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End of Life Signs & Symptoms

Many caregivers wonder about the changes that occur in the patient just before death. They want to be prepared and take the right actions.

The Physical Signs & Symptoms of Death

Unlike the way death is portrayed in the movies, the patient usually slips into death similar to how they have fallen asleep each night of their lives. It is unusual for someone to convulse or hemorrhage just before they die, although this can happen depending on their different medical conditions.

There are are some common signs seen in near-to-death patients. The skin becomes very cool, particularly in the arms and legs, and it may feel clammy, damp, or appear bluish. The number of times and how deeply the patient breahes will lessen until the patient stops breathing entirely. Breathing may become noisy due to mucous collecting in the throat. Decreased movement and loss of strength can be observed and sensation is gradually lost. Awareness will vary; the patient may or may not be conscious. Hallucinations may occur, or the patient may become restless or very anxious. Some or all of these changes may be seen in dying patients. Although watching their declining condition may be difficult for you, the patient is usually unconcerned about these changes.

Sometimes "active dying" occurs over a period of hours or days. Even when many of these signs are present, it is difficult to predict the amount of time before death will occur. Some patients will exhibit some of these changes and then for some unexplained reason their condition may begin to improve a little. Although the family is caring and loving towards the patient, these roller-coaster changes can be emmotionally and physicially exhausting for the caregiver. Usually in the weeks and days prior to the death, your primary nurse will begin to visit more often and other members of the hospice team will increase their availability and support. As caregivers can suffer from the feelings of helplessness. Withdrawal is normal for the dying patient as he or she becomes less concerned about his or her surroundings.

Alternative ways to keep the patient comfortable is needed during this time, which might include a sponge bath and moistening the lips with cool water. Holding the patient's hands can be very meaningful and comforting at this time. It is important to continue to talk to the patient and offer reassurance. Simply saying, "I'm here, I'll be with you" can offer the patient great support and comfort.

Tell visitors and other family members not to speak in front of the patient as if he or she isn't there, even if the patient appears to be sleeping. Nothing should be said that would distress the patient should the conversation be overheard.

When you feel that death is near, it is a good time to bring the family members together, since they may have some last thoughts or expressions of love to share with the dying person. You should also call your doctor and primary nurse to let them know that the patient's death is approaching. You will know that death has occurred when the patient stops breathing for several minutes and the heart is no longer breathing.


Preparing for Death

Just as each person's lif is unique, so is his or her death. Because of this, it is difficult to give hard facts about what the actual death of the patient will be like when it happens. Instead, some common concerns and approaches will be shared in this section. Although difficult, it is a good idea for some pre-death arrangements to be made by the patient and the family. This topic can be difficult to bring up, as itis another way of acknowledging the patient's approaching death. Your primary nurse and social worker can help open discussions on this topic.

The patient can provide for survivors and prevent legal problems for the family after his or her death by having a current well prepared will. Your social worker can give you advice about whom to contact to draw up a will or to make changes in a current will. Making funeral plans before the patietn's death may seem morbid to you. However, it is a good idea to contact the funeral home you plan to use and discuss with them the patietn's and your wishes for funeral arrangements. Although it is difficult to discuss this with the patient, involving him or her in planning for what could be a meaningful service can provide reassurance that you have acted according to the patient's wishes.


After Death Care

Soon after the patient dies, the caregiver or the primary nurse should notify the funeral director so that he or she can come to your home and remove the patient's body. In some communities, the patient's body must be taken to the hospital so that a doctor can officially or legally pronounce them to be dead. Your primary nurse and doctor can give you information about the usual procedure in your area.

The final gal of hospice care is to help the family go on living after the patient's death. This means the members of the hospice team will continue to keep in touch with you and your family through visits and phone calls.

Often the period right after the patient's death is a time of regrouping and relief in the family. One should not feel guilty about the sense of relief. Later, more active grieving and sadness may occur and members of the hospice team are available to help you through this difficult time.

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