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10 Signs Death is Near



No one can predict the moment of death. But physicians and nurses involved in end-of-life care know that certain symptoms are usually associated with the body’s shutting down. These signs of approaching death are specific to the natural dying process (apart from the effects of particular illnesses the person may have). Not all dying symptoms are evident in every person, but most people experience some combination of the following in the final days or hours:



Loss of appetite. Energy needs decline. The person may begin to resist or refuse meals and liquids, or accept only small amounts of bland foods (such as hot cereals). Meat, which is hard to digest, may be refused first. Even favorite foods hold little appeal. Near the very end of life, the dying person may be physically unable to swallow.



Response: Don’t force-feed; follow the person’s cues even though you may be distressed by a loss of interest in eating. Periodically offer ice chips, a popsicle, or sips of water. Use a moistened warm cloth around the mouth and apply balm to the lips to keep them moist and comfortable.



Excessive fatigue and sleep. The person may begin to sleep the majority of the day and night as metabolism slows and the decline in food and water contribute to dehydration. He or she becomes difficult to rouse from sleep. The fatigue is so pronounced that awareness of immediate surroundings begins to drift.



Response: Permit sleep. Avoid jostling the person awake. Assume that everything you say can be heard, as the sense of hearing is thought to persist, even when the person is unconscious, in a coma, or otherwise not responsive.



Physical weakness. A decline in food intake and lack of energy leads to less energy, even for activities like lifting one’s head or shifting in bed. The person may even have difficulty sipping from a straw.



Response: Focus on keeping the person comfortable.



Mental confusion or disorientation. Organs begin to fail, including the brain. Higher-order consciousness tends to change. “Few conditions leave people hyperaware when they’re dying,” says palliative-care physician Ira Byock, author of Dying Well. The person may not be aware of where he or she is or who else is in the room, may speak or reply less often, may respond to people who can’t be seen in the room by others, may say seemingly nonsensical things, may be confused about time, or may be restless and pick at bed linens.



Response: Remain calm and reassuring. Speak to the person softly and identify yourself when you approach.



Labored breathing. Breath intakes and exhales become raggedy, irregular and labored. A distinctive pattern called Cheyne-Stokes respiration might be heard: a loud, deep inhalation is followed by a pause of not breathing (apnea) for between five seconds to as long as a full minute, before a loud, deep breath resumes and again slowly peters out. Sometimes excessive secretions create loud, gurling inhalations and exhalations that some people call a “death rattle.”



Response: The ragged breathing or loud rattle can be alarming to listeners, but the dying person is unaware of this changed – focus on overall comfort. Positions that may help: the head slightly elevated with a pillow, sitting up well-supported, or the head or lying body tilted to the side slightly. Moisten the mouth with a wet cloth and moisturize with lip balm or petroleum jelly. If there’s a lot of phlegm, allow it to drain naturally from the mouth, since suctioning it out can increase its quantity. A vaporizer in the room might help. Some people are given oxygen for comfort. Be a calm, physical presence, stroking the arm or speaking softly.



Social withdrawal. As the body shuts down, the dying person may gradually lose interest in those in the room. He/she may stop talking or mutter unintelligibly, stop responding to questions, or simply turn away. A few days before receding socially for the last time, the dying person sometimes surprises loved ones with an unexpected burst of alert, attentive behavior. This can last less than an hour or up to a full day.



Response: Be aware this is a natural part of the dying process and not a reflection of your relationship. Maintain a physical presence by touching the dying person and continuing to talk, if it feels appropriate, without demanding anything back. Treasure an alert interlude if and when it occurs, because it’s almost always fleeting.



Changes in urination. Little going in (as the person loses interest in food and drink) means little coming out. Dropping blood pressure, part of the dying process (and therefore not treated at this point, in tandem with other symptoms), also contributes to shutting down of the kidneys. The concentrated urine is brownish, reddish or tea-colored. Loss of bladder and bowel control may happen late in the dying process.



Response: Hospice medical staff sometimes decides that a catheter is necessary, although not in the final hours of life. Kidney failure can increase blood toxins and contribute to a peaceful coma before death. Add a bed pad when placing fresh sheets.



Swelling in the feet and ankles. As the kidneys are less able to process bodily fluids, they can accumulate and may be deposited in areas of the body, particularly the feet and ankles. The feet and ankles, as well as the face and hands may appear puffy.



Response: Usually no special treatment (such as diuretics) is given when the swelling seems directly related to the dying process. (The swelling is the result of the natural death process, not its cause.)



Coolness in the tips of the fingers and toes. In the hours or minutes before death, blood circulation draws back from the periphery of the body to assist the vital organs. As this happens, the extremities (hands, feet, fingers, toes) become notably cooler. Nail beds may also appear more pale, or bluish.



Response: A warm blanket can keep the person comfortable, or he or she may be oblivious. The person may complain about the weight of coverings on the legs, so keep them loose.



Mottled veins. Skin that had been uniformly pale or ashen develops a distinctive pattern of purplish/reddish/bluish mottling as one of the later signs of approaching death. This is the result of reduced blood circulation. It may be seen first on the soles of the feet.



Response: No special steps need be taken.



Note: These general signs of impending death may vary in sequence and combination from person to person. If a person is on life support (respirator, feeding tube), the process death follows may be different. The signs of death listed here describe a natural dying process.



Source: Paula Spencer Scott, Caring, September 2015.



See also “The Symptoms of Approaching Death”: whatliesbeyond.boards.net/thread/7102/symptoms-approaching-death



