End of Life - Taranaki District Health Board

Body temperature and colourPāmahana tinana me te karaThe skin may sweat and still be very cool or very hot totouch. As the heart becomes weaker, circulation fails toadequately reach the hands and feet which causes themto feel cold to touch and change colour. Skin can bepale grey and have a blue/purple tinge (mottled).It does not usually mean that they need extra blankets.It’s a natural occurrence when the body is shutting down.When death has occurred:Inahea te mate i taka• There is no breathing.• The chest does not rise.• There is no heart beat (no pulse).• Sometimes there is release of the bladder or bowel.• Please inform the staff when this has occurred if noone is with you at this time.End of LifeQuestions and AnswersPressure area carePēhinga te tinana tūporeIt is still important for staff to change the personsposition because they may not be able to express theneed to move. Sometimes when people get restlessthey settle with this. It is still very important to preventpressure areas developing in this late stage as these cancause pain and further complications. The nursing staffmay need to administer some pain relief before theychange their position.ContactWhakapāIf you have any questions about changes in conditionplease do not hesitate to talk to one of our team.Taranaki District Health BoardPrivate Bag 2016New PlymouthPhone: 06 753 6139 Extn 7623Fax: 06 753 7770PainMamaeIf you feel the person who is dying is in some discomfortplease inform the nursing staff. We can perform anassessment and administer pain relief if it is needed.If the person cannot talk, there are still signs we canlook for such as facial grimacing, increased respiratoryrate, restlessness or tense limbs.Published: Communications TeamResponsibility: Older Person’s Health and RehabilitationDate Published: July 2012Last Reviewed: July 2012Version: 1TDHB 07-2012Older Person’s Health andRehabilitation ServicesWard One - Inpatient Serviceswww.tdhb.org.nzTaranaki Together, a Healthy CommunityTaranaki Whanui He Rohe Oranga

When confronted with changes that indicate finalstages of living, commonly called “dying”, there aremany questions you may have.How exactly will it happen? How much time is left?These can be difficult questions for health professionalsto answer as every individual is different.Signs of dying with suggested caresNgā whakaaro puaki tūpore mo tetohu mateLooking back, there may have been early signs tosuggest that someone is dying. This can occur overdays, weeks, months. Often this is seen in retrospect,as sometimes these symptoms can also be associatedwith other medical problems that the team had initiallythought could be treated to improve the person’squality of life and comfort. These signs may include:• Increased restlessness, confusion, agitation, “notknowing where to put themselves” i.e. requiringfrequent positional changes.• Withdrawal and reluctance to see visitors.• Increased periods of sleep/lethargy.• Beginning to show periods of pausing in thebreathing when awake or sleeping.• Inability to heal or recover from wounds or infections.• Increased swelling of the extremities or theentire body.• Reporting seeing people who have died or senseimpending death themselves.Food and fluidKai me te waiThey may become less interested and only be ableto tolerate small sips of fluid and small amounts offood. They may lose their ability to swallow properly.We will keep their mouth clean and comfortable byswabbing with sponges and applying moisture to thelips and mouth.Artificial hydration/feeding is not normally given at thisstage as not eating/drinking is a normal process as thebody shuts down. In some patients artificial hydrationcan cause further complications. If you have any morequestions please ask.Bowel and bladderWhēkau me te pukumimiUrine can become darker and more concentrated.Control of their bladder and bowel can be lost.This is managed by using incontinence productsto maintain comfort.Levels of awarenessNgā kōeke mohiotangaPeople who are dying may become less aware of thetime of day or their surroundings, not recognise familiarpeople, or they may see or hear voices that are notthere. If it disturbs them you could reassure them byholding their hand and letting them know you arethere. They will eventually go into a coma (not rouse).RestlessnessTāhurihuriA person can become quite restless and fidgety –making movements like plucking at bed linen orattempting to get out of bed. Let the nurses know andthey can do an assessment to check if there is somethingcausing this such as pain, discomfort from a full bladderor bowel. This restlessness can also be caused bychanges in their metabolism. Sometimes the nurses mayhave to give medication to relieve this symptom if anobvious cause isn’t found.Aromatherapy, music or massage can be used if youfeel comfortable.BreathingWhakahāYou may notice dramatic changes in breathing patternssuch as slow progressing to very fast and then slowagain, or shallow progressing to very deep breathingand occasional gaps between breaths (apneas).There may be a “rattling” noise at the back of thethroat due to a pooling of saliva/phelgm. This does notnormally cause distress to them but can be unsettlingfor you to listen to. Often a change of position ormedication can relieve this symptom. Suctioning theperson can be distressing for them and therefore isnormally avoided.www.tdhb.org.nzTaranaki Together, a Healthy CommunityTaranaki Whanui He Rohe Oranga