Final Hours
Similar characteristics, both physical and psychosocial, are seen during the final hours of a patient’s life. These are often divided into two major categories: the preactive phase and the active phase.
PREACTIVE PHASE (7-14 DAYS BEFORE DEATH)
• Need for assistance with activities of daily living
• Bed to chair or bed-bound status
• Disorientation or episodes or near death awareness (talking to or seeing visions)
• Limited food and fluid intake
• Swallowing difficulty, including a need to discontinue or alter the route of medication
• Restless, agitated, withdrawal, loss of bowel and bladder control, withdrawal from family and friends, fear of the dying process or asking when will it be
ACTIVE PHASE (2-3 DAYS BEFORE DEATH)
• Altered vital signs, lowered blood pressure, temperature, abnormal respiratory pattern (apnea, Cheyne-Stokes breathing) present or increasing, rapid heart rate or faded muffled heart sounds
• Decreased level of consciousness
• Cooling and mottling of skin
• Decreased responsiveness to external stimuli
• No or very limited oral intake
• Staring or disconnected viewing of environment
NURSING CONSIDERATIONS BEFORE DEATH
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