302 Physiology of dying

Question 1

What is the deterioration phase?

Answer 1

Changes common to all disease trajectories that signal a person may be approaching the last year of life:
-Unplanned hospital admissions
-Deteriorating performance status
-Increased dependence of carers
-Progressive weight loss
-Persistent symptoms despite optimum treatment
-The person asks for palliative care

Question 2

What are some neurological signs that somebody is dying?

Answer 2

-Hypoactive delirium
-Reduced consciousness level
-Reduced response to visual stimuli )no eye tracking movements)
-Agitation
-Reduced response to verbal stimuli
-Changes in breathing (Eg. cheyne stokes)
-Non-reactive pupils

Question 3

What are some neuromuscular changes when somebody is dying?

Answer 3

-Inability to close eyelids
-Inability to swallow
-Neck hyperextension
-Breathing with mandibular movement
-Grunting sound when breathing
-Death rattle

Question 4

What is the death rattle?

Answer 4

An accumulation of secretions in the upper airway that can’t easily be coughed up

Question 5

What are some cardiovascular system changes of dying?

Answer 5

-Reduced BP
-Varied electrical activity of the heart
-Reduced organ perfusion

Question 6

What are the 5 priorities of care when somebody is dying?

Answer 6

1. Recognise
2. Communicate – with the person & those important to them
3. Involve – the dying person & those important to them in decision making and care
4. Support – psychological, spiritual and social needs
5. Plan & Do – individualised care plan (symptom control, interventions, nutrition / hydration)