End of life stages timeline skin#
Skin on arms, legs, hands, and feet may darken and look blue or mottled (blotchy).Arms and legs may feel cool to the touch as circulation slows down.Possible changes in circulation and temperature Continue to clean the teeth and mouth with water and a soft toothbrush or foam mouth swabs. Change the patient’s position – turning them to the side may help secretions drain from the mouth.If the patient can swallow, give ice chips or sips of liquid through a straw.If the mouth secretions increase, keep them loose by adding humidity to the room with a cool mist humidifier.Secretions may thicken and build up due to less fluid intake and because the patient can’t cough.This may cause a rattling sound with breathing that’s very distressing to hear, but it isn’t usually uncomfortable for the patient. Mucus may collect in the back of the throat.Medicines for pain, nausea, fever, seizures, or anxiety should be continued to keep the patient comfortable. Check with the doctor to see which medicines may be stopped.Ice chips from a spoon, or sips of water or juice from a straw may be enough for the patient.Put lip balm, lubricant, or petroleum jelly (Vaseline ®) on the lips to prevent drying.May no longer need some of his or her medicines, such as vitamins, replacement hormones, blood pressure medicines, and diuretics, unless they help make the patient more comfortable.Mouth may dry out (see “Possible changes in secretions” below).(The patient has less need for food and drink.) The patient may have less interest in food.Gentle touching, caressing, holding, and rocking are usually helpful and comforting.When talking with a confused person, use calm, confident, gentle tones to reduce chances of startling or frightening the patient.If it appears they are, give breakthrough pain medicines as prescribed, or check with the doctor or nurse if needed. If the patient is very restless, try to find out if they are having pain.Continue pain medicines up to the end of life.When talking with the patient, remind her or him who you are and what day and time it is.Plan your times with the patient when he or she is most alert or during the night when your presence may be comforting.After a period of sleepiness and confusion, may have a short time when he or she is mentally clear before going back into semi-consciousness.May have more anxiety, restlessness, fear, and loneliness at night.May talk about things unrelated to the events or people present.Restless, might pick or pull at bed linen.Apply cool, moist washcloths to head, face, and body for comfort.Near the end of life, some dehydration is normal. If the patient is having trouble swallowing, do not give them solid foods.If the patient has trouble swallowing pain pills, ask about getting liquid pain medicines or a pain patch.Speak in a calm, quiet voice and avoid sudden noises or movements to reduce the chances of startling the patient.It's best to time any position changes to be about 30 minutes after pain medicine is given. Help the patient turn and change positions every 1 to 2 hours.Sudden movement of any muscle, jerking of hands, arms, legs, or face.Limited ability to cooperate with caregivers.Short attention span, may not be able to focus on what’s happening.More drowsiness – the patient may doze or sleep much of the time if pain is relieved, and may be hard to rouse or wake.Less and less interest in food, often with very little food and fluid intake for days.Profound weakness – usually the patient can’t get out of bed and has trouble moving around in bed.While not all may happen, it may help you to know about them. The following symptoms are examples of what may happen in some people with cancer who are dying. Just like the timing of the dying process cannot be predicted, it's also hard to predict what exactly will happen in the final stage of life and especially near death. If the patient is not in hospice, talk with the doctor so that you will know exactly what to do at the time of death. If the patient is in hospice, the hospice nurse and social worker will help you. If possible, it’s important to have a plan for what to do just following a death, so that the caregivers and other people who are with the patient know what to do during this very emotional time. Other times the dying process moves slowly and the patient seems to linger. Sometimes death comes quickly due to an unexpected event or problem. No one can really predict what may happen at the end of life, how long the final stage of life will last, or when death will actually happen. The signs of death being near can be different for each person. It gives some signs that death may be close and gives the caregivers some ideas about ways they may be able to help. This information has been written for the caregiver, but many patients want this same information for themselves.
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