Dying process

 

In the days or weeks leading up to death, symptoms gradually appear to give indication that patients may be approaching death and are listed below.

Symtoms of near death:

 

 Increasing fatique and time spent in bed

 Metabolism in the body gradually lowers as the body prepares to enter the final stages of life and may also be due to dehydration (which is not known to cause discomfort to patients). This causes patients to be difficult to rouse from sleep.

 

 Difficulty swallowing 

 Muscles involved in the swallowing reflex may receive reduced stimulation due to impaired neural functions. 

 

 Diminishing output of urine and faeces

 This may be due to reduced intake of food and fluids because the body is no longer able to expend energy to digest  food and the energy requirement lowers. It is important to advise relatives to not force feed because this may cause more harm to patients i.e. aspiration. Furthermore, kidneys begin to fail and hence less urine is produced.

 

 Referral to ideas of travelling

This may be due to confusion or patients mentally preparing for approaching death

 

 

 Cold extremities

 This is due to the body diverting bloodflow to the main organs rather than to the limbs.

 

 Mottled skin

Appearence of the skin appear to be purple or blue due to decreased cardiac output and hence reduced circulation. This may first appear in the soles of the feet.

 

 Confusion and agitation

 Organs (kidneys and liver) may begin to fail so toxins or metabolites accumulate, disturbances in electrolyte levels, hypoxia and infection all contribute to affect higher areas of the brain involved in consciousness.

 

 Cheyne stoke 

This is otherwise known as death rattle and is caused by pooling of secretions in the chest due to diminishing swallow reflex.