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Preparing for the End Part 2

Preparing for the End Part 2



The patient may become restless and pull at the bed linens. These symptoms are also a change in the body’s metabolism. Talk calmly and assuredly with the patient so as not to startle or frighten them. If the patient is a danger to himself or others, you may prescribe sedating neuroleptics (e.g.chlorpromazine), or neuroleptics (e.g. haloperidol) in combination with benzodiazepines (e.g. lorazepam), to help the patient rest.

Decreased Senses

Clarity of hearing and vision may decrease. Soft lights in the room may prevent visual misinterpretations. Never assume that the patient cannot hear you, as hearing is the last of the five senses to be lost.

Decreased Bowel and Bladder Control

often not a problem until death is very near. Invite family to participate in direct care; the nurse can help place absorbent pads under the patient for more comfort and cleanliness, or a urinary catheter may be used. The amount of urine will decrease and the urine become darker as death becomes near.

Common Physical Changes

  • Blood pressure decreases; the pulse may increase or decrease.

  • The body temperature can fluctuate; fever is common. There is increased perspiration often with clamminess.

  • The skin color changes: flushed with fever, bluish with cold. A pale yellowish pallor (not to be confused with jaundice) often accompanies approaching death.

  • Breathing changes also occur. Respirations may increase, decrease, or become irregular; periods of no breathing (apnea) are common.

  • Congestion will present as a rattling sound in the lungs and/or upper throat. This occurs because the patient is too weak to clear the throat or cough. The congestion can be affected by positioning, may be very loud, and sometimes just comes and goes. Elevating the head of the bed and swabbing the mouth with oral swabs give comfort and can be done effectively by the family.

  • The arms and legs may become cool to the touch. The hands and feet become purplish. The knees, ankles, and elbows are blotchy. These symptoms are a result of decreased circulation.

When preparing for the end of life please do not hesitate to discuss concerns about changes in physical, mental, emotional, or spiritual state of being with us here at Abbey Road Hospice to ensure all resources are made available. Hospice services extend beyond medication management of symptoms, often providing access to a comprehensive network to provide support however needed by the patient and/or family.


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