Care at the Time of Death Flashcards

Which physiological change is most indicative that death is imminent within hours?

Answer: Mottling extending to the knees and thighs

Mottling (livedo reticularis) extending from the extremities toward the trunk indicates severe circulatory failure and is a reliable sign that death is imminent within hours.

The 'death rattle' heard in actively dying patients is primarily caused by:

Answer: Accumulation of secretions in the oropharynx that the patient can no longer clear

The death rattle results from pooled oropharyngeal secretions and relaxation of throat muscles that prevent the patient from clearing secretions through coughing or swallowing.

Cheyne-Stokes respirations, commonly seen in the final days of life, are characterized by:

Answer: Alternating periods of apnea and hyperpnea in a crescendo-decrescendo pattern

Cheyne-Stokes respirations follow a cyclical pattern of gradually increasing depth and rate followed by decreasing depth, then apnea, reflecting brainstem dysfunction and altered carbon dioxide sensitivity.

A hospice patient's extremities are cool and cyanotic, with mottling, and respirations are irregular. The family asks how long the patient has to live. The most accurate response is:

Answer: These signs suggest death may occur within hours to a few days

Cool, cyanotic extremities with mottling and irregular respirations are classic signs of the active dying phase, which typically precedes death by hours to a few days.

Which of the following is considered a late sign of approaching death?

Answer: Mandibular breathing (jaw breathing)

Mandibular breathing, where only the jaw moves with each breath as chest wall muscles cease functioning, is a very late sign indicating death is typically minutes to hours away.

A dying patient's blood pressure is unobtainable, pulse is weak and irregular, and extremities are mottled to the hips. Which term best describes this patient's status?

Answer: Actively dying

Unobtainable blood pressure, weak/irregular pulse, and mottling to the hips are hallmarks of the actively dying phase, indicating imminent death.

Which change in urinary output is expected and normal in an actively dying hospice patient?

Answer: Oliguria or anuria as perfusion to the kidneys decreases

As cardiac output falls during the active dying phase, renal perfusion decreases dramatically, resulting in oliguria or anuria, which is an expected and normal physiological change.