The following signs and symptoms described are indicative of how the body prepares itself for the final stage of life.

The person´s hands and arms, feet and then legs may be increa­singly cool to the touch, and at the same time the color of the skin may change. This a normal indication that the circul­ation of blood is decreasing to the body’s extrem­ities and being reserved for the most vital organs.

The person may spend an increasing amount of time sleeping, and appear to be uncomm­uni­cative or unresp­onsive and at times be difficult to arouse. This normal change is due in part to changes in the metabolism of the body. Sit with your loved one, hold his or her hand, but do not shake it or speak loudly. Speak softly and naturally. Plan to spend time with your loved one during those times when he or she seems most alert or awake. Do not talk about the person in the person’s presence. Speak to him or her directly as you normally would, even though there may be no response.

The person may seem to be confused about the time, place, and identity of people surrou­nding him or her including close and familiar people. This is also due in part to the metabolism changes. Identify yourself by name before you speak rather than to ask the person to guess who you are. Speak softly, clearly, and truthfully when you need to commun­icate something important for the patient’s comfort, such as, It is time to take your medica­tion, and explain the reason for the commun­ica­tion, such as, so you won’t begin to hurt. Do not use this method to try to manipulate the patient to meet your needs.

The person may lose control of urine and/or bowel matter as the muscles in that area begin to relax. Discuss with your Hospice nurse what can be done to protect the bed and keep your loved one clean and comfor­table.

The person may have gurgling sounds coming from his or her chest as though marbles were rolling around inside these sounds may become very loud. This normal change is due to the decrease of fluid intake and an inability to cough up normal secret­ions. Suctioning usually only increases the secretions and causes sharp discom­fort. Gently turn the person s head to the side and allow gravity to drain the secret­ions. You may also gently wipe the mouth with a moist cloth. The sound of the congestion does not indicate the onset of severe or new pain.

The person may make restless and repetitive motions such as pulling at bed linen or clothing. This often happens and is due in part to the decrease in oxygen circul­ation to the brain and to metabolism changes. Do not interfere with or try to restrain such motions.

The person´s urine output normally decreases and may become tea colored referred to as concen­trated urine. This is due to the decreased fluid intake as well as decrease in circul­ation through the kidneys.

The person may have a decrease in appetite and thirst, wanting little or no food or fluid. The body will naturally begin to conserve energy which is expended on these tasks. Do not try to force food or drink into the person, or try to use guilt to manipulate them into eating or drinking something. To do this only makes the person much more uncomf­ort­able. Small chips of ice, frozen Gatorade or juice may be refreshing in the mouth. If the person is able to swallow, fluids may be given in small amounts by syringe (ask the Hospice nurse for guidance). Glycerin swabs may help keep the mouth and lips moist and comfor­table. A cool, moist washcloth on the forehead may also increase physical comfort.

The person s regular breathing pattern may change with the onset of a different breathing pace. A particular pattern consists of breathing irregu­larly, i.e., shallow breaths with periods of no breathing of five to thirty seconds and up to a full minute. This is called Cheyne­-Stokes breathing. The person may also experience periods of rapid shallow pant-like breathing. These patterns are very common and indicate decrease in circul­ation in the internal organs.