Author: Tencent Medical Oncology Editing Group
When death is imminent, certain signs and symptoms can help caregivers predict the death of a patient.
It’s important to note that everyone’s experience at the end of life is different, and what happens to one person may not happen to another.
Also, the presence of one or more of these symptoms does not necessarily mean that the patient is near death.
The signs and symptoms are described below, along with some management suggestions.
One. The patient begins to alienate friends and family
Patients often focus on their innermost thoughts during the last few weeks of life.
This does not necessarily mean the patient is unhappy or frustrated, nor does it mean that they dislike their caregiver. This is due to reduced oxygen supply to the brain, slowed blood flow, or the patient begins to mentally prepare for death.
They may lose interest in people or things they used to like, such as favorite TV shows, friends, and pets.
The caregiver can let the patient know that they will always support him/her, and even if the patient cannot respond, he/she may know and hear.
Expert Advice: It may be helpful to allow patients to do what they want.
If he/she really wants to chat, he or she may want to reminisce about past joys and sorrows, or connect bits and pieces.
Image source: Zhanku Hailuo
Second, the patient’s sleep habits have changed
Patients have frequent drowsiness, increased sleep time, and may remain in intermittent sleep or wake up feeling sleepy.
Worrying and worrying can cause the patient to lose sleep at night, and the caregiver can ask the patient if he or she would like to have someone by his side while he/she sleeps.
As the patient sleeps more and more over time, the caregiver should continue to talk to them, even if he or she is unconscious, but can still hear surrounding sounds .
Three, the patient has uncontrollable pain
As cancer progresses, managing pain becomes more difficult.
It is important to provide pain medication regularly, and caregivers need to consult with a palliative care or pain doctor for the correct use and dosage.
Also, there are other ways to manage pain, such as massage and some relaxation techniques.
4. The patient becomes weaker and weaker
Weakness and fatigue can increase over time.
Patients can go in and out, so they need more help with daily personal care and getting around.
The caregiver should help the patient to save as much energy as possible, because physical strength is very important to them at this time.
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5. The patient has a change in appetite
As the body gradually declines, people with cancer often need less food.
Loss of appetite is caused by the body’s need to conserve energy and the reduced ability of the body to digest and absorb food.
The patient should choose when to eat or drink, and the caregiver may provide small amounts of the patient’s preferred food.
Since chewing requires energy, they may prefer softer foods such as milk, juice, or pudding.
If the patient does not have difficulty swallowing, offer some liquid food, or a straw if they cannot sit up to eat.
Alternatively, help patients keep their lips moist by applying lip balm or wiping the lips with a soft damp cloth.
Six, the patient has a disturbance of consciousness
Towards the end of life, people are often confused or half-awake.
They will not be able to make clear judgments about the time, place, and identities of those around them, and the caregiver can remind the patient in a low voice where they are and who they are with, keeping the patient calm and feeling Peace of mind.
But if the patient is emotional,Caregivers should not try to control them. When the situation is serious, caregivers can inform medical workers and use some treatment methods to help patients control their emotions.
Sometimes a patient will say that he or she can see and even talk to loved ones who have passed away. The patient may mention that he is about to embark on a journey where he can see bright lights, butterflies, or other things that we cannot see.
As long as these things do not upset the patient, the caregiver may wish to ask them to say more. Caregivers can also allow patients to share their expectations and dreams without denying the illusions they see.
The process of dying:
Incontinence may occur due to loose pelvic muscles.
Care staff should provide patients with clean, dry bedding and comfortable personal care items. Disposable pads can be placed on the patient’s bed and replaced when soiled.
In addition, patients may have reduced urine output, dark color, and a distinct odor due to declining kidney function and reduced fluid intake.
Respiratory rates may become fast and slow without the patient noticing, and the caregiver should inform the doctor of these changes.
Also, saliva and mucus in the throat and upper airways can make breathing sounds rattling or gurgling.
Although these symptoms may seem very disturbing, patients generally experience no distress at this stage. The patient’s body can be turned to one side and pillows placed on the back and head, which can help make breathing easier.
If the patient is experiencing shortness of breath, the caregiver may also request the use of a humidifier or oxygen mask from the healthcare provider to help the patient breathe more easily.
The patient’s skin will turn bluish in color and the skin will become cooler due to the slowed blood flow, which is not painful or uncomfortable for the patient.
Caregivers should avoid using electric blankets or heating pads to help keep the patient warm, as this will only cause burns, and a small blanket may be used to help keep the patient warm.
What are the signs that a patient is dying?
No more breathing and no pulse.
The eyeballs are still and stop blinking, the pupils are dilated (dilated), and the eyelids may open slightly.
The jaw is relaxed and the mouth is slightly open.
Incontinence.
Not responding to other people’s touch or words.
The skin becomes pale and cool to the touch.
Image source: Zhanku Hailuo
What should family members do after a patient dies?
Families do not have to rush to arrange funerals after a patient dies. Caregivers and other family members may wish to spend time with the patient’s body.
When the family is ready, take the following steps:
Lay the body flat with its face up and a pillow under the head. A caregiver or family member can remove their dentures or other appliances if needed.
If the deceased was in hospice care, follow the guidance provided by the program.
When the family is ready, call to inform other relatives and friends of the death.
According to local regulations, contact the relevant department for death procedures and contact the funeral home.
Family and friends can help each other through this sad time by comforting each other.
References:
[1] National Cancer Institute (NCI). End-of-Life Care for People Who Have Cancer[DB/OL]. https:https://www.cancer.gov/about -cancer/advanced-cancer/care-choices/care-fact-sheet,2012-05-10/2018-06-29.
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