5 - 7 days prior to death
Motor
Urinary/Bowel
Cognitive/Personality/Speech
Physical
- May restlessly move the legs, as though uncomfortable
- Most patients would no longer be leaving the bed by this stage
- May reach up or out with the arms
- May pick at the bed linens as if covered with small objects
Urinary/Bowel
- As liquid intake decreases, output also decreases
- The bowel becomes quite sluggish and there may be few/no bowel movements
Cognitive/Personality/Speech- Minimally responding to caregiver's questions
- May begin sentences but not be able to finish them
- May say things that are impossible to make out or things that don't make sense
- May chant something ("Ohboyohboyohboy..." or "Ohmyohmyohmy...")
- May continue to seem restless and fidgety, as if late for something
- May be irritated by strong sounds or odours
Physical
- May be taking only minimal amounts of food (a spoonful or two, here and there); some, however, continue to eat well until about 48 hours before death
- Decreasing intake of fluids
- Administration of meds becomes harder or impossible
- Dosing of meds becoming sporadic due to sleep schedule
- May find it hard to clear the throat as mucus increases
- The voice may lower and deepen
- May have a wet cough
- Vital signs often still good
- Nearly always sleeping or resting
- May be uncomfortable being moved during clothing or linen changes
- Dramatic withering of the legs due to inactivity (skin 'n' bones)
- May have a low-grade fever
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