As death approaches, there are irreversible changes in some of the bodily functions. It is important to understand these physical changes so that the dying person’s comfort is maintained. It is a time of close partnership between the dying person and those taking care of him or her.

Breathing

Changes That May Occur:
The person may breath with his or her mouth open and the mouth may become very dry.
Thick secretions may accumulate in the back of his or her throat. There may be a ”rattling” sound at the back of his or her throat due to these secretions.
Breathing may be fast or slow, deep or shallow.
There is sometimes an absence of breathing for 5-25 seconds. This is not painful for the patient.

What You Can Do:
Use mouth swabs dipped in ice water to swab teeth, gums and tongue.
Prop the person’s head up with pillows.
Give the medications prescribed to dry up secretions.
Oxygen may be used. However, it does not always make the person more comfortable. The mask may increase a person’s agitation.
Always tell the person what you are going to do before doing it. For example, "I am going to wipe your mouth now."

Circulation

Changes That May Occur:
The person’s arms and legs may be cool to the touch.
The arms and legs may look pale or mottled.
The lips, nail beds, arms, and legs may become blue or purple.

What You Can Do:
The change in color and coolness of the person’s arms and legs is not painful.  Turn the person as instructed and gently massage the area on which the person was previously lying.

Confusion

Changes That May Occur:
The person may not be aware of the time of day.
The person may not be able to recognize people, places or familiar objects.
Speech may be slurred or make no sense.

What You Can Do:
Stand where the person can see you when you speak.
Gently remind the person what time of day it is or who you and others are.
Encourage the person to speak slowly.
Do not show your distress at the person’s inability to remember things.

Restlessness

Changes That May Occur:
The person may move about in bed.
The person may pull at the bed linens.
The person may reach out or pick at the air.
Muscle twitching may occur from imbalance in the blood.

What You Can Do:
Elevate bedside rails if there is a danger that the person may fall out of bed.
Do not try to stop the person from picking at the air; this may increase his or her agitation.
Muscle twitches are not painful and no action is needed unless it is affecting the person’s comfort.

Dreams

Changes That May Occur:
The person may talk about contacts with loved ones that have died before them.
The person may have ‘visualizations’ about going on a long trip.

What You Can Do:
Encourage the patient to share their dreams with you.

Eyes

Changes That May Occur:
The person’s eyes may become dry and crusty.
A person who is in a coma may have eyes that are partially or totally open; generally, blinking is absent.

What You Can Do:
Cleanse the eyes with a warm, wet wash cloth to remove any crusted matter.
If the person’s eyes remain wide open, artificial tears can be used periodically to soothe them.
You may try to close the person’s eyes. However, they will usually open again.
Always tell the person what you are going to do before doing it. For example, "I am going to wipe your eyes now."

Fatigue

Changes That May Occur:
The person may feel more tired.
The person will sleep more.

What You Can Do:
You can talk to the person even when in a coma and reassure him or her that you are near.
The person probably hears and understands even if he or she is unable to respond.
If there are things that you have not had a chance to say, you can say them now.

Fever

Changes That May Occur:
The person may run a high fever as the temperature regulating mechanism in the brain fails.
The person may perspire heavily as the fever breaks.
The person may have periods of extreme perspiration even if the body is cool.

What You Can Do:
Notify your nurse if a fever occurs.
You may be instructed to give appropriate medications.
You may need to change the person’s clothes and sheets.
You may need to cover the person if they have the chills or remove the blankets if they are too warm.
A warm sponge bath with a light application of baby powder is soothing.

Bodily Functions

Changes That May Occur:
The person may lose control of his or her bowel and bladder.
The amount of urine or stool may decrease or stop.

What You Can Do:
The nurse and home health aide will show you how to clean, turn and protect the person's skin.

What Not To Do

Do not leave the person alone.
Do not be afraid to touch the patient. It helps the person know that you are there and that you care.
Do not stop giving medications, especially pain medications.
Do not try to force liquids or fluids. As the body shuts down, the need for nourishment decreases.

Call Hospice of the Comforter IF:
Breathing becomes difficult for the person.
The person becomes anxious or afraid.
The person is complaining of pain.
You are afraid.
The person dies. There is no need to call 911. Death is natural and is not an emergency.

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