The Process of Dying
A. Events leading to death
1. Brain ceases to supply information vital for controlling ventilation, heart rhythm, and/or vasodilation
2. Lungs unable to supply O2 exchange with blood stream
3. Heart and blood vessels unable to maintain adequate circulation of blood to vital tissuesB. Cerebrovascular system
1. Hemorrhage
2. Pump failure
3. Decreased CO2 leads to decreased PCO2 leads to Cheyne-Stokes respirationC. CNS problems
1. Infection
2. Blood vessel disruption
3. Malignant tumors
4. Metabolic changes
a. Renal failure
b. Hepatic failure
c. Pancreatic failureD. CNS decompensation
1. Early signs
a. Sluggish pupils
(1) Non reactive
(2) Dilated and fixed - drugs also affect this
b. Confusion
c. Inability to orient2. Later signs:
a. Lethargy
b. Decreased ability to perform simple cognitive functions
c. Attention only by tactile, auditory or visual stimuli3. Late signs:
a. Stupor, sleep
b. Withdrawal of purposeless involvement to stimuli without wakefulness or arousal
c. Loss of bowel control4. Semicomatose - movement only with pain
5. Deep coma - no response
E. Respiratory system
1. CBF
2. COPD
3. Infections
4. Cancer metastasisSigns of approaching death
When death is imminent
Physical death is a progressive process, during which there are some signs that usually indicate that death is imminent. Not all of the following changes occur, nor do they necessarily occur in any particular order, as the body shuts down during the dying process. In general, the following information may help anticipate and understand changes that appear as an individual approaches death and is “actively dying.”
- The dying individual may become increasingly tired and sleepy, and may be difficult to arouse. The dying individual may become confused much of the time and may no longer recognize familiar persons, places, or objects.
- Hearing and vision may become impaired, and speech may be slurred, difficult to understand, or nonsensical.
- A few dying individuals become restless or very anxious and move about frequently in the bed, pull at the bed clothes or bedding (linen clutch), and reach out.
- The person may experience hallucinations.
- Less nourishment will be required, and the person’s intake of food and water will diminish. Difficulty in swallowing (dysphagia) may also occur.
- The person may sweat profusely.
- The dying person may lose control of his/her urine or bowels (incontinence), necessitating that the individual be kept especially clean and dry in order to prevent bed sores (decubitis ulcers).
- Urination may become darker and diminish or stop.
- The mouth of the dying individual may become dry, and then secretions may accumulate in the back of the throat. Breathing may become noisy because of the gurgling or rattling of the secretions in the mouth or chest (“death rattle”).
The pattern of breathing may change; become slower or faster, deeper or shallower, or irregular. Often the dying individual will have periods of rapid breathing followed by periods in which breathing is very slow or is even absent for as long as 15 seconds.- The legs, and then arms, may become cold and nonreflexive as the circulation slows down.
- The skin may be pale or mottled, and some parts, particularly the underside of the body, may become a dark color as the blood pools, usually a deep blue or purple.
When death occurs
- Breathing ceases entirely.
- Heartbeat and pulse stop.
- The person is entirely unresponsive to stimulus.
- The eyes may be fixed in directions. The pupils are dilated and fixed to light.
- The eyelids may be open or closed.
- A loss of control of urine and/or bowels may occur.
- The person becomes progressively mottled and cold and stiff (known as rigor mortis)
- The skin may become pale; there may be signs of blood buildup in the part of the body at lowest elevation (known as livor mortis).
