Modules:

More About:

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

Weakness/Fatigue

• Signs and Symptoms
• Management

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

Weakness/Fatigue

Signs and Symptoms

• Weakness and fatigue usually increase as the patient gets closer to death

• In the last hours of life, it is likely that the patient will not be able to move around in the bed or raise his or her head

• Joints may become uncomfortable if they are not moved

• Continuous pressure on the same area of skin, particularly over bony prominences, will increase the risk of skin ischemia and the development of pressure ulcers

• These may become painful or odoriferous if they become infected


• They are more easily prevented than treated (see Module 10: Common Physical Symptoms)

^top

Management

• At the end of life, fatigue need not be resisted and most treatment to alleviate it can be discontinued (see Module 10: Common Physical Symptoms)

• Patients who are too fatigued to move and have joint position fatigue may require passive movement of their joints every 1 to 2 hours

• To minimize the risk of pressure ulcer formation:

• Turn the patient from side to side every 1 to 1.5 hours


• Protect areas of bony prominence with hydrocolloid dressings and special supports


• A draw sheet can assist caregivers to turn the patient and minimize pain and shearing forces to the skin


• If turning is painful, consider a pressure-reducing surface (air mattress or airbed)


• As the patient approaches death, the need for turning lessens as the risk of skin breakdown becomes less important

• Intermittent massage before and after turning, particularly to areas of contact, can both

• Be comforting
• Reduce the risk of skin breakdown by improving circulation and shifting edema

• Avoid massaging areas of erythema or actual skin breakdown

^top

>continue