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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

Loss of Ability to Close Eyes

• Advanced wasting leads to loss of the retro-orbital fat pad, and the orbit falls posteriorly within the orbital socket

• As eyelids are of insufficient length to both extend the additional distance backward and cover the conjunctiva, they may not be able to fully appose

• This may leave some conjunctiva exposed even when the patient is sleeping

• Eyes that remain open can be distressing to onlookers unless the condition is understood

• If conjunctiva remains exposed, maintain moisture by using ophthalmic lubricants, artificial tears, or physiological saline as previously discussed

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Changes in Medication Needs

• As patients approach the last hour of their lives, reassess the need for each medication and minimize the number that the patient is taking

• Leave only those medications to manage symptoms such as pain, breathlessness, excess secretions, and terminal delirium and reduce the risk of seizures

• Choose the least invasive route of administration:

• The buccal mucosa or oral routes first
• The subcutaneous or intravenous routes only if necessary
• The intramuscular route almost never

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