Welcome Overview Pain Management Symptom Management Common Symptoms: Bowel Management Nausea and Vomiting Fatigue Fatigue Terminal Phase Changing Awareness Withdrawal Pain Altered Elimination Respiratory Changes Agitation or Restlessness Signs of Impending Death Caregiver Support
		The Terminal Phase of Illness Four Signs of Impending Death There are thought to be four signs of impending death that commonly occur in the following order and that are common to most patients. It is important to know these signs and teach the caregivers to understand them as well. From the HPNA Core Curriculum, 2002: The “death rattle” occurred before the other symptoms in 74% of patients, occurring approximately twenty-four hours or more before death. Respirations with jaw movements or “fish out of water” breathing occurred next Cyanosis of the extremities with or without mottling at the ankle or knee joints. Finally, pulselessness of the radial artery. The last three symptoms were observed during the final six hours of life, but this varied among the individual patients, and not all patients experienced the “death rattle.”