A bedridden patient continually asks for a drink. Increase and decrease in body temperature

It is not customary to talk about death out loud in our time. This is a very sensitive topic and not for the faint of heart. But there are times when knowledge is very useful, especially if there is a cancer patient or a bedridden elderly person at home. After all, this helps to mentally prepare for the inevitable end and notice the changes taking place in time. Let's discuss together the signs of death of a patient and pay attention to their key features.
Most often, signs of imminent death are classified into primary and secondary. Some develop as a consequence of others. It is logical that if a person begins to sleep more, then he eats less, etc. We will look at all of them. But, cases may be different and exceptions to the rules are acceptable. The same as options for normal median survival even with symbiosis scary signs changes in the patient's condition. This is a kind of miracle that happens at least once in a century.

What signs of death do you know?


Changing sleep and wake patterns
Discussing initial signs As death approaches, doctors agree that the patient has less and less time to stay awake. He is more often immersed in superficial sleep and seems to be dozing. This saves precious energy and reduces pain. The latter fades into the background, becoming, as it were, background. Of course, the emotional side suffers greatly. The paucity of expression of one’s feelings, the self-isolation of the desire to remain silent more than to speak leave an imprint on relationships with others. The desire to ask and answer any questions, to be interested in everyday life and the people around you disappears.
As a result, in advanced cases, patients become apathetic and detached. They sleep almost 20 hours a day unless there is acute pain or serious irritating factors. Unfortunately, such an imbalance threatens stagnant processes, mental problems and accelerates death.

Swelling

Edema appears on the lower extremities

Very reliable signs death is swelling and the presence of spots on the legs and arms. We are talking about malfunctions of the kidneys and circulatory system. In the first case of oncology, the kidneys do not have time to cope with toxins and they poison the body. At the same time, metabolic processes, the blood is redistributed unevenly in the vessels, forming areas with spots. It’s not for nothing that they say that if such marks appear, then we're talking about about complete dysfunction of the limbs.

Problems with hearing, vision, perception

The first signs of death are changes in hearing, vision and normal feeling happening around. Such changes can occur against the background of severe pain, cancer, blood stagnation or tissue death. Often, before death, you can observe a phenomenon with the pupils. The eye pressure drops and when pressed you can see how the pupil is deformed like a cat's.
Regarding hearing, everything is relative. He can recover in last days life or even worsen, but this is more agony.

Reduced need for food

Deterioration of appetite and sensitivity are signs of imminent death

When a cancer patient is at home, all her loved ones note the signs of death. She gradually refuses food. First, the dose decreases from a plate to a quarter of a saucer, and then the swallowing reflex gradually disappears. There is a need for nutrition through a syringe or tube. In half of the cases, a system with glucose and vitamin therapy is connected. But the effectiveness of such support is very low. The body tries to use up its own fat reserves and minimize waste. This worsens the patient’s general condition, causing drowsiness and difficulty breathing.
Urinary problems and problems with natural needs
It is believed that problems with going to the toilet are also signs of approaching death. No matter how funny it may seem, in reality there is a completely logical chain in this. If defecation is not carried out once every two days or with the regularity to which a person is accustomed, then feces accumulate in the intestines. Even stones can form. As a result, toxins are absorbed from them, which seriously poison the body and reduce its performance.
It's about the same story with urination. It's harder for the kidneys to work. They allow less and less fluid to pass through and eventually the urine comes out saturated. It contains a high concentration of acids and even blood is noted. For relief, a catheter can be installed, but this is not a panacea in the general context. unpleasant consequences for a bedridden patient.

Problems with thermoregulation

Weakness is a sign of imminent death

Natural signs before the death of a patient are impaired thermoregulation and agony. The limbs begin to get very cold. Especially if the patient has paralysis, then we can even talk about the progress of the disease. The blood circulation decreases. The body fights for life and tries to maintain the functioning of the main organs, thereby depriving the limbs. They may turn pale and even become blue with venous spots.

Weakness of the body

Signs near death Everyone's may be different depending on the situation. But more often than not, it's about severe weakness, weight loss and general fatigue. A period of self-isolation is approaching, which is getting worse internal processes intoxication and necrosis. The patient cannot even raise his arm or stand on a duck for natural needs. The process of urination and defecation can occur spontaneously and even unconsciously.

Foggy mind

Many see signs of impending death in the way the patient’s normal reaction to the world. He can become aggressive, nervous, or vice versa – very passive. Memory disappears and attacks of fear may occur due to this. The patient does not immediately understand what is happening and who is nearby. The areas in the brain responsible for thinking die. And obvious inadequacy may appear.

Predagonia

This is a protective reaction of all vital systems in the body. Often, it is expressed in the onset of stupor or coma. Regression plays a major role nervous system which calls in the future:
- decreased metabolism
- insufficient ventilation of the lungs due to breathing failures or alternating rapid breathing with stopping
- serious damage to organ tissue

Agony

Agony is characteristic of the last minutes of a person’s life

Agony is usually called a clear improvement in the patient’s condition against the background of destructive processes in the body. Essentially, these are the last efforts to maintain the necessary functions for continued existence. May be noted:
- improved hearing and restored vision
- adjusting breathing rhythm
- normalization of heart contractions
- restoration of consciousness in the patient
- muscle activity like cramps
- decreased sensitivity to pain
The agony can last from several minutes to an hour. Usually, she seems to foreshadow clinical death when the brain is still alive, and oxygen ceases to flow into the tissues.
These are typical signs of death in bedridden people. But you shouldn’t dwell too much on them. After all, there may be another side of the coin. It happens that one or two such signs are simply a consequence of an illness, but they are completely reversible with proper care. Even a hopelessly bedridden patient may not have all these signs before death. And this is not an indicator. So, it is difficult to talk about mandatory rules, as well as to impose death sentences.

From this article you will learn:

    Why does an elderly person refuse to eat?

    What are the consequences of not eating in old age?

    Which doctor should I contact to find out the reason for refusing to eat?

    How to help older people improve their appetite

    How to feed a bedridden patient if he refuses to eat

A healthy person, regardless of age, has a normal appetite. Various reasons, not always pathological nature, can lead to its decrease. This may also be a temporary decrease in appetite that does not require special attention, but, unfortunately, very often this is a symptom of a serious, and sometimes dangerous disease. Therefore, if an elderly person refuses to eat, you should not immediately blame everything on his age. This serious reason for concern.

Why does an elderly person refuse to eat?


A decrease or complete lack of appetite in an elderly person can be caused by the following reasons:

    pathologies of the gastrointestinal tract (GIT);

    endocrine diseases;

    oncology;

    senile dementia, mental disorders;

    acute infectious diseases;

    consequences of emotional or psychological trauma;

    side effects of medications;

    bad habits (tobacco smoking, alcohol abuse);

    acute respiratory diseases;

    incorrect diet.

Everyone knows that, in addition to fats, proteins and carbohydrates, which serve to build organs and supply them with energy, with food the body also receives the microelements and vitamins it needs to maintain normal life functions. Complete refusal of food, as well as poor nutrition can lead to serious consequences.

It has been noticed that if a bedridden patient does not eat for a long time, then the chances of his recovery decrease exponentially.

The very state of loss or sharp decline appetite, as a rule, is a symptom of many diseases, including the following:

    Stomatitis;

  1. Pancreatitis;

  2. Pneumonia;

    Oncology.

If it is confirmed that the cause of the deterioration in appetite is one or another disease, you should immediately consult a doctor and begin treatment under his supervision.

Consequences of malnutrition in an elderly person


The first thing that catches your eye when an elderly person refuses to eat is weight loss and exhaustion. In such cases, doctors artificially supplement the bedridden patient with nutritional mixtures. However, this cannot solve the problem radically. The old man’s body weight, although not so rapidly, is still decreasing.

Weight loss due to lack or complete absence food, in turn, leads to a slowdown in metabolism cellular level and dystrophic changes in organs. Physical activity quickly depletes the body of an elderly person who is constantly experiencing an energy deficit. It's not even enough to keep warm own body. In the end, his appetite disappears completely, and the old man stops drinking.

If you refuse to eat and lose weight, the pancreas cannot cope with the load and is unable to produce sufficient quantity insulin, which leads to hyperglycemia.

Besides, bone structures They begin to put more pressure on the skin, which causes poor circulation and increases the rate of formation of bedsores.

In this case, an elderly person, in order to gain weight again and return it to normal, needs to eat, strictly following special diets that allow the body to gradually increase its ability to absorb substances. This Long procces, requiring significant effort from the patient. And not every patient, depending on the severity of his condition, will have enough time and the body’s capabilities to fully recover.

Which doctor should you contact if an elderly person refuses to eat?


Medical care provided to elderly patients can only be considered effective when the cause of the problem can be eliminated. Below is short list diseases that cause loss of appetite in older people, as well as a list of specialists who should be contacted in each specific case.

    Diseases of the gastrointestinal tract (for example, dysbiosis, peptic ulcer, gastritis, inflammation of the pancreas or gall bladder, intestinal obstruction and others). In this case, you should contact a physician, gastroenterologist or hepatologist. Surgical help may also be needed.

    At diabetes mellitus, diseases thyroid gland and other organs endocrine system you need to seek help from an endocrinologist. The specialist will prescribe the necessary treatment and create an individual diet.

    At oncological pathologies As a rule, surgery is used in combination with radiation and chemotherapy. The patient must be under the supervision of an oncologist.

    In cases of acute intestinal infections such as salmonellosis, dysentery, food poisoning Staphylococcus infections are usually treated with antibiotics. Treatment can be prescribed by an infectious disease doctor.

    Therapy for depression, mental disorders, and loss of appetite due to bad habits are dealt with by psychologists, psychiatrists and narcologists, respectively.

How to improve appetite for an elderly person


Older people often refuse to eat. And the reason for this may be simple mistrust. If someone who is not very close, or even not at all, tries to feed an old man stranger, he most likely will not eat.

In this case, you need to make sure that the elderly person is fed by a relative or friend whom he trusts. It is important to establish contact with the patient, try to explain to him what will happen if he continues to refuse to drink and eat.

If you can’t persuade the old man, call a doctor to prescribe psychotropic drugs that neutralize nervous disorders.

If the reason that an elderly person refuses to eat is mental disorder, then after taking such medications, patients’ appetite is quickly restored.

If the cause is not a nervous disorder, but is caused by old age, it is necessary to administer 4-8 units of insulin. This drug stimulates appetite.

If even after this the old man does not start eating, 20 to 40 milliliters of glucose are prescribed intravenously to maintain his vital functions.

Remember that you cannot force feed a patient. By any means, you need to find the reason why an elderly person refuses to eat.

If, however, it is not possible to restore the appetite of an elderly person within two to three days, then solutions should be administered parenteral nutrition: “Aminoven”, “Glutargin”, “Infezol”, “Nutriflex”.

Methods of increasing appetite are known and successfully practiced in senior centers and some intensive care units. The first is to increase the portion daily by one or two spoons. The second is the introduction of thirst-stimulating foods to the menu, for example, pickles. Increasing the amount of water consumed per day provokes appetite. The second method can be used if the patient has no special dietary restrictions and drinks little.

Some patients, by dreaming about their favorite dish, themselves stimulate an increase in appetite, so try to ask the elderly person more often about what he would like to eat. You should not force feed a bedridden patient if he sleeps a lot. This most likely indicates that the body is trying to regain strength.

Often after serious poisoning, as well as in cases of dehydration, patients have no appetite, but have severe thirst. They drink water and eat nothing at all. In such cases, you should not limit a person’s drinking. This is the body trying to restore itself water balance. When thirst decreases, the patient himself will want to eat.

How to feed an elderly bedridden patient if he refuses to eat


A patient in a hospital is under constant supervision of specialists who monitor the level of protein in the blood and are able to take timely measures to organize additional nutrition with protein mixtures and provide the body with the right amount of water. But if an elderly person refuses to eat and/or drink while at home, they should immediately consult a doctor.

If a bedridden patient drinks more than five liters of water a day, he can harm his body. Such thirst is associated with some kind of pathology and must be controlled. Water consumption is considered normal at a level of one to three liters per day. But if an elderly person has no appetite, this is also a reason to consult a doctor.


If the patient does not eat or drink at all, there are ways to feed him without causing inconvenience:

    Tube feeding.

A feeding tube is inserted through the old man's nose so that the tube enters the stomach, and the old man begins to receive the necessary food in the form of mixtures. This is the most common method and may be the main one.

    Gastrostomy.

A gastrostomy is an opening with a feeding tube in the wall of the stomach that communicates with the external environment. It is installed when it is impossible to insert a probe, for example, due to injuries or diseases of the nasal passages, trachea or esophagus. The feeding tube has small sizes. It is placed for a period of several months to one year. Through a gastrostomy tube, an elderly person can be fed both nutritional mixtures and soups and liquid porridges.

    Parenteral nutrition.

This method is used when it is impossible to feed an old person by mouth or through a tube. For example, when surgical interventions affecting digestive system(removal of the stomach, part of the intestine). Parenteral is feeding the patient with liquid mixtures of fats, amino acids, vitamins and vital microelements. The composition is administered intravenously. To avoid fat embolism, it is given to the body through an IV. In this case, the calculation of the required calories must be done strictly individually.

Thus, if an elderly person completely or partially refuses to eat, he needs to be given medical care. Currently developed and used various ways feeding the patient if he does not eat or drink at all or is unable to drink due to an underlying disease required amount calories.

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    A person's life journey ends with his death. You need to be prepared for this, especially if there is a bedridden patient in the family. The signs before death will be different for each person. However, observational practice shows that it is still possible to distinguish a number common symptoms, which foreshadow the approach of death. What are these signs and what should you prepare for?
    which predict the approach of death. What are these signs and what should you prepare for?

    How does a dying person feel?

    A bedridden patient usually experiences mental anguish before death. A healthy consciousness is an understanding of what is to be experienced. The body experiences certain physical changes, this cannot be ignored. On the other hand, the emotional background also changes: mood, mental and psychological balance.

    Some people lose interest in life, others completely withdraw into themselves, and others may fall into a state of psychosis. Sooner or later, the condition worsens, the person feels that he is losing his own dignity, more often thinks about a quick and easy death, and asks for euthanasia. These changes are difficult to observe without being indifferent. But you will have to come to terms with this or try to alleviate the situation with medications.

    As death approaches, the patient sleeps more and more, showing apathy towards the world around him. In the last moments there may be a sharp improvement in the condition, it comes to the point that the lying for a long time the patient tries to get out of bed. This phase is replaced by subsequent relaxation of the body with an irreversible decrease in the activity of all body systems and the attenuation of its vital functions.

    Bedridden patient: 10 signs that death is near

    At the end of the life cycle, an elderly person or a bedridden patient increasingly feels weak and tired due to lack of energy. As a result, he is increasingly in a state of sleep. It can be deep or a slumber through which voices are heard and the surrounding reality is perceived.

    A dying person can see, hear, feel and perceive things and sounds that do not really exist. In order not to disturb the patient, do not deny. Disorientation and confusion may also occur. The patient becomes more and more immersed in himself and loses interest in the reality around him.

    Urine darkens due to kidney failure Brown with a reddish tint. As a result, swelling appears. The patient's breathing quickens, it becomes intermittent and unstable.

    Under pale skin, as a result of impaired blood circulation, dark “walking” venous spots appear that change location. They usually appear first on the feet. In the last moments, the limbs of a dying person become cold due to the fact that the blood, overflowing from them, is redirected to more important parts of the body.

    Failure of life support systems

    Distinguish primary signs, appearing on initial stage in organism dying person, and secondary, indicate the development of irreversible processes. Symptoms may be external manifestation or be hidden.

    Gastrointestinal tract disorders

    How does a bedridden patient react to this? Signs before death associated with loss of appetite and changes in the nature and amount of food consumed, manifested by problems with stool. Most often, constipation develops against this background. It becomes increasingly difficult for the patient to empty the intestines without a laxative or enema.

    Patients spend the last days of their lives completely refusing food and water. Don't worry too much about this. It is believed that when dehydrated, the body increases the synthesis of endorphins and anesthetics, which to a certain extent improve overall well-being.

    Functional disorders

    How does the condition of patients change and how does a bedridden patient react to this? Signs before death associated with weakening of the sphincters; in the last few hours of a person’s life, fecal and urinary incontinence is manifested. In such cases, you must be prepared to provide him with hygienic conditions using absorbent underwear, diapers or nappies.

    Even with an appetite, there are situations when the patient loses the ability to swallow food, and soon water and saliva. This may lead to aspiration.

    In case of severe exhaustion, when eyeballs severely sunken, the patient is unable to completely close his eyelids. This has a depressing effect on those around you. If the eyes are constantly open, the conjunctiva must be moisturized special ointments or saline solution.

    Impaired breathing and thermoregulation

    What are the symptoms of these changes if the patient is bedridden? Signs before death in a weakened person unconscious manifest themselves as terminal tachypnea - against the background of frequent breathing movements hear death rattles. This is due to the movement of mucous secretion in the large bronchi, trachea and pharynx. This situation is quite normal for a dying person and does not cause him suffering. If it is possible to place the patient on his side, wheezing will be less pronounced.

    The beginning of the death of the part of the brain responsible for thermoregulation is manifested by jumps in the patient’s body temperature in the critical range. He may feel hot flashes and sudden cold. Your limbs get cold, your skin becomes sweaty and changes color.

    Road to death

    Most patients die quietly: gradually losing consciousness, in their sleep, or falling into a coma. Sometimes in such situations they say that the patient passed away along the “usual path.” It is generally accepted that in this case, irreversible neurological processes occur without significant deviations.

    A different picture is observed with agonal delirium. In this case, the patient’s movement towards death will take place along a “difficult road”. Signs before death in a bedridden patient who has taken this path: psychosis with excessive excitement, anxiety, disorientation in space and time against a background of confusion. If there is a clear inversion of the cycles of wakefulness and sleep, then this condition can be extremely difficult for the patient’s family and relatives.

    Delirium with agitation is complicated by a feeling of anxiety, fear, and often turns into a need to go somewhere or run. Sometimes this is speech anxiety, manifested by an unconscious flow of words. A patient in this state can only perform simple actions, without fully understanding what he is doing, how and why. The ability to reason logically is impossible for him. These phenomena are reversible if the cause of such changes is identified in time and treated with medication.

    Painful sensations

    Before death, what symptoms and signs in a lying patient indicate physical suffering?

    In general, uncontrollable pain rarely worsens in the last hours of a dying person's life. However, it is still possible. An unconscious patient will not be able to let you know about this. Nevertheless, it is believed that pain even in such cases brings excruciating suffering. A sign of this is usually a tense forehead and deep wrinkles appear on it.

    If, upon examination of an unconscious patient, there is a suggestion that pain is developing, the doctor usually prescribes opiates. You should be careful, as they can accumulate and over time intensify an already difficult situation due to the development of excessive excitement and convulsions.

    Giving help

    A bedridden patient may experience significant suffering before death. Relief of symptoms of physiological pain can be achieved drug therapy. Mental suffering and psychological discomfort of the patient, as a rule, become a problem for relatives and close family members of the dying person.

    Experienced doctor at assessment stage general condition the patient can be recognized by him initial symptoms irreversible pathological changes in cognitive processes. This is, first of all: absent-mindedness, perception and understanding of reality, adequacy of thinking when making decisions. You can also notice disturbances in the affective function of consciousness: emotional and sensory perception, attitude to life, the relationship of the individual with society.

    The choice of methods to relieve suffering, the process of assessing chances and possible results in the presence of the patient, in some cases it can itself serve therapeutic agent. This approach gives the patient a chance to really realize that he is sympathized with, but is perceived as a capable person with the right to vote and choice. possible ways resolution of the situation.

    In some cases, a day or two before the expected death, it makes sense to stop taking certain medications: diuretics, antibiotics, vitamins, laxatives, hormonal and hypertensive drugs. They will only increase suffering and cause inconvenience to the patient. Painkillers, anticonvulsants, antiemetics, and tranquilizers should be left.

    Communication with a dying person

    How should relatives who have a bedridden patient behave?

    Signs of approaching death can be obvious or conditional. If there is the slightest prerequisite for a negative forecast, you should prepare in advance for the worst. Listening, asking, trying to understand nonverbal language patient, it is possible to determine the moment when changes in his emotional and physiological state indicate the rapid approach of death.

    Whether the dying person knows about it is not so important. If he realizes and perceives, it makes the situation easier. You should not give false promises and empty hopes about his recovery. It is necessary to make it clear that his last will will be fulfilled.

    The patient should not remain isolated from active cases. It’s bad if there is a feeling that something is being hidden from him. If a person wants to talk about the last moments of his life, then it is better to do this calmly than to hush up the topic or complain about stupid thoughts. A dying person wants to understand that he is not alone, that they will take care of him, that suffering will not affect him.

    At the same time, relatives and friends need to be prepared to show patience and provide all possible assistance. It is also important to listen, let them talk, and offer words of comfort.

    Drug assessment

    Do you need to tell the whole truth to relatives whose family has a bedridden patient before death? Signs of this condition?

    There are situations when the family of a terminally ill patient, being unaware of his condition, literally spends their last savings in the hope of changing the situation. But even the most flawless, most optimistic treatment plan may not produce results. It will happen that the patient will never get back on his feet and will not return to active life. All efforts will be in vain, expenses will be useless.

    Relatives and friends of the patient, in order to provide care in the hope of a quick recovery, quit their jobs and lose their source of income. Trying to ease the suffering, they put the family in a difficult situation. financial position. Relationship problems arise, unresolved conflicts due to lack of funds, legal issues- all this only aggravates the situation.

    Knowing the symptoms of imminent death, seeing irreversible signs physiological changes, experienced doctor must inform the patient's family about this. By being aware and understanding the inevitability of the outcome, they will be able to focus on providing him with psychological and spiritual support.

    Palliative care

    Do relatives who have a bedridden patient in their family need help before they die? What symptoms and signs of the patient indicate that they should seek help?

    Palliative care for a patient is not aimed at prolonging or shortening his life. Its principles affirm the concept of death as a natural and natural process in the life cycle of any person. However, for patients incurable disease, especially in its progressive stage, when all treatment options have been exhausted, the question of medical and social assistance is raised.

    First of all, you need to apply for it when the patient no longer has the opportunity to manage active image there are no conditions in life or in the family to ensure this. In this case, attention is paid to alleviating the suffering of the patient. At this stage, not only the medical component is important, but also social adaptation, psychological balance, peace of mind the patient and his family.

    A dying patient needs not only attention, care and normal living conditions. Psychological relief is also important for him, alleviation of experiences associated, on the one hand, with the inability to independently care, and on the other, with the awareness of the fact that imminent death is imminent. Prepared nurses and doctors in palliative clinics master the subtleties of the art of alleviating such suffering and can provide significant assistance to terminally ill people.

    Predictors of death according to scientists

    What should relatives who have a bedridden patient expect?

    Symptoms of approaching death of a person, “eaten” cancerous tumor, were documented by palliative care clinic staff. According to observations, not all patients showed obvious changes in their physiological state. A third of them showed symptoms or their recognition was conditional.

    But in most terminally ill patients, a marked decrease in response to verbal stimulation could be noted three days before death. They did not react to simple gestures and did not recognize the facial expressions of the staff communicating with them. The “smile line” in such patients was lowered, and an unusual sound of the voice was observed (groaning connection).

    In addition, some patients had hyperextension of the neck muscles (increased relaxation and mobility of the vertebrae), non-reactive pupils were observed, and patients could not close their eyelids tightly. From the obvious functional disorders bleeding was diagnosed gastrointestinal tract(in the upper sections).

    According to scientists, the presence of half or more of these signs may most likely indicate poor prognosis for the patient and his sudden death.

    Folk signs and beliefs

    In the old days, our ancestors paid attention to the behavior of a dying person before death. The symptoms (signs) of a bedridden patient could foresee not only death, but also the future prosperity of his family. So, if in the last moments a dying person asked for food (milk, honey, butter) and relatives gave it, then this could affect the future of the family. There was a belief that the deceased could take wealth and success with him.

    It was necessary to prepare for imminent death if the patient obvious reasons shuddered violently. It was believed that it was death that looked into his eyes. Also a sign close care from life there was a cold and pointed nose. It was believed that it was his death that held the candidate in the last days before his death.

    The ancestors were convinced that if a person fatal disease turns away from the light and most time lies facing the wall, he is on the threshold into another world. If he suddenly felt relief and asked to be transferred to his left side, then this is a sure sign of imminent death. Such a person will die without suffering if the windows and doors in the room are opened.

    Bedridden patient: how to recognize the signs of impending death?

    Relatives of a dying patient at home should be aware of what they may encounter in the last days, hours, minutes of his life. It is impossible to accurately predict the moment of death and how everything will happen. Not all of the symptoms and symptoms described above may be present before the death of a bedridden patient.

    The stages of dying, like the processes of the birth of life, are individual. No matter how difficult it is for relatives, you need to remember that it is even more difficult for a dying person. Close people need to be patient and provide the dying person with the maximum possible conditions, moral support and attention and care. Death is an inevitable outcome of the life cycle, and this cannot be changed.

    If you are dying or caring for someone who is dying, you may have questions about what the dying process will be like physically and emotionally. The following information will help you answer some questions.

    Signs of approaching death

    The process of dying is as diverse (individual) as the process of birth. Impossible to predict exact time death, and how exactly the person will die. But people who are on the verge of death experience a lot similar symptoms, regardless of the type of disease.

    As death approaches, a person may experience some physical and emotional changes, such as:

      Excessive drowsiness and weakness, at the same time periods of wakefulness decrease, energy fades.

      Breathing changes, periods of rapid breathing are replaced by pauses in breathing.

      Hearing and vision change, for example, a person hears and sees things that others do not notice.

      Appetite worsens, the person drinks and eats less than usual.

      Changes in urinary and gastrointestinal systems. Your urine may turn dark brown or dark red, and you may have bad (difficult) stools.

      Body temperature changes, ranging from very high to very low.

      Emotional changes, the person is not interested outside world and individual parts Everyday life such as time and date.

    A dying person may experience other symptoms depending on the disease. Talk to your doctor about what you can expect. You can also contact the program for helping the hopelessly ill, where all your questions regarding the dying process will be answered. The more you and your loved ones know, the more prepared you will be for this moment.

      Excessive drowsiness and weakness associated with approaching death

    As death approaches, a person sleeps more and it becomes more and more difficult to wake up. Periods of wakefulness are becoming shorter and shorter.

    As death approaches, people caring for you will notice that you are unresponsive and that you are in very deep sleep. This condition is called coma. If you are in a coma, you will be tied to your bed and all your physiological needs(bathing, turning, feeding and urinating) will need to be supervised by someone else.

    General weakness is a very common occurrence as death approaches. It is normal for a person to need assistance with walking, bathing, and going to the toilet. Over time, you may need help turning over in bed. Medical equipment such as wheelchairs, a walker or a hospital bed can be of great help during this period. This equipment can be rented from a hospital or care center for the terminally ill.

      Respiratory changes as death approaches

    As death approaches, periods rapid breathing may be followed by periods of breathlessness.

    Your breath may become wet and congested. This is called the "death rattle." Changes in breathing usually happen when you are weak and normal discharge your airways and lungs cannot escape.

    Although noisy breathing may be a signal to your family, you probably won't feel any pain or notice any congestion. Since the fluid is deep in the lungs, it is difficult to remove it. Your doctor may prescribe oral tablets(atropines) or patches (scopolamine) to reduce congestion.

    Your loved ones may turn you on your other side to help the discharge come out of your mouth. They can also wipe this discharge with a damp cloth or special tampons (you can ask for it at a help center for the hopelessly ill or buy it at pharmacies).

    Your doctor may prescribe oxygen therapy to relieve your shortness of breath. Oxygen therapy will make you feel better, but will not prolong your life.

      Changes in vision and hearing as death approaches

    Visual impairment is very common in last weeks life. You may notice that your vision has become difficult. You may see or hear things that no one else notices (hallucinations). Visual hallucinations are common before death.

    If you are caring for a dying person who is hallucinating, you need to reassure them. Acknowledge what the person sees. Denying hallucinations can be distressing to a dying person. Talk to the person, even if he or she is in a coma. It is known that dying people can hear even when they are in a deep coma. People who came out of comas said that they could hear the entire time they were in the coma.

      Hallucinations

    Hallucinations are the perception of something that is not actually there. Hallucinations can involve all the senses: hearing, seeing, smelling, tasting or touching.

    The most common hallucinations are visual and auditory. For example, a person may hear voices or see objects that another person cannot see.

    Other types of hallucinations include gustatory, olfactory and tactile.

    Treatment for hallucinations depends on the cause.

      ChangesappetiteWithapproachingof death

    As death approaches, you are likely to eat and drink less. This is associated with a general feeling of weakness and a slower metabolism.

    Since food has such important social significance, it will be difficult for your family and friends to watch you not eat. However, changes in metabolism mean that you do not need the same amount of food and fluid as before.

    You can consume small amounts of food and liquid as long as you are active and able to swallow. If swallowing is a problem for you, you can prevent thirst by moistening your mouth with a damp cloth or a special swab (available at a pharmacy) soaked in water.

      Changes in the urinary and gastrointestinal systems as death approaches

    Often the kidneys gradually stop producing urine as death approaches. As a result, your urine turns dark brown or dark red. This is due to the inability of the kidneys to properly filter urine. As a result, the urine becomes very concentrated. Its quantity is also decreasing.

    As appetite decreases, some changes also occur in the intestines. The stool becomes harder and more difficult to pass (constipation) as the person takes in less fluid and becomes weaker.

    You should tell your doctor if you have bowel movements less than once every three days or if your bowel movements cause you discomfort. Stool softeners may be recommended to prevent constipation. You can also use an enema to cleanse your colon.

    As you become increasingly weak, it is natural that you find it difficult to control bladder and intestines. They may put it in your bladder urinary catheter as a means of continuous drainage of urine. Also, the program for helping hopelessly ill patients can provide toilet paper or underwear (these can also be purchased at the pharmacy).

      Changes in body temperature as death approaches

    As death approaches, the area of ​​the brain responsible for regulating body temperature begins to function poorly. You may have a high fever and then feel cold within a minute. Your hands and feet may feel very cold to the touch and may even become pale and blotchy. Changes in skin color are called mottled skin lesions and are very common in the last days or hours of life.

    The person caring for you can monitor your temperature by rubbing your skin with a wet, slightly warm washcloth or giving you the following medications:

      Acetaminophen (Tylenol)

      Ibuprofen (Advil)

      Naproxen (Aleve).

    Many of these medications are available in the form rectal suppositories if you have difficulty swallowing.

      Emotional changes as death approaches

    Just as your body prepares physically for death, you must prepare for it emotionally and mentally.

    As death approaches, you may lose interest in the world around you and certain details of daily life, such as the date or time. You may withdraw into yourself and communicate less with people. You may only want to communicate with a few people. This kind of introspection can be a way of saying goodbye to everything you knew.

    In the days before your death, you may enter a unique state of conscious awareness and communication that may be misinterpreted by your family and friends. You can talk about how you need to go somewhere - “go home” or “go somewhere.” The meaning of such conversations is unknown, but some people think that such conversations help prepare for death.

    Events from your recent past may be mixed with distant events. You can remember very long ago events in great detail, but not remember what happened an hour ago.

    You may be thinking about people who have already died. You may say that you heard or saw someone who has already died. Your loved ones may hear you talking to the deceased person.

    If you are caring for a dying person, you may be upset or frightened by this strange behavior. You may want to bring your loved one back to reality. If this kind of communication is bothering you, talk to your doctor to better understand what's going on. Your close person may fall into a state of psychosis, and it may be scary for you to watch. Psychosis occurs in many people before death. It may have one cause or be the result of several factors. Reasons may include:

      Medicines such as morphine, sedatives and painkillers, or taking too much of a medicine that doesn't work well together.

      Metabolic changes associated with high temperature or dehydration.

      Metastasis.

      Deep depression.

    Symptoms may include:

      Revival.

      Hallucinations.

      Unconscious state, which is replaced by revival.

    Delirium tremens can sometimes be prevented by using alternative medicine, such as relaxation and breathing techniques, and other methods that reduce the need for sedatives.

    Pain

    Palliative care can help you relieve physical symptoms associated with your illness, such as nausea or difficulty breathing. Controlling pain and other symptoms is an important part of your treatment and improving your quality of life.

    How often a person feels pain depends on their disease. Some fatal diseases, such as bone cancer or pancreatic cancer, can be accompanied by severe physical pain.

    A person may become so afraid of pain and other physical symptoms that they may consider physician-assisted suicide. But the pain before death can be effectively dealt with. You should tell your doctor and loved ones about any pain. There are many medications and alternative methods (such as massage) that can help you cope with the pain of death. Be sure to ask for help. Ask a loved one to tell the doctor about your pain if you are unable to do so yourself.

    You may want your family not to see you suffer. But it is very important to tell them about your pain if you cannot bear it so that they see a doctor immediately.

    Spirituality

    Spirituality means a person's awareness of the purpose and meaning of his life. It also denotes a person's relationship with higher powers or energy that gives meaning to life.

    Some people don't think about spirituality often. For others, it is part of everyday life. As you approach the end of your life, you may be faced with your own spiritual questions and challenges. Connecting with religion often helps some people achieve comfort before death. Other people find solace in nature, social work, strengthening relationships with loved ones, or creating new relationships. Think about what can give you peace and support. What questions concern you? Seek support from friends, family, programs, and spiritual guides.

    Caring for a dying relative

    Physician-assisted suicide

    Physician-assisted suicide refers to the practice of medical professionals assisting a person who voluntarily chooses to die. This is usually done by prescribing a lethal dose of medication. Although the doctor indirect way participates in the death of a person, he is not its direct cause. Oregon is currently the only state to have legalized physician-assisted suicide.

    A person with a terminal illness may consider suicide with the assistance of a physician. Among the factors that can cause such a decision are severe pain, depression and fear of dependence on other people. A dying person may consider himself a burden to his loved ones and not understand that his loved ones want to provide him with their help as an expression of love and sympathy.

    Often a person with a terminal illness contemplates suicide with the assistance of a doctor when his physical or emotional symptoms don't get it effective treatment. Symptoms associated with the dying process (such as pain, depression or nausea) can be controlled. Talk to your doctor and family about your symptoms, especially if your symptoms bother you so much that you think about dying.

    Control of pain and symptoms at the end of life

    At the end of life, pain and other symptoms can be managed effectively. Talk to your doctor and loved ones about the symptoms you are experiencing. Family is an important link between you and your doctor. If you yourself cannot communicate with a doctor, your loved one can do this for you. There is always something that can be done to relieve your pain and symptoms so that you feel comfortable.

    Physical pain

    There are many painkillers available. Your doctor will choose the easiest and most atraumatic drug to relieve pain. Usually applied first oral medications, as they are easier to take and less expensive. If your pain is not severe, painkillers can be purchased without a doctor's prescription. These include drugs such as acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin or ibuprofen. It is important to stay ahead of your pain and take your medications as scheduled. Irregular use of medications is often the cause of ineffective treatment.

    Sometimes pain cannot be controlled with over-the-counter medications. In this case, more are needed effective forms treatment. Your doctor may prescribe painkillers such as codeine, morphine, or fentanyl. These medications can be combined with others, such as antidepressants, to help you get rid of your pain.

    If you cannot take the pills, there are other forms of treatment. If you have trouble swallowing, you can use liquid medications. Medicines can also be in the form of:

      Rectal suppositories. Suppositories can be taken if you have trouble swallowing or nausea.

      Drops under the tongue. Just like nitroglycerin tablets or heart pain sprays, liquid forms some substances, such as morphine or fentanyl, may be absorbed blood vessels under the tongue. These drugs are given in very small quantities - usually just a few drops - and are effective way pain relief for people who have trouble swallowing.

      Patches applied to the skin (transdermal patches). These patches allow painkillers, such as fentanyl, to pass through the skin. The advantage of patches is that you instantly receive the required dose of medication. These patches provide better pain control than pills. In addition, a new patch must be applied every 48 to 72 hours, and the tablets must be taken several times a day.

      Intravenous injections (drips). Your doctor may prescribe treatment with a needle inserted into a vein in your arm or chest if your pain is very severe and cannot be controlled with oral, rectal, or transdermal treatments. Medicines can be given as a single injection several times a day, or continuously in small quantities. Just because you are connected to an IV does not mean your activities will be limited. Some people carry small, portable pumps that provide small amounts of medication throughout the day.

      Injections into the area of ​​the spinal nerves (epidural) or under the spinal tissue (intrathecal). For acute pain, strong painkillers such as morphine or fentanyl are injected into the spine.

    Many people who suffer from severe pain fear that they will become dependent on painkillers. However, addiction rarely occurs in terminally ill people. If your condition improves, you can slowly stop taking the medicine to prevent dependence.

    Painkillers can be used to manage the pain and help keep it at a tolerable level. But sometimes painkillers make you drowsy. You can only take a small amount of the medicine and tolerate it accordingly slight pain to stay active at the same time. On the other hand, maybe weakness doesn't matter to you. of great importance and you are not bothered by drowsiness caused by certain medications.

    The main thing is to take medications on a specific schedule, and not just when “the need arises.” But even if you take medication regularly, you may sometimes feel severe pain. These are called "breakthrough pain." Talk to your doctor about what medications you should always have on hand to help manage breakthrough pain. And always tell your doctor if you stop taking your medicine. Sudden cessation may cause serious side effects and severe pain. Talk to your doctor about ways to relieve pain without using drugs. Alternative medical therapy can help some people relax and get rid of pain. You can combine traditional treatment with alternative methods, such as:

      Acupuncture

      Aromatherapy

      Biofeedback

      Chiropractic

      Imaging

      Healing Touch

      Homeopathy

      Hydrotherapy

    • Magnetotherapy

    • Meditation

    For more detailed information, see section Chronic pain

    Emotional stress

    During the period when you are learning to cope with your illness, short-term emotional stress is normal occurrence. Depression that lasts more than 2 weeks is no longer normal and should be reported to your doctor. Depression can be treated even if you have a terminal illness. Antidepressants in combination with counseling from a psychologist will help you cope with emotional distress.

    Talk to your doctor and family about your emotional distress. Although the feeling of grief is natural part the dying process does not mean you have to endure severe emotional pain. Emotional distress can increase physical pain. They can also have a negative impact on your relationships with loved ones and prevent you from saying goodbye to them properly.

    Other symptoms

    As death approaches, you may experience other symptoms. Talk to your doctor about any symptoms you may experience. Symptoms such as nausea, fatigue, constipation or shortness of breath can be managed with medication, special diets And oxygen therapy. Have a friend or family member describe your symptoms to a doctor or emergency services worker. It can be helpful to keep a journal and write down all your symptoms.