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Modules:

  • Introduction
  • 1. Advance Care Planning
  • 2. Communicating Bad News
  • 3. Whole Patient Assessment
  • 4. Pain Management
  • 5. Assisted Suicide Debate
  • 6. Anxiety, Delirium
  • 7. Goals of Care
  • 8. Sudden Illness
  • 9. Medical Futility
  • 10. Common Symptoms
  • 11. Withholding Treatment
  • 12. Last Hours of Living
  • 13. Cultural Issues
  • 14. Religion, Spirituality
  • 15. Legal Issues
  • 16. Social and Psychological

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    Back to Module 12: Last Hours of Living
    Part I: Physiological Changes and Symptom Management During the Dying Process

    Weakness/Fatigue
    Decreasing Appetite/Food Intake, Wasting
    Decreasing Fluid Intake, Dehydration
    Decreasing Blood Perfusion, Renal Failure
    Neurological Dysfunction: An Overview
    Pain
    Loss of Ability to Close Eyes
    Changes in Medication Needs

    Decreasing Blood Perfusion, Renal Failure

    • As cardiac output and intravascular volume decrease toward the end of life, there will be evidence of diminished peripheral blood perfusion
    • Normal symptoms include:
      • Tachycardia
      • Hypotension
      • Peripheral cooling
      • Mottling of the skin (livedo reticularis)
      • Venous blood may pool along dependent skin surfaces
      • Urine output falls as perfusion of the kidney diminishes
      • Oliguria or anuria
    • Parenteral fluids will not reverse this circulatory shut down

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