Question

How do hospice nurses know when death is near?

Answer 1

Hospice nurses know when death is near, by monitoring the hospice patient for the signs of death being near and they have lots of experience around patients dying in hospice.

When death is near the hospice patient will experience a combination of signs of near death, which include decreased consciousness, significantly reduced appetite, skin color changes (mottling), and irregular, shallow, or noisy breathing. Key indicators include long sleeping periods, unresponsiveness, and cold, bluish hands and feet.

The length of time that transitioning to death takes can vary from several weeks to months.

The final phase of death also known as active dying lasts around 2 days to 3 days and the process of dying involves gradual slowing of your bodily functions, including a reduced appetite, increased sleep, social withdrawal and eventually reduced responsiveness.

In the weeks and moths prior to death, people often sleep more, eat less, experience fatigue and become more withdrawn from social activity.

In the 1 to 2 weeks prior to death, people often experience mental confusion, increased restlessness, reduced kidney function and skin color changes like pale/bluish color skin can occur.

In the active dying and final days to hours phase of dying, the person is often bedbound, largely unresponsive and the dying person may also experience hallucinations, breathing changes significantly, with breathing irregularities and long pauses and the body struggles to regulate it's temperature.

During the final stages of dying, breathing can become very noisy, which is also known as the death rattle, or erratic, with long gaps between breaths, hands and feet become cold to the touch and bluish or mottled as the blood circulation slows down.

And a significant drop in blood pressure and a deep coma like state often occur within 2 to 3 days of death.

Some dying people experience a sudden and quick decline and other dying people may follow a slower and gradual decline over several weeks as they are dying.

The drugs that are given in end of life care are morphine for pain and breathlessness, lorazepam or midazolam for agitation and anxiety, and hyoscine for terminal secretions.

Hospice often gives these injections to dying patients to make the transition from life to death easier and painless.

Morphine or even alternatives like hydromorphone is used at the end of life to relieve severe pain and alleviate air hunger or shortness of breath and it also helps to calm the dying patients breathing.

Lorazepam or Ativan or Midazolam are sedatives that are used at end of life to treat severe anxiety, restless and terminal agitation.

Haldol also known as haloperidol is used at end of life for managing delirium, terminal agitation or nausea and vomiting and hyoscine butylbromide also known as Levsin or Scopolamine is used at end of life to dry up terminal secretions or the death rattle, which is the sound of saliva accumulating in the throat.

These injections are not given at the end of life to hasten death and instead when used appropriately, these injections are meant as comfort medications to manage symptoms and allow for a peaceful and comfortable passing on and not to cause death.

The two conditions that must be present for a patient to enroll in hospice are having a life expectancy of 6 months or less and having a terminal diagnosis.

For a patient to enroll in hospice, the patient must have a certified prognosis of a life expectancy of 6 months or less if the illness runs it's normal course and have a terminal diagnosis, with a documented decline in their health, in which the patient opts for palliative comfort care, instead of curative treatment.

For a patient to be eligible for hospice care, whether in a hospice center or at home, a doctor and a hospice medical director has to certify that the patient has an expected life expectancy of 6 months or less.

Although the hospice care can still be extended if the patient in hospice continues to meet the criteria.

There must also be documented and rapid decline in the patients status, like increased weakness, unintentional weight loss or frequent infections.

And the patient chooses to focus on quality of life and pain management, and forgoes further curative treatments.

A PPS or Palliative Performance Scale rating of <50% to 60% or needing assistance with daily living indicates that it's time for the patient to consider hospice.

Hospice can be provided in a hospice center or even in home through at home hospice, where a hospice nurse will visit the patients home.

Hospice care provides comprehensive comfort care (palliative care) for patients with a terminal illness (typically a life expectancy of six months or less) who choose to forgo curative treatments.

Hospice care focuses on pain management, quality of life, and emotional/spiritual support for patients and families, usually in the home, nursing home, or specialized facility.

Services of hospice care include routine home care, continuous home care (during crisis), inpatient care for symptom management and respite care to provide temporary relief to family caregivers.