The phone rings and you are told something like, “Get the family together. It won’t be long now.” You may wonder how professional caregivers know when a patient is transitioning to death.
By Kevin RR Williams
Ready To Go
Movies portray touching moments of deathbed confessions and resolutions. After cancer has metastasized to vital organs, a patient is often transferred to hospice care. This can be arranged in-home or in-facility. Here, registered nurses and licensed vocational/
Prior to the last 24–48 hours some patients may be somewhat lucid. When nurses see a combination of key symptoms, they realize the somber period called transitioning has arrived.
Signs of The Pre-Active Phase of Dying
The pre-active phase of dying is apparent approximately two weeks prior to death. Not all symptoms are apparent within each patient.
- Increased restlessness, confusion, agitation, inability to stay content in one position and insisting on changing positions frequently (exhausting family and caregivers).
- Withdrawal from active participation in social activities.
- Increased periods of sleep, lethargy.
- Decreased intake of food and liquids.
- Beginning to show periods of pausing in the breathing (apnea) whether awake or sleeping.
- Patient reports seeing persons who had already died.
- Patient states that he or she is dying.
- Patient requests family visit to settle “unfinished business” and tie up “loose ends.”
- Inability to heal or recover from wounds or infections.
- Increased swelling (edema) of either the extremities or the entire body.
Signs of the Active Phase of Dying
The active phase of dying is evident approximately within three days of death. Not all symptoms are apparent within each patient.
- Inability to arouse patient at all (coma) or, ability to only arouse patient with great effort but patient quickly returns to severely unresponsive state (semi-coma).
- Severe agitation in patient, hallucinations, acting “crazy” and not in patient's normal manner or personality.
- Much longer periods of pausing in the breathing (apnea).
- Dramatic changes in the breathing pattern including apnea, but also including very rapid breathing or cyclic changes in the patterns of breathing (such as slow progressing to very fast and then slow again, or shallow progressing to very deep breathing while also changing rate of breathing to very fast and then slow).
- Other very abnormal breathing patterns.
- Severely increased respiratory congestion or fluid buildup in lungs.
- Inability to swallow any fluids at all (not taking any food by mouth voluntarily as well).
- Patient states that he or she is going to die.
- patient breathing through wide open mouth continuously and no longer can speak even if awake.
- Urinary or bowel incontinence in a patient who was not incontinent before.
- Marked decrease in urine output and darkening color of urine or very abnormal colors (such as red or brown).
- Blood pressure dropping dramatically from patient’s normal blood pressure range (more than a 20 or 30 point drop).
- Systolic blood pressure below 70, diastolic blood pressure below 50.
- Patient’s extremities (such as hands, arms, feet and legs) feel very cold to touch.
- Patient complains that his or her legs/feet are numb and cannot be felt at all.
- Cyanosis, or a bluish or purple coloring to the patients arms and legs, especially the feet, knees, and hands).
- Patient’s body is held in rigid unchanging position.
- Jaw drop; the patient’s jaw is no longer held straight and may drop to the side their head is lying towards.
Hospice agencies and nurses can provide palliative care for patients with terminal illness.