End of Life Management - How to Prepare
Preparing for death
The end of life cannot be predicted for any of us. We do not know when it will happen, who will be with us, how it will occur or what we will feel. However, we know some valuable things about how many people die, which can help put your situation into perspective.
Certain physical signs alert us that the end of life may be growing close
In the final weeks of life, many people become very weak. They are tired and sometimes sleep most of the day and night. They have a decreased appetite and thirst with an inability or unwillingness to eat food. They frequently have difficulty swallowing fluids. They may be less able or willing to talk or concentrate. It is reassuring that the person and his or her family and caregivers know everything reasonable is being done to ensure patient comfort, including wise and judicious use of medications. This helps the person to accept and find peace with dying. However, not every warning sign is physical.
Signs and symptoms of approaching death
The arms and legs of the patient may become cool to the touch, and the underside of the body becomes darker in color. These symptoms are a result of a slowdown in blood circulation.
The patient will gradually spend more time sleeping during the day. At times, the patient may be difficult to arouse. This symptom is the result of a change in the body's metabolism.
The patient may become increasingly confused about close and familiar people's time, place, and identity. This is another result of metabolic change.
Incontinence may occur. If the patient has a urinary drainage catheter in place, urinary output may decrease as death approaches.
Clarity of vision and hearing may decrease slightly.
The patient will have a decreased need for food and drink as the body naturally conserves energy.
The patient may become restless, pulling at bed linens and having visions of people or things that are not evident to anyone else.
These symptoms result from a decrease in oxygen circulation to the brain and a change in the body's metabolism.
Oral secretions may become more profuse and collect in the back of the throat. This symptom results from a decrease in the body's intake of fluids and an inability to cough up average saliva production. This may cause noisy, congested, or "gurgling" breath sounds. The patient often sounds as though they are gasping for air; however, the lungs are in fact, receiving an adequate supply of air.
During sleep, you may first notice breathing patterns in the patient change to an irregular pace. There may be 10 to 30-second intervals during which a patient seldom or does not breathe. This symptom is called "apnea" and indicates a decrease in circulation and build-up in body waste products.
Suggestions for comfort
Keep lightweight blankets on the patient's body to prevent chill.
Plan to spend your time with the patient during times of alertness.
Provide a cool-mist humidifier to increase moisture in the room if oral secretions begin to guild up.
Elevate the head with pillows and adjust a hospital bed to make breathing easier.
Keep lights on in the room when vision decreases.
Always assume the patient can hear you. Hearing remains even when all other senses seem absent.
Talk calmly and assuredly in the event the patient is confused.
Remind the patient frequently what day it is, time of day, and techniques for cleanliness.
Consult with your Hospice Team regarding hygiene and techniques for cleanliness.
Inform your Hospice Nurse as the patient's urine output decreases.
Goals
Keep the patient as safe, comfortable, and secure as possible.
Know when to recognize situations that require professional help for the person to reach a natural death.
Create an environment that is welcoming to visitors who may come to say goodbye.
Take care of your own needs and find ways to manage the stresses of caregiving.
Signs of death
There is no breathing.
There is no heartbeat.
There is a loss of control of the bladder and bowel.
There is no response to voice and touch.
The eyelids are slightly open.
The eyes are fixed on a specific spot.
The jaw is relaxed, and the mouth is slightly open.
The Stillwater Hospice team nourishes quality care for patients, families, and caregivers by facilitating individual goals for comfort and dignity. Reach out to us if you need assistance navigating this next phase of life.
