The Clinical Guide to Supportive and Palliative Care for HIV/AIDS

A Clinical Guide to Supportive and Palliative Care for HIV/AIDS • Chapter 22: Facilitating the TransitionLoss of Control of Bladder and BowelsAs the body weakens, the amount of urine normally decreases and becomes tea-colored ordarker. The patient may lose control of his or her bladder and/or bowels as the muscles in thatarea begin to relax. The home care or hospice nurse can determine if there is a need to insert orapply an external or internal catheter for comfort. Protective measures such as layering the bedor resting area with pads will prevent frequent linen changes and soiling of furniture. Wearinggloves when handling soiled clothing and linens, and washing hands with soap and water beforeand after personal care, should be demonstrated and instructed. Care should be taken to keepthe patient clean and comfortable. The home care or hospice nurse should teach techniques forcleanliness, universal body fluid precautions, skin care, and monitoring of bowel patterns.Described “Supernatural” ExperiencesIt is common for many people who are getting closer to dying to describe experiences offeeling that they have been in contact with people who have died before. Generally, these experiencesare described as “So and so came to see me” or “I just saw so and so.” Although thesemay not seem believable to many people, they feel very real to the person experiencing them.For people who have significant anxiety about their approaching death, this is often a time whenthey may express feeling less frightened. Often people are reported to be resting better andfeeling calmer with less emotional strain or struggle after describing this type of experience.Energy SurgeIt is very common for caregivers to witness a predictable, significant increase in energy andrestlessness at the very end-of-life. This may occur after a period of extreme weakness and deepsleeping, then suddenly the patient becomes VERY alert. The patient may want to stand, walk,or sit upright in a chair, when they have not done so for days or weeks. Patients may start takingtheir clothes off and on when they normally were quite modest. They may be found standingnaked at the end of the bed. Agitated “picking” at their clothes, bed linens, or the air may also bea sign of this stage. Other times the patient may request specific food, and eat the entire amountwhen they have not eaten more than a spoonful of anything for days.Often this surge of energy confuses and sometimes frightens the individuals closest to the patient.When not educated about the possibility of it occurring, loved ones can interpret thissurge of energy as renewed strength and an answer to prayers for recovery. It is important forfamilies to be educated about this possibility, because it is a potential sign that death may occurwithin the next 24 hours.PEOPLE WITH SPECIAL NEEDSWomenThe greatest percentage of HIV-infected women are mothers of young children under the ageof ten years. Often women learn of their HIV infection during their prenatal care, which meansthey immediately have pregnancy needs as well as needs regarding their HIV status, preventionof HIV transmission to their unborn child, risk reduction education, and the possibility of theirother children being HIV-infected.XXIIU.S. Department of Health and Human Services • Health Resources and Services Administration • HIV/AIDS Bureau 471