2- 5 days prior to death
Motor
Urinary/Bowel
Cognitive/Personality/Speech
Physical
- Motor movements (e.g. waving or hugging) are likely to appear weak
- Unable to help the caregiver by leaning or moving during linen changes
Urinary/Bowel
- Bowel activity likely will have stopped
- Urine output will lessen considerably
- Urine colour usually lightens
Cognitive/Personality/Speech- Very little interaction, often no initiation
- Speech may be quite slurred and hard to understand
- May sit in the room with others and say nothing for hours
- Could be described as "neither here nor there"
- Restlessness and agitation give way to calm
Physical
- Hands and feet may become cool
- Forehead and cheeks may be warm or hot
- Thighs and abdomen may be warm or hot
- Hard to keep the eyelids open, even when awake
- May spend a couple of days with the eyes closed, even though still slightly responsive
- Minimal interest in food
- May turn or clench lips to indicate refusal of food or pills
- May seem unaware of how to use a straw
- May have had last decent fluid intake
- May bring mucus up into the mouth with a productive cough
- Last steroid dose may be administered (either intentionally or due to difficulty of administration)
- Some drugs may be given only by suppository or dropper now
- Vital signs often still normal, but some report cardiac changes (e.g. racing heart)
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