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CAREGIVERS

Your care to provide support and love to a terminally ill family member or friend can seem like a daunting task.

Here at Heartsway Hospice we will be with you every step of the way.

GUIDE TO THE DYING PROCESS

One of the most frequent questions that is asked of our nurses is, “How
long does he or she have to live?” One of the greatest sources of stress for
caregivers is the onset of new or more severe symptoms as death approaches.
The fear of the unknown is always greater than the fear of the known. In
this respect, we offer you this information to help you to prepare for and
anticipate symptoms which are indicative of approaching death. Your nurse
and your physician are your best resources to help clarify your concerns
about this information.

Not all of these symptoms will appear at the same time. Some may
never appear. We want to relate each possible symptom to you in order to
decrease your fear in case one appears suddenly. All the symptoms described
are indicative of how the body prepares itself for the final stage of life...
death. This is not the time to try to change the dying person, but the time
to give full acceptance, support and comfort.

Signs and Symptoms of Impending Death
Sleepiness

Your loved one may begin to sleep more and may be difficult to arouse. This
is partially due to metabolic changes in the body. Sit down and hold your
loved one’s hand, speaking softly and naturally. Don’t shake the patient
or speak loudly. Do not try to give oral medications, food or fluids to an
unconscious person.

Confusion

The person may sometimes be confused about time, place or who is present
in the room. Some of this may be due to changes in metabolism, changes
in vision or increased sleeping. Have each visitor identify himself. Do not
ask, “Do you know who I am?” Speak softly, clearly and truthfully when
you need to communicate something important. Try to orient him/her to
reality with familiar objects and pictures of loved ones, etc.
Vision Changes
As the person’s vision begins to fail, he/she may only see what is nearby.
Use indirect lighting and sit near the head of the bed where you can be
seen more easily. Remember that although vision may decrease, the sense
of hearing remains. Inform all visitors that the person may be able to hear
voices, although he/she may no longer be capable of responding. Encourage
everyone to continue talking to the person. Do not whisper.

Decreased Appetite/Refusing Food & Fluids

As death approaches, the person may want less and less food and fluids,
eventually refusing them altogether. The body is conserving energy that
would be used to digest the food for other functions. Don’t force foods
or fluids. Ice chips of crushed up frozen juice are often refreshing in the
mouth. Chapstick or lip balm helps soothe dry lips. If oxygen is being
used, use a non-petroleum based product.

Decreased Urine Output

This occurs as fluid intake decreases and as circulation through the kidneys
decreases. The person may lose bladder and/or bowel control as muscles
in that area begin to relax. Pads may be needed to protect the bed and keep
him/her clean, dry and comfortable.
If your loved one has a bladder catheter in place, you will notice that the
amount of urine will decrease as death comes closer.
Periods of Apnea (no breathing)
The person may stop breathing for 15-45 seconds. There may be periods
of rapid respiration alternating with periods of apnea. This is called
“Cheynes-Stokes” respiration. It is very common and indicates a decrease
in circulation to the internal organs and build-up in the body waste products.
Elevating the head of the bed 30-45 degrees may help bring comfort.
Wet Gurgling or Rattling Breathing
This is caused by secretions building up in the throat. Elevating the
head of the bed 30-45 degrees helps the patient cough effectively and is
more comfortable than lying flat. Turning him/her on the side may help
secretions drain out of the mouth and prevent choking. Ask your nurse
about medications to help control this.

Cool Skin

As the body shuts down, circulation diminishes to the arms and the legs
and they may feel very cool to the touch. The pulse will become harder to
feel. The skin color may change. The upper parts of the body may sweat
as the peripheral circulation decreases.
You may notice the underside of the body becoming much darker in color.
Even though the skin is cold to the touch, most dying persons aren’t aware
of feeling cold. Use light clothing and make sure there is fresh, circulating
air. Do not use an electric blanket. A change of position every two hours
protects the skin and promotes comfort.

High Temperature

It is not unusual for a dying person to have an elevated temperature even
as high as 104 degrees as they draw closer to death. Give analgesics such
as Tylenol. These are available in pill, suppository and gel form. Use light
clothing and cover; and apply cool moist cloths to the forehead or back of
the neck.

Withdrawal

The person may seem unresponsive or withdrawn. This may be the
beginning of “letting go”. Just as you are losing someone you love, the
dying person is in the process of losing everyone and everything he/she
loves. It is only natural to be withdrawn. If the patient is allowed to express
his/her sorrow, the stage of final acceptance will be easier.
If the person is unresponsive, remember hearing remains all the way to the
end. Speak to your loved one in your normal tone of voice, identifying
yourself by name when speaking. Hold his/her hand and say whatever you
need to say that will help the person to “let go”.

Out of Character Requests or Statements

This is a sign of preparation for death. Often a certain individual’s support
is most needed. If you are not a part of this “inner circle” at the end, it
doesn’t mean you are unloved or unimportant. It means you have already
fulfilled your task with them and it is time for you to say goodbye. If
you are part of the final “inner circle” of support, the person needs your
affirmation and permission
.
Performing Restless, Useless, Repetitive Tasks

This sometimes indicates something is still unresolved and unfinished and
they can’t let go. The care team may be able to help you identify what is
happening and help discover a way for your loved one to find release from
tension or fear. A dying person will try to hold on, even though it brings
prolonged discomfort, in order to make sure those who are left behind will
be alright.

Your ability to release your loved one from this concern and give the
assurance it’s alright to let go whenever he/she is ready, is one of the greatest
gifts you can give.

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Longview Office: 4351 McCann Road, Longview, TX 75605 • Mailing Address: P.O. Box 5608 Longview, TX 75608
Carthage Office: 437 W. Panola St., Carthage, TX 75633 • Marshall Office: 205 East Austin, Marshall TX 75670
Winnsboro Office: 209 East Broadway St., Winnsboro, TX 75494

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