...HOSPICE HANDS CONTINUED
Congestion
The person may have gurgling sounds coming from his or
her chest
as though marbles were rolling around inside. These
sounds may
become very loud. This normal change is due to the
decrease of
fluid intake and an inability to cough up normal
secretions.
Suctioning usually only increases the secretions and
causes sharp
discomfort. Gently turn the person's head to the side
and allow
gravity to drain the secretions. You may also gently
wipe the mouth
with a moist cloth. The sound of the congestion does
not indicate the
onset of severe or new pain.
Restlessness
The person may make restless and repetitive motions
such as pulling
at bed linen or clothing. This often happens and is due
in part to the
decrease in oxygen circulation to the brain and to
metabolism
changes. Do not interfere with or try to restrain such
motions. To
have a calming effect, speak in a quiet, natural way,
lightly massage
the forehead, read to the person, or play some soothing
music.
Urine Decrease
The person's urine output normally decreases and may
become tea
colored, referred to as concentrated urine. This is due
to the
decreased fluid intake as well as decrease in
circulation through the
kidneys. Consult with your Hospice nurse to determine
whether
there may be a need to insert or irrigate a catheter.
Fluid and Food Decrease
The person may have a decrease in appetite and thirst,
wanting little
or no food or fluid. The body will naturally begin to
conserve energy
which is expended on these tasks. Do not try to force
food or drink
into the person, or try to use guilt to manipulate them
into eating or
drinking something. To do this only makes the person
much more
uncomfortable. Small chips of ice, frozen gatorade or
juice may be
refreshing in the mouth. If the person is able to
swallow, fluids may
be given in small amounts by syringe (ask the Hospice
nurse for
guidance). Glycerin swabs may help keep the mouth and
lips moist
and comfortable. A cool, moist washcloth on the
forehead may also
increase physical comfort.
Breathing Pattern Change
The person's regular breathing pattern may change with
the onset of
a different breathing pace. A particular pattern
consists of breathing
irregularly, i.e., shallow breaths with periods of no
breathing of 5 to
30 seconds and up to a full minute. This is called
Cheyne-Stokes
breathing. The person may also experience periods of
rapid shallow
pant-like breathing. These patterns are very common and
indicate
decrease in circulation in the internal organs.
Elevating the head,
and/or turning the person onto his or her side may
bring comfort.
Hold your loved one's hand. Speak gently.
Normal Emotional, Spiritual, and Mental Signs and
Symptoms with Appropriate Responses
Withdrawal
The person may seem unresponsive, withdrawn, or in a
comatose-like state. This indicates preparation for
release, a
detaching from surroundings and relationships, and a
beginning of
letting go. Since hearing remains all the way to the
end, speak to
your loved one in your normal tone of voice,
identifying yourself by
name when you speak, hold his or her hand, and say
whatever you
need to say that will help the person let go.
Vision-like experiences
The person may speak or claim to have spoken to persons
who
have already died, or to see or have seen places not
presently
accessible or visible to you. This does not indicate an
hallucination
or a drug reaction. The person is beginning to detach
from this life
and is being prepared for the transition so it will not
be frightening.
Do not contradict, explain away, belittle or argue
about what the
person claims to have seen or heard. Just because you
cannot see
or hear it does not mean it is not real to your loved
one. Affirm his
or her experience. They are normal and common. If they
frighten
your loved one, explain that they are normal
occurrences.
Restlessness
The person may perform repetitive and restless tasks.
This may in
part indicate that something still unresolved or
unfinished is
disturbing him or her, and prevents him or her from
letting go. Your
Hospice team members will assist you in identifying
what may be
happening, and help you find ways to help the person
find release
from the tension or fear. Other things which may be
helpful in
calming the person are to recall a favorite place the
person enjoyed,
a favorite experience, read something comforting, play
music, and
give assurance that it is OK to let go.
Fluid and Food Decrease
When the person may want little or no fluid or food,
this may
indicate readiness for the final shut down. Do not try
to force food
or fluid. You may help your loved one by giving
permission to let go
whenever he or she is ready. At the same time affirm
the person's
ongoing value to you and the good you will carry
forward into your
life that you received from him or her.
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