting to the patient. |
| Incontinence may become a problem. The amount
of urine may decrease, and it may be darker than usual. |
Pads placed under the patient provide comfort
and cleanliness. |
| The patient’s respirations may sound moist,
due to sagging of the tongue muscles and inability to clear throat
secretions. |
Often, the patient is not uncomfortable, and may
not even be aware of their respirations. Elevating the head of the
bed or turning the patient to one side usually quiets the sounds.
Medication can dry the secretions. |
| Hearing and vision acuity may deteriorate. Hearing
is thought to be the last of the senses to diminish. |
Assume that the patient can hear, and explain
to him whatever is happening in the room. |
| The patient may become cool to the touch. Often,
this prompts caregivers to pile on blankets. However, most dying patients
can not tolerate even slight weight on the feet and extremities. |
Blankets and sheets should be loose and untucked. |
| The skin will change in appearance from being
uniformly pale to mottled, with colors varying from red to blue and
purple. Mottling usually occurs first on the soles of the feet and
over bony areas, such as the knees. The underside of the body becomes
darker as blood circulation diminishes. These symptoms occur late
in the dying process. Fevers are also common. |
|
| Often, there is a change in the breathing pattern.
There may be 10- to 30-second periods of apnea, which is very common
in the final stage of life. |
|
| Most of the time, the patient will be unable to
respond to touch or sound. |
|
| Pain and discomfort may increase, decrease, or
stay the same as death approaches. |
|
One important role that you can play is to discuss the above
signs of imminent death with loved ones before they occur, and as they
occur. Family members are often concerned about the changes they observe,
but they seldom know the right questions to ask to make sense of the process
of death.
At the moment of death, it is important to allow the loved
ones to mourn in whatever way is important to them. Simply being with
the family, observing the scene, and offering to pray is helpful. It is
important for you to express sympathy for the family, such as, “I
am sorry for your loss.” Anecdotal reports indicate that health
care professionals often leave the room without saying anything –
to give the loved ones privacy – but this is often distressing to
the family.
