Loss of appetite and decrease in thirst are common. The body is beginning to shut down and does not need nourishment. People commonly feel it is necessary to encourage the person to eat in the hope of sustaining life; however, food and fluid may cause discomfort. The person may ask for ice chips, popsicles, ice cream or some other food choice. Do not be surprised if only a mouthful or two is taken. When swallowing is no longer possible, mouth care provides moisture and comfort. Do not offer a fluid if swallowing is not possible.
Output of urine and stool will decrease as the food and fluid intake decreases. Urine and stool may also change color, be passed less frequently and in smaller amounts. Other factors such as immobility and medication may contribute to this.
Your loved one may lose control of bladder or bowel function as the muscles begin to relax. In this instance it may be necessary to use an incontinence brief.
Ask the health care professional about the management of these symptoms. It is important to provide skin care and cleansing on a routine basis.
Sleeping
Sleeping an increased amount of time is common. It may become more difficult to waken the person. As death nears, the person may slip into a coma and become unresponsive.
Restlessness & Disorientation
Confusion as to time, place and recognition of people, even family members and close friends is common.
At times your loved one may become restless. For example, he/she may reach out to unseen objects, pull at the bedding or try to get out of bed. This can occur for many reasons such as lack of oxygen circulation to the brain or changes in condition or medications. It would be helpful to discuss these changes with a health care professional.
Changes in Breathing
Regular breathing patterns may change. Breathing may stop for 10 to 30 second periods, or there may be periods of rapid, shallow panting. These breathing patterns are normal and indicate the natural progression towards death.
A moaning sound occurs as the breath passes over the relaxed vocal cords.
Congestion
Gurgling sounds, often loud, occur when a person is unable to cough up normal secretions. This does not normally cause pain or discomfort. It may be helpful to turn the person to one side and gently wipe away secretions with a moist cloth. As secretions build up, keeping the head of the bed elevated (by using pillows) will make breathing easier. Sometimes medications can be ordered to help dry up secretions.
Oral suctioning may be done, however, this usually causes an increase in secretion production.
Skin
You may notice the skin begin to change color and become cooler to touch.
The face may be pale and the feet and legs a purple-blue mottled color. The circulation of the blood is slowing down.
Although your loved one is cool to touch, he/she is usually comfortable. Offer a warm blanket but avoid using an electric blanket to prevent the risk of skin burns.
Social and Emotional Signs
Loss of Interest
As death approaches, the person becomes quieter and less interested in physical surroundings. He/she may become withdrawn, less sociable and also be confused about time and place.
Vision-Like Experiences May Occur
The person may see or speak to people and places not visible to you. Try not to explain away what the person is saying. Be supportive by listening to the person.
Emotional States
The person dying may be going through different emotional states such as guilt, anger, frustration, helplessness or sadness. Tears are a natural expression of one's feelings and may occur in both the person and his/her family.
Spirituality & Cultural Rituals
People vary greatly in their spiritual and religious beliefs and needs. During this time a member of the clergy, chaplain or a spiritual adviser can provide support to both the dying person and the family.
It may be helpful for you to attend to your own special cultural needs at this time.
Signs a Death Has Occurred
Even though death is expected, you may not be prepared for the actual moment it occurs. At the time of death:
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There will be no response
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There will be no breathing
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There will be no pulse
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Eyes will be fixed in one direction
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Eyelids may be opened or closed
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There may be loss of control of the bladder or bowel
The procedures followed prior to and after death by nurses, physicians and funeral directors will be different from county to county and state to state. If your loved one is living with a terminal disease you should ask your physician and funeral director what the procedures are in your area.
Remember: This is an expected death and no further medical intervention is required. Do not call 911, the police or the fire department.
After Death Has Occurred
If you have health care professionals involved in the care of the dying person they should be notified of the death. They are available to provide you with emotional support and assistance regarding phone calls to the physician and the funeral home.
A physician must be called by the nurse or the family so that the death can be certified.
At the same time, it is necessary to call the funeral home to inform them that your loved one has died.
You may spend as much time as needed with the deceased person. Do not be afraid to touch, hug or kiss the person. Some people may wish to lie down beside him/her.
A health care provider may also help with the safe, responsible way of storing and disposing of medication and equipment, but it is the family's responsibility to do so.
You may have dealt with many intense emotions and challenges in your journey through the loss of your loved one. It is important to realize that grief is a highly personal response to life losses. Grief may last longer than society recognizes, so be patient with yourself and allow for the expression of feelings that you are feeling.
