End-of-Life Signs and Helpful Tips: One of the most common questions surrounding the hospice experience is how will we know when the end is near for our terminally ill loved one? While no two patients and their symptoms are alike there are some common traits that our hospice professionals look for. Here are some common physical symptoms that you may observe: 1. Confusion: It is common for patient’s to become more disoriented in their speech, unable to respond when asked direct questions, and may even become unable to identify family and friends. A positive response is to identify who you are before speaking with the patient. Speak slowly, clearly and honestly. Make sure to explain what you need to do before you do it, such as “I need to give you your medicine now.” 2. Incontinence and a decrease in urine output: They may lose control of urinary/bowel functions. This is a common change that occurs during the end of life process. Urinary output may decrease and appear rose colored. These medical events may occur months or weeks before a patient passes so by itself it is not an immediate sign of death. A positive response is to keep the patient clean and comfortable to prevent skin issues that may occur. Make sure to visit with your hospice nurse with any questions or concerns. 3. Decrease in fluid and food intake: It is common for patients who are at end of life and expending significantly less energy to require less food and fluids. The body naturally conserves energy in order to help sustain itself. While offering food and fluids is helpful do not be surprised if you notice this response. 4. Sleeping: As a patient’s symptoms continue to overtake their body, the body’s common response is to rest. It is very common for a person to increase the amount of time they sleep. The patient may begin to communicate and interact less, become unresponsive to voice commands and difficult to arouse. A productive response includes sitting quietly with them, speaking in a calm tone of voice, and holding their hand. Your presence is very reassuring to them and may help reduce feelings of anxiety by both the patient and the caregiver. 5. Restlessness: The process of dying can create an uncomfortable feeling in the body as well as the mind. Some of this maybe influenced by a decrease in the flow of oxygen. As a patient grows closer to death you may notice increased signs of agitation or anxiety. You may also notice fidgeting and repetitive motions by the patient such as pulling at clothing, folding behaviors with linens, etc. A positive response may include playing soothing music for them, softly massage their forehead and cheek and to speak in a calm soothing tone of voice. Do not attempt to restrict their movements. If there are items nearby (such as a lit candle or sharp objects) simple move them from the immediate area. 6. Mottling: This is a discoloration of the skin surrounding the extremities on a body such as the fingers, toes, and lower legs. Hands and feet may become blotchy and purplish (mottled). This mottling may slowly work its way up the arms and legs. Lips and nail beds are bluish or purple. It is also common to notice that fingers, hands, arms, feet and legs become colder than normal when you touch them. This too is influenced by the lack of blood flow throughout the body. A productive response is to contact your hospice nurse and share this change in condition. 7. Fluid and food decrease: Your loved one may want little or no food or fluid. The body will naturally conserve energy required for the task ahead. Food is no longer needed. A productive response: Do not force them to eat or drink if they don’t want to as it may create anxiety for the patient. Small chips of ice or frozen juice chips might be refreshing. 8. Develop a fever: It is fairly common for the body’s temperature to rise at the end of life. A productive response may involve placing a cool, moist cloth of their forehead to comfort them and contacting your hospice nurse to update them on the change in condition. 9. Change in breathing patterns: This common behavior can seem troubling to caregivers but it is fairly common. Between shallow breaths and periods of no breathing for several seconds to minute, caregivers can experience some anxiety from observing this change. It is also common to notice a period of rapid, shallow breathing and panting. The reason for these changes relate to the decrease in circulation in the patient’s body. A productive response will involve elevating their head or turning them onto their side. It can also be helpful to hold their hand and speak calmly to them. 10. Congestion: You may notice gurgling sounds coming from the chest. The sounds may be a low murmuring or a louder sound. This symptom does not automatically refer to the presence of pain but there may be some discomfort. A productive response may involve gently turning the patient’s head to the side to allow any secretions to drain. Gently wipe their mouth with a moist cloth, and speak in a calm soothing tone to them. For supportive patient and family care, contact Three Rivers Hospice in Blue Springs area (816-295-0544), Cameron area (816-632-2910), Platte City area (816-431-2333) and St Joseph area (816-279-8600).
Posted on: Fri, 02 Jan 2015 16:49:54 +0000
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