Physiologic Changes |
Signs/Symptoms |
Intervention |
Cardiac and Circulation Changes |
| Decreased blood perfusion |
Skin may become mottled and
discolored. Mottling and cyanosis of the upper extremities appear to
indicate impending death versus such changes in the lower extremities. |
Provide good skin care. Turn
patient every 2-3 hours if this does not cause discomfort. Lotion to
back and extremities. Support extremities with soft pillows. |
| Decreased cerebral perfusion |
Decreased level of consciousness
or terminal delirium.
Drowsiness/disorientation |
Orient patient gently if tolerated
and this is not upsetting. Allow pt. to rest. |
| Decrease in cardiac output and
intravascular volume |
Tachycardia
Hypotension
Central and peripheral cyanosis and peripheral cooling. |
Comfort measures. Space out
activities. |
Urinary function |
|
|
| Decreased urinary output |
Possible urinary incontinence.
Concentrated urine. |
Keep patient clean and dry.
Place a Foley if skin starts to break down or if patient is large and
difficult to change diapers or if caregiver unable to provide diaper
and linen changes. |
Food and Fluids |
| Decreased interest in food and
fluid. |
Weight loss/dehydration |
Do not force fluid or foods.
Provide excellent mouth care. |
| Swallowing difficulties |
Food pocketed in cheeks or mouth/choking
with eating/coughing after eating |
Soft foods and thickened fluids
(e.g. nectar) as tolerated. Stop feeding patient if choking or pocketing
food. |
Skin |
| Skin may become mottled or discolored. |
Patches of purplish or dark pinkish
color can be noted on back and posterior arms/legs. |
Keep sheets clean and dry-avoid
paper chux directly to skin. Apply lotion as tolerated. |
| Decubitus ulcers may
develop from pressure of being bedbound, decreased nutritional status. |
Red spots to bony prominences are
first signs of Stage I decubiti and open sores may develop. |
Relieve pressure to bony prominences
or other areas of breakdown with turning and positioning Q2 hrs if tolerated.
If patient has increased pain or discomfort with position changes, decrease
the frequency.
Special mattress as needed.
Duoderm or specialized skin patch to Stage I-II ulcers. Change Q5-7
days or as needed. Goals of wound care for Stage III and IV decubiti
should be to promote comfort and prevent worsening rather than healing
since healing most likely will not occur.
Consider application of specialized products such as charcoal or
metronidazole paste (compounded) if odors are present. |
Respiratory |
| Retention of secretions in the pharynx
and the upper respiratory tract. |
Noisy respirations - usually no
cough or weak cough. |
Head of bed up at 45 degrees. Can
fold small soft pillow or towel behind neck for extra support. |
| Dyspnea
|
Shortness of breath |
Oxygen at 2-3 liters may help
for some patients and often helps families to feel better. Link
to Dyspnea module |
Cheyne-Stokes respirations
Definition
|
Notable changes in breathing. |
A gentle fan blowing toward the
patient may provide relief.
Educate families that this is normal as the patient is dying. |
General changes |
| Profound weakness and fatigue. |
Drowsy for extended periods. Sleeping
more. |
This is normal. Educate family. |
| Disoriented with respect to time
and a severely limited attention span. |
More withdrawn and detached from
surroundings. May appear to be in a comatose-like state. |
This is normal. Educate family. |
| Patient may speak to persons
who have already died or see places others cannot see. |
Family may think these are hallucinations
or a drug reaction. |
If patient appears frightened
may need to treat with medication. Otherwise, educate family that this
is normal and common. |
