- Cheyne-Stokes Breathing: A cycle of deep, rapid breaths followed by periods of no breathing (apnea) that can last from a few seconds to a minute.
- "Death Rattle": A gurgling or rattling sound caused by saliva or secretions pooling in the back of the throat because the person is too weak to swallow or cough.
How to Cope:
- Stay Calm: The "death rattle" sounds worse to listeners than it feels to the patient. It is generally not painful for the dying person.
- Adjust Positioning: Gently turning their head to the side or elevating their head with pillows can help drain secretions and ease breathing.
- Humidify the Air: A cool-mist humidifier can help keep airways moist.
- Medication: If the breathing seems labored or distressing, ask the hospice team about medications to reduce secretions or ease air hunger.
4. Coolness & Color Changes in Extremities
What Happens: As circulation slows, blood is directed to vital organs (heart, brain) and away from the extremities. Hands, feet, arms, and legs may feel cool or cold to the touch. The skin may look blotchy, pale, gray, or have a bluish/purplish tint (mottling), especially on the knees, feet, and hands.
How to Cope:
- Use Light Blankets: Cover them with a light, soft blanket for warmth, but avoid heavy electric blankets or heating pads, which can burn fragile skin.
- Touch Gently: Their skin may be sensitive. Handle them with care.
- Understand It’s Normal: Mottling is a sign that circulation is concentrating on the core. It is a natural part of the process and not painful for the patient.
5. Confusion, Restlessness, or Withdrawal
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What Happens: Your loved one may become agitated, pick at bed linens, try to get out of bed, or speak to people who aren’t there. Conversely, they may withdraw completely, seeming uninterested in their surroundings. This is often due to changes in brain chemistry, oxygen levels, or metabolic shifts.
How to Cope:
- Don’t Correct Them: If they see deceased relatives or talk about "going home," go with the flow. Arguing or correcting them causes distress. Instead, validate their feelings: "It sounds like you’re seeing someone special."
- Reduce Stimulation: Keep the room quiet, dimly lit, and calm. Too much noise or activity can increase agitation.
- Reorient Gently: If they seem scared, speak calmly and remind them who you are and that they are safe.
- Consult Hospice: If restlessness becomes severe, medical intervention can help ease their discomfort.
