What are the signs before death in a bedridden patient. Signs of imminent death of a cancer patient - what are they? Response: let sleep, do not wake or push the sleeping person. Assume that everything you say can be heard because
The concept of the terminal state, its stages and characteristics
The terminal state is the final state of the extinction of the functions of organs and tissues, which precedes clinical and biological death. It includes a peredagonal state, agony and clinical death. According to experts, the term "terminal state" includes severe forms of shock, collapse, transagonal state, terminal pause, agony and clinical death. A characteristic feature that combines these processes into a terminal state is rapidly growing hypoxia (oxygen starvation of all tissues and organs) with the development of acidosis (blood souring) due to the accumulation of unoxidized metabolic products.
In the peredagonal state, various pronounced disorders of hemodynamics () and respiration occur, which lead to the development of tissue hypoxia and acidosis. The duration of the peredagonal state can be different, it basically leads to the duration of the entire period of dying.
The main symptoms of the peredagonal state: lethargy, dizziness, pallor of the skin, cyanosis of the face, the corneal reflex is preserved, breathing is weakened, there is no pulse on the peripheral arteries, but it can be felt on the carotid arteries (filamentous), blood pressure is not determined. After the peredagonal state, a terminal pause occurs, which is most clearly expressed when dying from bleeding. The latter is characterized by the absence of reflexes, short-term cessation of breathing, cardiac activity and bioelectrical activity of the brain. In this state, the patient may look like a corpse. The duration of the pause ranges from 5–10 s to 3–4 min. A characteristic feature is the deep inhibition of the cerebral cortex, the reaction of the pupils to light disappears in the victim, they expand. The agony (struggle) begins - the last outbreak of the body's struggle for life, which lasts from several minutes to half an hour or more (sometimes for hours and even for several days).
In the atonal period, the higher functions of the brain are excluded, consciousness is lost and can only be restored for a short time. At the same time, the activity of the centers of the medulla oblongata is noted, which is accompanied by a short-term increase in the function of respiration and blood circulation.
A sign of agony after the terminal pause is the appearance of the first breath. Agonal breathing differs sharply from the usual one - all respiratory, including auxiliary muscles (muscles of the neck and mouth) participate in the act of inhalation.
The heartbeat during the period of agony accelerates somewhat , the level of blood pressure can rise to 30-40 mm Hg. , and naturally does not provide normal functioning of the brain. There are peculiar changes in blood circulation: the arteries of the heart and the arteries that carry blood to the brain expand, and the peripheral vessels and vessels of the internal organs narrow sharply. So, the fading forces of the heart are directed mainly to maintaining the vital activity of the heart itself.
Usually, at the end of the agony, the breathing stops first, and the heart activity continues for a while. Primary cardiac arrest is less common. With the cessation of heart contractions and breathing, a state of so-called clinical death sets in, which is a kind of transitional state between life and death. At this stage, the organism as a whole no longer lives, but the vital activity of individual organs and tissues is preserved, irreversible changes in them have not yet occurred. Therefore, if immediately to a person who is in state of clinical death, provide medical assistance, sometimes it is possible to bring her back to life. The period of clinical death is characterized by deep inhibition, which also extends to the medulla oblongata, circulatory and respiratory arrest, and the maintenance of metabolic processes in the tissues of the body at a minimum level. The duration of clinical death is determined by the survival time of the cerebral cortex in the absence of blood circulation and respiration. On average, this time is 5-6 minutes. It increases if death occurs at a low temperature in young, physically healthy people. Many factors influence the duration of clinical death: the period of dying, the presence of a severe debilitating disease, age, etc.
The main symptoms of clinical death are as follows: lack of breathing, heartbeat, pulse on the carotid arteries, the pupils are dilated and do not react to light.
It is often difficult even for a doctor to determine the fact of death in the first moments, minutes, and sometimes even hours. In some cases, the vital processes, in particular respiration and blood circulation, can occur within such insignificant limits that it is difficult to determine with the help of our senses whether a person is breathing or not, whether there are heartbeats or they are absent. Such a deep extinction of respiration and blood circulation occurs in diseases and some types of external influences, for example, electric shock, sun and heat stroke, drowning, poisoning with drugs and sleeping pills, diseases of the central nervous system (epilepsy, encephalitis), premature babies. This phenomenon is called imaginary, apparent death.
Imaginary death - this is a state of a person when the main functions of the body are expressed so weakly that they are not noticeable to the observer, therefore a living person gives the impression of a dead one. Only a careful examination allows you to establish signs of life. At the slightest suspicion of apparent death, first aid measures should be taken immediately and, if necessary, referred to the nearest hospital. In order to avoid erroneous ascertainment of death, the bodies of persons who died in the hospital are sent to the pathoanatomical department no earlier than two hours after the ascertainment of death, i.e. after the appearance of early cadaveric changes.
If breathing is absent for 5-6 minutes, then first in the cells of the cortex, and then in the less sensitive to oxygen starvation parts of the brain and cells of other organs, the processes of decay of the protoplasm of the cell nuclei begin, which leads to irreversible phenomena, i.e. biological death — the final stage of the individual existence of any living system. In different tissues and organs, irreversible changes develop simultaneously. Most often they occur in the cerebral cortex. This moment, when the integrating activity of the central nervous system is disturbed, should be considered the beginning of biological death. The vital activity of other organs and tissues, including the brain stem, can still be restored.
Given the above, we can conclude that from the moment when it is not possible to establish a heartbeat, until at least one of the absolute signs of death appears, a person can be in a state of sharp depression of vital functions. It is impossible to exclude the possibility of such a state in such cases, and therefore during this period, which is called imaginary, relative or clinical death (it would be more correct to say minimal life), regardless of its duration, measures must be taken to return vital functions to this organism. To ascertain death, the so-called indicative (probable) and reliable (absolute) signs of death are used. Indicative signs include: immovable, passive position of the body, pallor of the skin, lack of consciousness, respiration, pulse and heartbeat, lack of sensitivity to pain, thermal irritations, lack of a corneal reflex, pupillary reaction to light.
It is not always easy to recognize real death by probable signs, if a little time has passed since death. Therefore, in doubtful cases, in the presence of only indicative signs of death (immovable, passive position of the body, pallor of the skin, lack of consciousness, respiration, pulse on the carotid arteries and heartbeat, lack of sensitivity to pain, thermal irritation, lack of corneal reflex, pupillary reaction to light) and the absence of injuries that are clearly incompatible with life, first medical aid should be provided (artificial ventilation of the lungs, indirect heart massage, the introduction of cardiac drugs, etc.) until you are convinced of the onset of early cadaveric changes. Only after the appearance of cadaveric spots, attempts to revive can be stopped and death is ascertained.
None of us can predict exactly when death will occur. However, doctors and nurses who deal with the critically ill know that the approach of death is accompanied by certain symptoms.
The signs of impending death vary from person to person, and not all of the symptoms listed below are "mandatory." But there is still something in common.
1. Loss of appetite
The body's need for energy becomes less and less. A person may begin to resist eating and drinking, or eating only certain foods (for example, cereals). First of all, a dying person refuses meat, since it is difficult for a weakened body to digest it. And then the most favorite foods no longer cause any appetite. At the end of a patient's life, it happens that even physically he is not able to swallow what is in his mouth.
It is impossible to force-feed a dying person, no matter how much you worry about the fact that he does not eat. You can periodically offer the patient some water, ice or ice cream. And so that his lips do not dry out, moisten them with a damp cloth or moisturize with lip balm.
2. Excessive fatigue and drowsiness
On the threshold of death, a person begins to sleep atypically a lot, and it becomes more and more difficult to wake him up. Metabolism slows down, and insufficient intake of food and water contributes to dehydration, which turns on a protective mechanism and hibernates. This patient should not be denied - let him sleep. Don't push him to wake him up. What you will say to a person in this state, he may well hear and remember, no matter how deep the dream may seem. In the end, even in a coma, patients hear and realize those words that are addressed to them.
3. Physical weakness
Due to the loss of appetite and the resulting lack of energy, the dying person cannot do even the simplest things - for example, he cannot roll over on his side, raise his head, or draw juice through a straw. All you can do is try to make him as comfortable as possible.
4. Cloudy mind and disorientation
Organs begin to fail, including the brain. A person may no longer understand where he is and who is next to him, start talking nonsense or thrashing about in bed. At the same time, you need to remain calm. Every time you approach a dying person, you should call yourself by name and speak to him as gently as possible.
5. Difficulty breathing
The breath of the dying becomes erratic and uneven. Often they have the so-called Cheyne-Stokes breathing: superficial and rare respiratory movements gradually become deeper and longer, weaken and slow down again, then a pause follows, after which the cycle repeats. Sometimes the dying person wheezes or breathes louder than usual. You can help in such a situation by raising his head, putting an extra pillow or seating him in a reclining position so that the person does not fall on his side.
6. Self-isolation
As the vitality fades away, a person loses interest in what is happening around. He may stop talking, answer questions, or simply turn away from everyone. This is a natural part of the dying process, not your fault. Show the dying person that you are there by simply touching him or taking his hand in yours if he does not mind, and talk to him, even if this conversation will be your monologue.
7. Violation of urination
Since there is little water in the body, and the kidneys are working worse, the dying person "walks a little" really little, and concentrated urine has a brownish or reddish tint. That is why in hospices in the last days of life the terminally ill often put a catheter. Due to kidney failure, the amount of toxins in the blood increases, which contributes to the quiet flow of the dying into a coma and a peaceful death.
8. Swelling of the legs
When the kidneys fail, bodily fluids accumulate in the body, most often in the legs, instead of being expelled. Because of this, before death, many swell. Nothing can be done here, and it makes no sense: swelling is a side effect of approaching death, and not its cause.
9. "Icing" of the tips of the fingers and toes
A few hours or even minutes before death, blood drains from peripheral organs to support vital ones. For this reason, the limbs become noticeably colder than the rest of the body, and the nails may become pale or bluish. A warm blanket will help to provide comfort to the dying person, which needs to cover him more freely so as not to create a feeling of swaddling.
10. Venous spots
On pale skin, a characteristic "pattern" of purple, reddish or bluish spots appears - the result of poor circulation and uneven filling of the veins with blood. These spots usually appear first on the soles and feet.
is an oncological disease that smokers most often suffer from. Often, in the first stages, cancer develops asymptomatically and the person does not even suspect that he is already sick. When the malaise becomes permanent, the person goes to the doctor, but it's too late. Not many people know how sick people die from lung cancer. This is a real tragedy not only for the dying person himself, but also for his family and friends.
The disease does not develop by gender, both men and women can get sick equally.
The main symptoms of the terminal stage
The terminal stage of cancer is the last (fourth) irreparable stage of the disease, when tumor cells grow uncontrollably and spread throughout the body. Death from lung cancer is inevitable at this stage.
In modern medicine, there is no effective therapy for malignant lung tumors. If in the early stages there is still a chance for recovery, then at stages 3 and 4 the disease progresses so rapidly that it is already impossible to stop it.
Existing methods of treatment can only prolong the life of the patient and alleviate suffering for a short time. Stage 4 lung cancer is characterized by certain symptoms that appear before death:
Symptoms appear differently in each patient. It depends on the individual characteristics of the organism and the severity of the disease (localization of foci). The condition of a terminally ill person is steadily deteriorating every day.
How do terminal cancer patients die?
It is impossible to determine how long a person with stage IV cancer will live. One can only speculate based on specific signs. The process of dying from lung cancer is similar to dying from other diseases.
The person is already aware that they are dying and is ready to accept it. In the last days of their lives, cancer patients are mostly constantly immersed in sleep, but for some, on the contrary, psychosis may begin and last for a long time.
Death comes gradually and in stages:
The process of dying is individual and is different for each patient. At this moment, for the dying, it is necessary to create conditions for a calm departure from life. It is important to remember that in the last moments of life, relatives should be nearby and provide comfortable conditions for a terminally ill person.
Causes of death in patients with grade 4 lung cancer
With lung cancer, metastases quickly occur, penetrating the bones, neighboring organs and the brain.
When a tumor affects the lung tissue, and tumor cells actively multiply, either the complete destruction of this tissue or the blockage of oxygen occurs - which in both cases reduces the vitality of the body and leads to death. Causes of death in lung cancer can be:
- bleeding;
- consequences of chemotherapy;
- asphyxia (suffocation).
Bleeding
Bleeding in 30-60% of cases is the cause of death of cancer patients. It all starts with the appearance of blood in the sputum, the amount of which increases over time. This is due to an increase in the tumor and the appearance of ulcers on the bronchial mucosa. An abscess or pneumonia may develop. Bronchial vessels are damaged, followed by profuse bleeding, which leads to death.
Pulmonary bleeding is considered the most dangerous:
- Asphyxic (lungs filled with blood) - resuscitation is ineffective, death can occur within 5 minutes;
- Undulating continuous- blood flows into the lungs.
Complications caused by lung cancer (penetration of metastases to other organs) can cause bleeding in the intestines, hemorrhages in the brain, due to which the patient may also die.
Complications after chemotherapy
This method of treatment is used to destroy and stop the growth of tumor cells in the initial stages of the disease and as an additional measure (preparation of the patient for surgical treatment).
A cancerous tumor with metastases greatly lowers the immune system. Chemotherapy drugs destroy cancer cells, but significantly reduce the protective functions of a weakened body.
Therefore, immediately after therapy, the patient may feel relief for a while, but then there is a sharp deterioration in the condition, loss of strength and progression of the disease with a fatal outcome.
Asphyxia
Fluid of cancerous infiltrates gradually accumulates in the lungs and causes suffocation. The patient begins to choke and dies. Medicine does not yet know how to alleviate this condition of the patient. The torment to which the sick are doomed is difficult to describe, but, unfortunately, they all experience them.
Medical management of pain
Cancer patients are saved from suffering by painkillers, of which there are many, but only a doctor can choose the most suitable one for a particular patient. Pain comes in different intensities, so the task of the doctor is to determine the individual dosage.
Pain therapy involves the use of follow-up medications:
For acute pain, you can take over-the-counter pain relievers, which are sold at the pharmacy. Usually these are oral medicines with a low price. If the pain becomes persistent, your doctor may prescribe Tramadol (prescription) tablets or injections. The patient should keep a log of taking the drug in time, describe the pain. Based on these data, the doctor will adjust the frequency of administration and the dose of drugs per day.
Important! You should strictly follow the schedule of taking painkillers "ahead" of the pain. Treatment will be ineffective if the medication is taken irregularly.
When the medications used no longer help, the oncologist will prescribe strong narcotic medications, such as Morphine or Oxycodone.
They work well with antidepressants. For patients with impaired swallowing function or severe nausea, dosage forms such as rectal suppositories, drops under the tongue (one dose is 2-3 drops), patches (sticked every 2-3 days), injections and droppers are suitable.
Many cancer patients are afraid of becoming addicted to pain medications, but this is extremely rare. If the condition improves during treatment, you can gradually reduce the dose of the drug. Painkillers cause drowsiness, if the patient is not satisfied with this, the doctor may lower the dosage to a tolerable pain limit.
Nutrition and patient care
The more the disease progresses, the more the patient begins to depend on the help of others. He himself cannot move, go to the toilet, bathe, and eventually even turn over in bed.
For the movement of patients in hospices there are walkers and wheelchairs, hopelessly ill patients are recommended to communicate with a psychologist who will mentally prepare them for the impending death.
If the patient began to rarely empty the intestines (a break of more than three days), and the stool became hard, he is prescribed enemas or laxatives. Violations occur in the urinary system. Often an indwelling catheter is required. With the fading of vitality, the patient's appetite also dies. With each meal and water portions become smaller. When problems with swallowing begin, relatives can only moisten their mouth and lips.
The last days of the life of a person with stage 4 cancer should pass in a calm atmosphere of relatives and friends. You can talk to him, read books to him or turn on soothing music. But sometimes it happens that the patient no longer wants to live and thinks about suicide, despite all the efforts and care of relatives.
In modern society, there are disputes about euthanasia (translated from Greek - “good death”) - is the procedure a humane way to end the life of terminally ill people and why, at the request of the patient, the doctor cannot stop his suffering by injecting a lethal dose of the drug.
The only place where euthanasia is legal is Oregon. Over the past few centuries, medical ethics has undergone a number of changes. If earlier it was believed that only the sick should be dealt with, now a lot of attention is paid to the dying.
The death statistics for cancer patients are disappointing. Everything is complicated by the fact that in the early stages the cancer may not manifest itself in any way, and in the absence of specific treatment during the first year, about 90% of patients die.
Cancer cells in the lungs can only be detected by passing a sputum test, but often a debilitating night cough (one of the signs of lung cancer) is simply attributed to colds. Therefore, everyone should undergo preventive medical examinations in a timely and regular manner.
What is agony? In Russian, this word was borrowed from French in the early 19th century. It was previously used in the 16th century. What is the meaning of the word "agony"? It means "struggle", "final moments of life", "a state preceding death". The medical definition of agony as a state of the body was described in his writings by Hippocrates, who lived in 360 BC.
This article details how this condition comes and what its symptoms are.
medical interpretation
What is agony medically? The last moment of life before irreversible death. There is such a thing as a terminal state of a person, in which resuscitation is still possible. If it fails, agony ensues. In this case, clinical death turns into biological. Another name for agony is death.
In this state, a person's blood circulation is disturbed and breathing becomes very difficult, as a result, oxygen starvation, hypoxia occurs. The deterioration of blood flow leads to a slow work of the heart, in the future to its complete stop. The duration of the agony is determined by the factors that caused this process. They are different. Let's look at them now. The agony caused by some injuries, acute diseases, lasts a very short period of time, up to a few seconds.
In some cases, it can last up to several hours, even more rarely days, delivering terrible torment to a person.
signs
Depending on what caused this condition, the signs of agony can be very different. But there are also general indicators of what is happening in the body at these moments.
The main sign of an atonal state is the appearance of arrhythmia. A person's breathing becomes frequent, intermittent and superficial. Another manifestation of arrhythmia during agony is rare breathing, with prolonged wheezing. At the same time, the head of the dying person leans back, the mouth opens wide. He seems to be gasping for air. But in this state, he does not receive the required amount of air, as pulmonary edema appears.
There is a suppression of cardiac activity. This is the final moment in agony. In some cases, the heart rate accelerates, blood pressure rises, the person regains consciousness for a very short period. In those last few seconds, he might say something else. This condition is an indicator that resuscitation will be useless.
Another sign of an agonal state is the failure of brain functions. The subcortex of the brain becomes the regulator of all systems. At these moments, the body works at a primitive level, this determines the state of breathing and heart function during the agony.
Other signs
Other signs of agony, depending on the causes that caused it:
- Mechanical asphyxia, in simple terms, suffocation. In this case, there is a sharp jump in blood pressure with a simultaneous slowing of the heartbeat (bradycardia). In this case, the skin of the upper body becomes cyanotic, involuntary convulsions occur, the tongue falls out, involuntary emptying of the bladder and rectum.
- An agonal state in heart failure: blood pressure drops sharply, heart rhythm (tachycardia) is disturbed, the pulse weakens, the body becomes completely cyanotic, the face swells, death cramps occur.
State of agony
This state of a person lasts from a few seconds. In some cases, its duration reaches three or more hours. The predagonal state of a person can last up to several days. During this period, a person may fall into a coma. The transition from the preagonal state to agony is called the terminal pause. Its duration ranges from a few seconds to two to four minutes.
Sometimes during the agony, a person, fighting for life, regains consciousness. As described above, the control of body functions passes from the higher parts of the central nervous system to the secondary ones. At this point, the body is actively trying to maintain life by mobilizing the remaining forces. But this happens for a very short time, after which death occurs.
First symptoms
How does the agony begin? The person's breathing changes. Becomes intermittent. As the brain shuts down, breathing becomes faster and the breaths become deeper. The agony doesn't last long. This is a short term process. At the end of the agony, breathing stops, then the turn of the heart, then the brain. The agony ends with a complete stop of the activity of the brain, breathing and heart.
clinical death
After the agony comes clinical death. So to speak, a "bridge" between life and death. Metabolic processes in the body are still functioning at a primitive level. Clinical death can be reversible. With timely medical intervention, there is a chance to bring a person back to life. Resuscitation, carried out over the next 5-7 minutes, makes it possible to start the heart, thereby ensuring blood flow to the brain tissues. Brain tissues that do not receive oxygen from the bloodstream die within two to three minutes. If resuscitation fails, biological death occurs and the person dies. The pathologist fixes the time of death.
In some cases, death occurs instantly, without agony. This happens when severe and extensive injuries of the skull are received, with instantaneous dismemberment of the body in catastrophes, with anaphylactic shock, and with certain cardiovascular diseases. A thrombus detached from the vessel wall can block a vein or artery. In this case, death occurs instantly. Also, a rupture of a vessel of the brain or heart can lead to rapid death.
The medical term "imaginary death" is when a person's processes are so weakly expressed that he is mistaken for dead. Respiration and heartbeat are not particularly pronounced. This happens with some types of diseases. At some points, it can be difficult to determine whether a person is dead or still alive. Only a medical officer certifies death. A person in this condition needs first aid as soon as possible in order to avoid clinical death.
So what is agony? This short-term process can be characterized as a struggle for life.
How to ease a person's agony
Modern medicine is able to alleviate human suffering with the help of medicines. Many patients, in order to avoid the death agony, agree to euthanasia. This issue is quite controversial and sensitive. Someone cannot give up moral principles; religion does not allow someone to do this. Such a choice is extremely difficult to make.
During agony, a person completely loses control over his own body. It is the fear of death throes that pushes people to such a decision. Taking it, a person must be in full consciousness.
Life after death
Many facts are known when people returned "from the next world." That is, they returned to life, suffering a clinical death.
Quite often, after such a life, people's lives change dramatically. Sometimes they acquire unusual abilities. For example, it can be clairvoyance. Also, sometimes there is an ability to treat various ailments.
The opinions of scientists differ in many respects, but some still believe that this is possible.
Conclusion
Now you know what agony is, what are its signs. We hope that this information was interesting and useful to you.
A person's life path ends with his death. You need to be prepared for this, especially if there is a bed patient in the family. Signs before death will be different for each person. However, the practice of observations shows that it is still possible to identify a number of common symptoms that portend the proximity of death. What are these signs and what should be prepared for?
How does a dying person feel?
A bedridden patient before death, as a rule, experiences mental anguish. In sound consciousness there is an understanding of what is to be experienced. The body undergoes certain physical changes, this cannot be overlooked. On the other hand, the emotional background also changes: mood, mental and psychological balance.
Some lose interest in life, others completely close in on themselves, 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 he thinks about a quick and easy death, asks for euthanasia. These changes are hard to observe, remaining indifferent. But you will have to come to terms with this or try to alleviate the situation with drugs.
With the approach of death, the patient sleeps more and more, showing apathy towards the outside world. In the last moments, a sharp improvement in the condition may occur, reaching the point that the patient who has been lying for a long time is eager to get out of bed. This phase is replaced by the 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: ten signs that death is near
At the end of the life cycle, an elderly person or a bedridden patient feels more and more weak and tired due to a lack of energy. As a result, he is increasingly in a state of sleep. It can be deep or drowsy, through which voices are heard and the surrounding reality is perceived.
A dying person can see, hear, feel and perceive things that do not actually exist, sounds. In order not to upset the patient, this should not be denied. It is also possible to lose orientation and the Patient is more and more immersed in himself and loses interest in the reality around him.
Urine due to kidney failure darkens to almost brown with a reddish tint. As a result, edema appears. The patient's breathing quickens, it becomes intermittent and unstable.
Under pale skin, as a result of a violation of blood circulation, dark “walking” venous spots appear, which change their location. They usually first appear on the feet. In the last moments, the limbs of a dying person become cold due to the fact that the blood, draining from them, is redirected to more important parts of the body.
Failure of life support systems
There are primary signs that appear at the initial stage in the body of a dying person, and secondary ones, indicating the development of irreversible processes. Symptoms may be external or hidden.
Disorders of the gastrointestinal tract
How does the bedridden patient react to this? Signs before death, associated with loss of appetite and a change in the nature and volume of food consumed, are manifested by problems with the stool. Most often, constipation develops against this background. A patient without a laxative or an enema finds it increasingly difficult to empty the bowels.
Patients spend the last days of their lives refusing food and water altogether. You shouldn't worry too much about this. It is believed that dehydration in the body increases the synthesis of endorphins and anesthetics, which to some extent improve overall well-being.
Functional disorders
How does the condition of patients change and how does the bed patient react to this? Signs before death, associated with the weakening of the sphincters, in the last few hours of a person's life are manifested by fecal and urinary incontinence. In such cases, you must be prepared to provide him with hygienic conditions, using absorbent underwear, diapers or diapers.
Even in the presence of appetite, there are situations when the patient loses the ability to swallow food, and soon water and saliva. This may lead to aspiration.
With severe exhaustion, when the eyeballs are very sunken, the patient is not able to completely close the eyelids. This has a depressing effect on those around you. If the eyes are constantly open, the conjunctiva must be moistened with special ointments or saline.
and thermoregulation
What are the symptoms of these changes if the patient is bedridden? Signs before death in a weakened person in an unconscious state are manifested by terminal tachypnea - against the background of frequent respiratory movements, death rattles are heard. This is due to the movement of the mucous secretion in the large bronchi, trachea and pharynx. This condition is quite normal for a dying person and does not cause him suffering. If it is possible to lay 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 a critical range. He can feel hot flashes and sudden cold. The extremities are cold, the perspiring skin changes color.
Road to death
Most patients die quietly: gradually losing consciousness, in a dream, falling into a coma. Sometimes it is said about such situations that the patient died on the “usual road”. It is generally accepted that in this case, irreversible neurological processes occur without significant deviations.
Another picture is observed in agonal delirium. The movement of the patient to death in this case will take place along the “difficult road”. Signs before death in a bedridden patient who embarked on this path: psychoses with excessive excitement, anxiety, disorientation in space and time against the background of confusion. If at the same time there is a clear inversion of the wakefulness and sleep cycles, then for the patient's family and relatives such a condition can be extremely difficult.
Delirium with agitation is complicated by a feeling of anxiety, fear, often turning into a need to go somewhere, to run. Sometimes this is speech anxiety, manifested by an unconscious flow of words. The patient in this state can perform only simple actions, not 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 stopped by medical intervention.
Pain
Before death, what symptoms and signs in a bedridden patient indicate physical suffering?
As a rule, uncontrolled pain in the last hours of a dying person's life rarely increases. However, it is still possible. An unconscious patient will not be able to let you know about this. Nevertheless, it is believed that pain in such cases also causes excruciating suffering. A sign of this is usually a tense forehead and deep wrinkles appearing on it.
If, during examination of an unconscious patient, there are assumptions about the presence of a developing pain syndrome, the doctor usually prescribes opiates. You should be careful, as they can accumulate and, over time, aggravate an already serious condition due to the development of excessive overexcitation and convulsions.
Giving help
A bedridden patient before death may experience significant suffering. Relief of symptoms of physiological pain can be achieved with 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.
An experienced doctor at the stage of assessing the general condition of the patient can recognize the initial symptoms of irreversible pathological changes in cognitive processes. First of all, this is: absent-mindedness, perception and understanding of reality, the adequacy of thinking when making decisions. You can also notice violations of the affective function of consciousness: emotional and sensory perception, attitude to life, the relationship of the individual with society.
The choice of methods of alleviating suffering, the process of assessing the chances and possible outcomes in the presence of the patient, in individual cases, can itself serve as a therapeutic tool. This approach gives the patient a chance to really realize that they sympathize with him, but they perceive him as a capable person with the right to vote and choose possible ways to solve 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 exacerbate suffering, cause inconvenience to the patient. Painkillers, anticonvulsants and antiemetics, tranquilizers should be left.
Communication with a dying person
How to behave relatives, in whose family there is a bed patient?
Signs of approaching death can be obvious or conditional. If there are the slightest prerequisites for a negative forecast, it is worth preparing in advance for the worst. Listening, asking, trying to understand the non-verbal language of the patient, you can determine the moment when changes in his emotional and physiological state indicate the imminent approach of death.
Whether the dying person will know about it is not so important. If he realizes and perceives, it alleviates the situation. False promises and vain hopes for his recovery should not be made. It must be made clear that his last will will be fulfilled.
The patient should not remain isolated from active affairs. It is 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 it calmly than to hush up the topic or blame stupid thoughts. A dying person wants to understand that he will not be alone, that he will be taken care of, that suffering will not touch him.
At the same time, relatives and friends need to be ready to show patience and provide all possible assistance. It is also important to listen, let them talk and say words of comfort.
Medical assessment
Is it necessary to tell the whole truth to relatives in whose family there is a bed patient before death? What are the signs of this condition?
There are situations when the family of a terminally ill patient, being in the dark about his condition, literally spends his last savings in the hope of changing the situation. But even the best and most optimistic treatment plan can fail. It will happen that the patient will never get back on his feet, will not return to active life. All efforts will be in vain, spending will be useless.
Relatives and friends of the patient, in order to provide care in the hope of a speedy recovery, quit their jobs and lose their source of income. In an attempt to alleviate suffering, they put the family in a difficult financial situation. 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 of physiological changes, an experienced doctor is obliged to inform the patient's family about this. Informed, 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 bed patient need help before death? What symptoms and signs of the patient suggest that she should be treated?
Palliative care for the patient is not aimed at prolonging or shortening his life. Its principles affirm the concept of death as a natural and regular process of the life cycle of any person. However, for patients with an 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 lead an active lifestyle or the family does not have the conditions 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 of the patient and his family.
A dying patient needs not only attention, care and normal living conditions. Psychological relief is also important for him, relief of experiences associated, on the one hand, with the inability to self-service, and on the other hand, with the realization of the fact of an imminent imminent death. Trained nurses also know 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 to expect for relatives who have a bed patient in the family?
Symptoms of the approaching death of a person "eaten" by a cancerous tumor were documented by the staff of palliative care clinics. According to observations, not all patients showed obvious changes in the physiological state. A third of them did not show symptoms or their recognition was conditional.
But in the majority of terminally ill patients, three days before death, a marked decrease in the response to verbal stimulation could be noted. They did not respond to simple gestures and did not recognize the facial expressions of the personnel communicating with them. The “smile line” in such patients was omitted, an unusual sounding of the voice (grunting of the ligaments) was observed.
In some patients, in addition, there was hyperextension of the neck muscles (increased relaxation and mobility of the vertebrae), non-reactive pupils were observed, patients could not close their eyelids tightly. Of the obvious functional disorders, bleeding in the gastrointestinal tract (in the upper sections) was diagnosed.
According to scientists, the presence of half or more of these signs may most likely indicate an unfavorable prognosis for the patient and his sudden death.
Signs and folk beliefs
In the old days, our ancestors paid attention to the behavior of a dying person before death. Symptoms (signs) in a bedridden patient could predict not only death, but also the future prosperity of his family. So, if a dying person asked for food (milk, honey, butter) in the last moments and relatives gave it, then this could affect the future of the family. There was a belief that the deceased could take wealth and good luck with him.
It was necessary to prepare for imminent death if the patient shuddered violently for no apparent reason. It was like looking into his eyes. Also a sign of close death was a cold and pointed nose. There was a belief that it was for him that death was holding the candidate in the last days before his death.
The ancestors were convinced that if a person turns away from the light and most of the time lies facing the wall, he is on the threshold of another world. If he suddenly felt relieved and asked to be transferred to his left side, then this is a sure sign of an imminent death. Such a person will die without pain if the windows and the door are opened in the room.
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, moments 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 origin of life, are individual. No matter how hard 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 it cannot be changed.
