American Medical Association Family Medical Guide - American Medical Association [310]
Other pain-relief methods (including relaxation techniques such as deep breathing, meditation, guided imagery, and massage) can be used along with medication to help control pain and improve a dying person’s sense of well-being. In general, the earlier a person begins to use relaxation techniques and massage for pain relief, the more effective these methods are likely to be.
The Process of Dying
The term dying refers to the process in which the body’s systems shut down and prepare for death. It is difficult to estimate how long the dying process will take. The actual moment of death is often very peaceful.
Nutrition and Elimination
One sign of dying is decreased food consumption and increased weight loss. If the person can (and wants to) eat, give him or her soft foods that won’t cause choking. The person may not be hungry or thirsty and may gradually withdraw from food or may refuse to eat or drink. Moisten his or her mouth by giving ice chips to suck on or by wetting his or her mouth with a wet cloth. Don’t force the person to eat or drink. Swallowing may be difficult. Urine output will start to decrease because the person is not drinking enough fluid, and he or she will have few bowel movements because of decreased food intake and movement. Keep the dying person clean and dry by using incontinence pads or disposable briefs and changing them when they are soiled.
Circulation
Circulation will slow, and the person’s pulse will grow weaker. The underside of the body may become darker in color as blood begins to pool. The person’s arms and legs may be cold and look bluish purple. If the dying person feels chilled, keep him or her covered with blankets. (Don’t use electric blankets because of the possibility of causing burns.) Keep the room comfortable and not too warm.
Agitation
A person who is dying may become agitated, especially just before death. The agitation may be a sign not of pain but of discomfort. The person may become more and more restless. He or she may pull at the sheets, have trouble sleeping, continuously fidget, and even groan. Although reassuring the person can be helpful, the agitation is often a physical response that cannot be relieved by reassurance alone. In this case, the doctor may prescribe a medication such as alprazolam or lorazepam to help calm the person.
Anxiety and Depression
Depression is a normal emotional response to dying. Depression may be relieved somewhat by antidepressants and counseling. If a dying person is anxious, the anxiety may be the result of unresolved personal or religious issues. If the person cannot be comforted by a friend or relative, ask a member of the clergy or another person to whom the dying person looks for comfort to try to provide guidance and reassurance.
Breathing
A dying person may breathe rapidly (sometimes more than 30 breaths per minute). At times the periods of rapid breathing may be mixed with periods of no breathing that may last up to 15 seconds. Breathing may also become shallower. An increase in the amount and thickness of secretions in the back of the throat (caused by decreased fluid intake and decreased ability to cough up saliva) can produce a rattlelike sound while breathing. If breathing becomes difficult, elevate the person’s head by putting pillows under it or by raising the head of the bed. Repositioning the dying person on his or her side may also help relieve a breathing problem.
Responsiveness
The person may begin to spend more and more time sleeping and may become difficult to arouse. He or she may stop communicating with people. If your loved one is no longer able to speak, communicate through the sense of touch. Holding your loved one or stroking his or her head or hand can convey your love and help you reassure him or her. During