Elderly care

Frail Care

Post-operative care

Respite Care

Palliative Care

Short/long term illnesses
Things you may notice in the last few days of life
Expect the following signs and symptoms as the body prepares itself for the final stage of life;

Coolness
The personīs hands and arms, feet and then legs may be increasingly cool to the touch, and at the same time the colour of the skin may change. The overall complexion may be pale and you may notice mottling on the heels, toes, hands and fingers and even in parts of the face. This happens when the blood circulation is decreasing to the body's extremities and is being reserved for the most vital organs. Keep the person nice and warm. We do not feel that hot water bottles and electric blankets are safe. A nice pair of warm loose socks and a snuggly soft blanket should be help keep the person warm and comfortable.

Sleeping
As the person's metabolism is winding down; they may spend more time sleeping. They may eventually reach a stage where they cannot be roused at all. Sit with your loved one, hold his or her hand and speak softly and directly as you normally would, even though there may be no response.  Plan to spend time with your loved one during those times when he or she seems most alert or awake. Be aware that even though the person may not be responsive, they can still hear you so never talk about the person in their presence. Hearing is the last of the senses to be lost.

Disorientation
You may notice that the person may seem confused at times.  This confusion can be mild or may be more severe where at times they do not know where they are and who you are.  It can be distressing for close family members but this is completely normal and can be related to decreased intake of fluid causing a mild dehydration as well as the metabolic changes. It is important to keep in mind that when a person gets confused, they often feel afraid and their own environment which at a time was familiar to them and can appear frightening especially if it is dark or if they are alone. Keep a soft light on when it is dark and if possible try and take turns with family members to ensure that someone familiar is always around. Very often a caregiver or nurse is introduced to care for the person at this stage and it may take some time for the person to feel safe with her.

Speak softly and directly to the person, reminding them who you are and what day it is.  Read the daily newspaper, put the news on the television and update the person about what is happening in the world around them. For example:  We are going to Mary's school play tonight. Remember she is plating the lead role in Annie. (Once you have been to the play, report back and perhaps show some photographs). By continually including the person in the outside world, they will feel important and considered and less confused.  Do this even if they are not conscious.
Identify yourself by name before you speak rather than to ask the person to guess who you are. Speak softly, clearly and truthfully when you need to communicate something important for the patient's comfort, such as, it is time to take your medication, and explain the reason for the communication such as: Dad, its Lucy. I need to sit you up to give you some medicine. I am going to give it to you on a spoon which I will put slowly into your mouth.  This will keep you comfortable and help with the pain.

Incontinence
The person may lose control of urine and/or bowel matter as the muscles around the abdomen begin to relax. Buy a waterproof fitted sheet as well as some disposable linen savers.  You may need to consider purchasing some incontinence garments to keep your loved one clean and comfortable. Keeping the skin clean and dry and applying a non-scented barrier cream to the buttocks and groin can prevent rashes and troublesome painful pressure sores. This change can often be embarrassing for the person.  Do not make a big deal about it and quietly and gently clean the person without showing any sign of disgust. TIP: We love Cavilon barrier cream which is a 3M product.  This offers excellent protection from bodily fluids whilst moisturising and soothing.

Chest congestion
The person may become congested, chesty and breathing may become noisy as the time goes on.  And, it may help to know that this noisy breathing is usually not upsetting to the person dying, even if it is to family and friends.This normal change is due to the decrease of fluid intake and an inability to cough up normal secretions. Suctioning can distress and be painful for the person and usually only increases the secretions. Try and keep the person in an upright position as much as possible as lying flat can worsen the problem. If you cannot sit him/her up, lie the person on his/her side to allow gravity to drain the secretions. (Always vary the person's position and be careful not to keep them on one side for longer than 2 hours.  Painful pressure sores can appear overnight especially when the person's circulation is slowing down and they become less mobile).

Breathing Pattern Change
The persons regular breathing pattern may change and you may notice the start of a different breathing pace. A particular pattern consists of breathing irregularly, i.e., shallow breaths with periods of no breathing of five to thirty seconds and up to a full minute. This is called Cheyne-Stokes breathing. The person may also experience periods of rapid shallow pant-like breathing. These patterns are very common and indicate decrease in circulation in the internal organs.

Restlessness
The person may make restless and repetitive motions such as pulling at bed linen or clothing. This often happens and is due in part to the decrease in oxygen circulation to the brain and to metabolic changes. Sometimes medication may also cause this restlessness.  Do not interfere with or try to restrain their movements. To have a calming effect, speak in a quiet, natural way, lightly massage the forehead, read to the person, or play some soothing music.

Urine Decrease
The personīs urine output normally decreases and may become dark and concentrated urine. This is due to the decreased fluid intake as well as decrease in circulation through the kidneys.

Fluid and Food Decrease
For most people at this stage, it is quite normal to experience a decrease in appetite and a diminished feeling of thirst. This is a natural occurrence to conserve energy. Force feeding can causes distress and discomfort.  If the person is still fully conscious and you do wish to try offer food, give small amounts of soft food which will be easier to swallow.  Sometimes thin liquids can fall down the throat too quickly and cause choking so it is better to offer food that is soft and liquids that have slight texture (like Yogisip or smoothies) - the person will be able to control the swallowing better. If the person is able to swallow, fluids may be given in small amounts by syringe. Glycerin swabs may help keep the mouth and lips moist and comfortable as you will notice that the mouth and tongue become dry and thick.
TIP:  Lie the person on his/her side in a semi upright position facing you.  Place a towel under their face.  Take a single piece of gauze swab. Open it and roll it onto the back of a spoon or an ice-cream stick/spatula. Moisten this in water mixed with a little baking soda, squeeze it and roll it over the persons tongue and inside of the mouth.  Repeat this until the secretions are removed and the mouth is clean. Repeat every 4 to 6 hours. If the person is unconscious, avoid brushing the teeth with toothpaste and do not squirt fluid in the mouth. Rather use the method above.
Expect the following signs and symptoms as the body prepares itself for the final stage of life;


Withdrawal
The person may seem unresponsive, withdrawn, or in a comatose-like state. This indicates preparation for release, a detaching from surroundings and relationships, and a beginning of letting go. Since hearing remains all the way to the end, speak to your loved one in your normal tone of voice, identifying yourself by name when you speak, hold his or her hand, and say whatever you need to say that will help the person let go.



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