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发帖数: 2300 | 1 No one can predict the moment of death. But physicians and nurses involved
in end-of-life care know that certain symptoms are usually associated with
the body's shutting down. These signs of approaching death are specific to
the natural dying process (apart from the effects of particular illnesses
the person may have).
Not all dying symptoms show up in every person, but most people experience
some combination of the following in the final days or hours:
1. Loss of appetite
Energy needs decline. The person may begin to resist or refuse meals and
liquids, or accept only small amounts of bland foods (such as hot cereals).
Meat, which is hard to digest, may be refused first. Even favorite foods
hold little appeal.
Near the very end of life, the dying person may be physically unable to
swallow.
How to respond: Don't force-feed; follow the person's cues even though you
may be distressed by a loss of interest in eating. Periodically offer ice
chips, a popsicle, or sips of water. Use a moistened warm cloth around the
mouth and apply balm to the lips to keep them moist and comfortable.
2. Excessive fatigue and sleep
The person may begin to sleep the majority of the day and night as
metabolism slows and the decline in food and water contribute to dehydration
. He or she becomes difficult to rouse from sleep. The fatigue is so
pronounced that awareness of immediate surroundings begins to drift.
How to respond: Permit sleep. Avoid jostling the person awake. Assume that
everything you say can be heard, as the sense of hearing is thought to
persist, even when the person is unconscious, in a coma, or otherwise not
responsive.
3. Increased physical weakness
A decline in food intake and lack of energy leads to less energy, even for
activities like lifting one's head or shifting in bed. The person may even
have difficulty sipping from a straw.
How to respond: Focus on keeping the person comfortable.
4. Mental confusion or disorientation
Organs begin to fail, including the brain. Higher-order consciousness tends
to change. "Few conditions leave people hyperaware when they're dying," says
palliative-care physician Ira Byock, author of Dying Well.
The person may not be aware of where he or she is or who else is in the room
, may speak or reply less often, may respond to people who can't be seen in
the room by others (see Passing Away: What to Expect When Witnessing a Loved
One's Death), may seem to say nonsensical things, may be confused about
time, or may act restless and pick at bed linens.
How to respond: Remain calm and reassuring. Speak to the person softly, and
identify yourself when you approach.
5. Labored breathing
Breath intakes and exhales become raggedy, irregular, and labored. A
distinctive pattern called Cheyne-Stokes respiration might be heard: a loud,
deep inhalation is followed by a pause of not breathing (apnea) for between
five seconds to as long as a full minute, before a loud, deep breath
resumes and again slowly peters out.
Sometimes excessive secretions create loud, gurling inhalations and
exhalations that some people call a "death rattle."
How to respond: The stopped breathing or loud rattle can be alarming to
listeners, but the dying person is unaware of this changed breathing; focus
on overall comfort. Positions that may help: the head slightly elevated with
a pillow, sitting up well-supported, or the head or lying body tilted to
the side slightly. Moisten the mouth with a wet cloth and moisturize with
lip balm or petroleum jelly.
If there's a lot of phlegm, allow it to drain naturally from the mouth,
since suctioning it out can increase its quantity. A vaporizer in the room
might help. Some people are given oxygen for comfort. Be a calm, physical
presence, stroking the arm or speaking softly.
6. Social withdrawal
As the body shuts down, the dying person may gradually lose interest in
those nearby. He or she may stop talking or mutter unintelligibly, stop
responding to questions, or simply turn away.
A few days before receding socially for the last time, the dying person
sometimes surprises loved ones with an unexpected burst of alert, attentive
behavior. This can last less than an hour or up to a full day.
How to respond: Be aware that this is a natural part of the dying process
and not a reflection of your relationship. Maintain a physical presence by
touching the dying person and continuing to talk, if it feels appropriate,
without demanding anything back. Treasure an alert interlude if and when it
occurs, because it's almost always fleeting.
7. Changes in urination
Little going in (as the person loses interest in food and drink) means
little coming out. Dropping blood pressure, part of the dying process (and
therefore not treated at this point, in tandem with other symptoms), also
contributes to the kidneys shutting down. The concentrated urine is brownish
, reddish, or tea-colored.
Loss of bladder and bowel control may happen late in the dying process.
How to respond: Hospice medical staff sometimes decides that a catheter is
necessary, although not in the final hours of life. Kidney failure can
increase blood toxins and contribute to a peaceful coma before death. Add a
bed pad when placing fresh sheets.
8. Swelling in the feet and ankles
As the kidneys are less able to process bodily fluids, they can accumulate
and get deposited in areas of the body away from the heart, in the feet and
ankles especially. These places, and sometimes also the hands, face, or feet
, take on a swollen, puffy appearance.
How to respond: Usually no special treatment (such as diuretics) is given
when the swelling seems directly related to the dying process. (The swelling
is the result of the natural death process, not its cause.)
9. Coolness in the tips of the fingers and toes
In the hours or minutes before death, blood circulation draws back from the
periphery of the body to help the vital organs. As this happens, the
extremities (hands, feet, fingers, toes) become notably cooler. Nail beds
may also look more pale, or bluish.
How to respond: A warm blanket can keep the person comfortable, or he or she
may be oblivious. The person may complain about the weight of coverings on
the legs, so keep them loose.
10. Mottled veins
Skin that had been uniformly pale or ashen develops a distinctive pattern of
purplish/reddish/bluish mottling as one of the later signs of death
approaching. This is the result of reduced blood circulation. It may be seen
first on the soles of the feet.
How to respond: No special steps need to be taken.
Note: These general signs of impending death can vary in sequence and
combination from person to person. If a person is on life support (
respirator, feeding tube), the process dying follows can be different. The
signs of death listed here describe a natural dying process. |
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