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  • 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
  • More About:

  • Hospice Care
  • Clergy and Faith Communities
  • Additional Links
    Site Index
    Back to Module 12: Last Hours of Living
    Part I: Physiological Changes and Symptom Management During the Dying Process


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


    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



    • 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
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