when someone you love is dyingfinalapps.hnehealth.nsw.gov.au/hapcn/assets/resource... · Even after...

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I am standing upon the seashore. A ship at my side spreads her white sails to the morning breeze and starts for the blue ocean. She is an object of beauty and strength. I stand and watch her until at length she hangs like a speck of white cloud just where the sea and sky come to mingle with each other. Then someone at my side says: "There, she is gone!" "Gone where?" Gone from my sight. That is all. She is just as large in mast and hull and spar as she was when she left my side and she is just as able to bear her load of living freight to her destined port. Her diminished size is in me, not in her. And just at the moment when someone at my side says: "There, she is gone!" there are other eyes watching her coming, and other voices ready to take up the glad shout: 'Here she comes!" And that is dying. Henry Van Dyke THAT IS DYING WHEN SOMEONE YOU LOVE IS DYING DYING IS PART OF LIVING If you have a loved one that is dying, you may have questions and concerns about what will happen physically, emotionally and spiri- tually as death approaches. The following information may help answer some of these questions or empower you to ask the questions you need to.

Transcript of when someone you love is dyingfinalapps.hnehealth.nsw.gov.au/hapcn/assets/resource... · Even after...

Page 1: when someone you love is dyingfinalapps.hnehealth.nsw.gov.au/hapcn/assets/resource... · Even after someone has died, family and friends may wish to stay by the bedside and say whatever

I am standing upon the seashore. A ship at my side spreads her white sails to the morning breeze and starts for the blue ocean. She is an object of beauty and strength. I stand and watch her until at length she hangs like a speck of white cloud just where the sea and sky come to mingle with each other. Then someone at my side says: "There, she is gone!" "Gone where?" Gone from my sight. That is all. She is just as large in mast and hull and spar as she was when she left my side and she is just as able to bear her load of living freight to her destined port. Her diminished size is in me, not in her. And just at the moment when someone at my side says: "There, she is gone!" there are other eyes watching her coming, and other voices ready to take up the glad shout: 'Here she comes!" And that is dying. Henry Van Dyke

THAT IS DYING WHEN SOMEONE YOU LOVE IS DYING

DYING IS PART OF LIVING If you have a loved one that is dying, you may have questions and concerns about what will happen physically, emotionally and spiri-

tually as death approaches. The following information may help answer some of these questions or empower you to ask the

questions you need to.

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THE DYING PROCESS

Dying is a personal journey that each individual approaches in their own unique way. Nothing is concrete, there are many paths one can take on this journey, with different milestones along the way . Because everyone experiences dying in their own unique way, not everyone will experience each milestone.. Some may take months to reach their des-tination, others will take only days. Always keeping in mind that the journey is subject to the traveller taking it. THE JOURNEY BEGINS:( 1-3 MTHS MONTHS PRIOR TO DEATH) Sometimes when a person becomes aware that death is approaching they may begin to withdraw, decline visits from friends and family, revisit old memories, evaluating their life and possibly sort through regrets. The dying person may be sleeping more now and not engaging in activities they once enjoyed. Food becomes less appealing as the body begins to slow down and the body doesn't need the energy from food that it once did. They no longer need the nourishment from food they once did. The body does a wonderful thing during this time as altered body chemistry produces a mild sense of euphoria. They are neither hungry nor thirsty and are not suffering in any way by not eating or drinking. It is an expected part of the journey they have begun.

Breakthrough medication (PRNs) Medications for pain and other symptoms such as agitation / restlessness or noisy breathing may be required at any time. These are commonly called "breakthrough medications", "PRN", or "as needed" medications and are usually given subcutaneously . Nursing staff may also assess the need to give pain medications prior to moving the patient for hygiene and pressure care.

How do I know when death has occurred? Usually the most obvious sign that death has occurred are: breathing has stopped, and there are not even any

slight breathing motions muscles of the face will have relaxed and there will

be no movement anywhere sometimes shortly after death there are minor muscle twitches, however these go away in a few minutes. there will be no pulse felt or heartbeat. eyelids may not close all of the way. This is often the

natural resting position pupils are quite large and do not change in size in

response to light. Even after someone has died, family and friends may wish to stay by the bedside and say whatever words seem appropriate. There is no harm in touching the person's body and there should be no rush to move the person until everyone has had a chance to say their final good-byes.

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WHAT IS HAPPENING IN THE FINAL DAYS Physical changes in dying Although dying is a unique experience, some generaliza-tions can be made about the process of dying. The body's various systems gradually weaken and shut down as most health conditions affect vital systems of the body. The cause of death is generally Specific complication of the illness such as heart failure, renal failure Accumulation of total burden of disease with people

experiencing a profound depletion of energy, sleeping most or all of the time.

Infection such as pneumonia may occur due to inabil-ity to clear secretions that the lungs normally pro-duce. This infection doesn't respond to antibiotics due to fragility and a weakened immune system.

Medications at end of life Trouble swallowing medications is an expected develop-ment in someone who is nearing death. This may be due to the disease, to general weakness, or to the fact that the person is not as alert. This requires health staff to identify other ways of giving medications. These may include placing medicine under the tongue; delivering medication under the skin through injections (subcutaneous) or continue with topical patches Under the surface of the skin (Subcutaneous) A subcutaneous infusion involves using a line connected to a pump to send medicine into the tissue under the surface of the skin. The patient's pain and symptoms are assessed by the medical and nursing staff. Medications normally taken orally are replaced by medications suitable for injec-tion. Some people fear opioids such as Morphine (pain medicines) shorten the life of the dying person. Opioids are for the relief of pain and aid patient comfort. Pain assessment will continue during the final hours of the persons life. The persons pain level may require increased doses of pain medicines. Even if the dying person is unresponsive pain medication is usually required to b

continued.

ONE TO TWO WEEKS PRIOR TO DEATH

MENTAL CHANGES This is the time when a person begins to sleep most of the time. Disorientation is common and an altered sense of perception can occur . They may experience delusions, for example, thinking others are trying to hurt them or thinking they are invincible, or they may state they have been visited by deceased relatives. They may also experience hallucina-tions, sometimes seeing or speaking to people that aren't there. They may pick at the sheets and their clothing in a state of agitation and their movements and actions may seem aimless and make no sense to others. PHYSICAL CHANGES The body is having a more difficult time maintaining itself and there are some signs that the body may show to con-firm this

ð The body temperature lowers .

ð The blood pressure lowers.

ð The pulse becomes irregular

ð There is increased perspiration.

ð Skin color changes as circulation decreases

ð The lips and nail beds maybe pale and bluish.

ð Breathing changes occur, rapid and labored.

ð Congestion may also occur causing a rattling sound and cough.

ð Speaking decreases and eventually stops

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from friends and family SleepWHAT HAPPENS IN THE FINAL DAYS OF LIFE They may sleep a lot more, or sleep for a few hours at a time, day and night. They may seem drowsy and be confused at times. They may like company or they might prefer to be alone; be sure to ask. Increasing Weakness Weakness and fatigue will increase and they will need more help with their activities of daily living. As the body naturally shuts down, people need and want less food. Offer small amounts of the food they enjoy. Since chewing takes energy, they may prefer milkshakes ice cream or pudding. Offer sips of fluids or small ice chips as long as they can comfortably swallow. Using a flexible straw helps if they have difficulty sitting up. When a person can no longer swallow, their lips are kept moist with lip balm and their mouth cleaned and moistened. You will also notice a decrease in urination and bowel actions Your loved one may sleep more and over time they may seem unable to respond at all. Continue to talk to them ,even if they are unconscious, as they may hear you. Talk to them, share your favorite memories, pray or play favorite music. Touch allows your loved one know you are there, as long as it doesn’t cause pain. .Friends and family may feel they need to do or say something while at the bedside. However, the presence of loved ones near the end is usually more important than what is done or said. Families often just go on visiting, reading, laughing and jok-ing, telling stories, watching television...in other words, being a family. This is quite likely what would most please the person who is dying - knowing that family members are there and supporting each other. The care team can also help those at the bedside take part in making sure the person is as comfortable as possible, by providing some aspects of comfort care, such as moistening a dry mouth, personal hygiene and position changing.

JOURNEY'S END: A COUPLE OF DAYS TO HOURS PRIOR

TO DEATH

As the person is moving closer towards death, they may experience a surge of energy. They may even want to get out of bed and talk to loved ones. They may even ask for food when they haven't eaten in days. This surge of energy may be quite a bit less noticeable but is usually used as a dying persons final physical expression before moving on. The surge of energy however is usually short lived and then the signs become more pronounced as death approaches. Breathing becomes more irregular and often slower. "Cheyne-Stokes" breathing, rapid breaths followed by periods of no breaths, may occur. Congestion in the airway can in-crease causing loud, rattled breathing. As blood flow slows, some parts of the body may discolor and feel cool. This is not painful or uncomfortable. Hands and feet may become blotchy and purplish (mottled). This mottling may slowly work it's way up the arms and legs. Lips and nail beds are bluish or purple. The person usually becomes unresponsive and may have their eyes open or semi-open but not seeing their surroundings. It is however widely believed that hearing is the last sense to go so it is recommended that loved ones sit with ,and talk to, the dying person during this time. Eventually, breathing will cease altogether and the heart stops. At this point ,Death has occurred. Each person and every death is unique, but there are some common things that accompany the process of dying. These changes are natural and can happen over months, days or hours. Withdrawal