Benito Rodriguez
Miami Dade College
Imminent death syndrome
Everybody is different, different fingerprints, different iris, different genes, personality, gifts, talents, and also a different death. Nobody dies the same way, this is another difference, so here is a collection of experiences when impending death is present. Nurses are the ones to take care of those who are at the end of life. It is a sad privilege to share with their families when this crucial moment comes. It is a privilege, because nurses have the education, experience and dedication to help during this transitional period.
Dignity is a distinguishing concept that only human beings have. This concept goes with us until the …show more content…
last breath. Care givers like nurses, doctors, families and any other member of the interdisciplinary team should consider it. Nobody knows how is going to die, maybe violently or suddenly, maybe slowly, we don’t know. This work is a compendium of signs before death, collected from those that have experienced the process of dying.
Clinicians are unable to accurately predict how long individual patients will survive. Although they may not be able to predict the overall course and nature of any individual’s illness, experienced clinicians recognize the impending death. In many cases, a dying process, lasting hours, days, or occasionally weeks, precedes death. Nurses have used the term “terminal syndrome” for the dying process (Dendaas, 2002)
Patients with advanced cancer and their families commonly ask clinicians for estimates of survival. Knowledge of the projected length of an advanced illness enables patients to make appropriate plans. Most of these patients want to know what’s going to happen as far as how they will deteriorate, how will affect them as it gets closer to the end. They often think it’s traumatic, whether they lose control of their bowels or bladder or cough up blood or gasp for air.
Families need to be advised of breathing changes, twitch, wiggle and irregular movements, they get very concerned about what they see, that are normal irregularities (Dendaas, 2002). Impending death have different changes in physical, emotional, and activity status. A change in behavior, like a separation from the world, family and friends. It seems that they’ve come to peace with themselves. Symbolic language also was noted like talking about leaving, and bags being packed, vision-like experiences like talking about people who’ve died before them. They talk about going on a trip that they have got to get ready (Dendaas, 2002).
Clinical signs associated with the dying process included weight loss, anorexia, declining interest in daily life, increased weakness and somnolence, decreased level of consciousness, skin mottling, chest and upper airway congestion, a “glazed” look in the eyes, changes in vital signs and anuria; Sometimes the pain is increased and sometimes the pain is just gone.
Increased sleeping, incontinence, restlessness, decreased socialization, emotional changes, increased temperature, dysphagia, visions, coma and surge of energy (Kehi et al, 2008)
Another particular sign described is palmar petechiae, or black spots on palms in terminally ill patients with cancer. This is a sign that appears few days before death. The laboratory confirms normal platelet count and no other skin lesion in any other area, just the palms and fingers. Palm petequiae are bilateral and sudden appearance. This is not result from injury, thermal, or mechanical stimulation and are less than 2 mm in diameter like a pinhead size (Shinjo & Okada, 2010, p. …show more content…
616)
Hours before death are more dramatic with severe agitation, no longer able to speak if awake, blood pressure dropping dramatically, patient’s extremities feel very cold to the touch, fever, patient complaints that his or her legs/feet are numb and cannot be felt al all, cyanosis or mottling on arms, legs, hands, knees and feet, no tactile response when eyelashes touched, no radial pulse, open-mouthed, gasping respirations, unresponsive, mouth open, eyes partially open (Guido, 2010, p. 15)
Unexpected death occurred when a dying process went much faster or slower than expected, which is a “surprise.” This could happen because acute events or complications, like heart attack, bled out, or something like you don’t expect (Dendaas, 2002).
Dying process is influenced by multiple factors, including the patient’s attitude about life, death, and the illness.
Some wouldn’t quit and are active until the last days because their enthusiasm and their will for life make a difference. Others are affected by prognosis, events and circumstances that allow them to even know the day they are going to die. Some are waiting for a loved one to pass (Dendaas, 2002). The loss of privacy and dignity has a great impact on a psychological concern to the patient when they move from independence to dependency often creates a feeling of being a burden to others. Subsequent lowered self-esteem can intensify physical pain, aloneness, depletion of energy, helplessness and hopelessness (Guido, 2010,
p.12)
Social structure and integrity of the family may be affected. Relationships and roles are disrupted. Children may manifest their concerns by isolating at home and/or school. Financial issues may arise due to lost income from family members missing work. Because all of these factors, may cause the patient to withdraw from the people around them. Professional health care providers should explain this to the family, in order to understand that this is a natural part of the dying process (Guido, 2010, p.13).
Religion may have a great impact on a patient’s well-being, and help giving comfort to the patient and family members. The system of faith, customs and practices of spirituality helps them to approach death in different way, and contribute to this process. Well educated and trained nurses help the patient and family better with our professional support.
References
Dendaas, N. R. (2002). Prognostication in advanced cancer: nurses’ perceptions of the dying process. Oncology Nursing Forum 29(3): 493-498.
Guido, G. W. (2010). Nursing care at the end of life. Upper Saddle River, NJ: Pearson.
Kehi, K. A., Kirchhoff, K. T., Finster, M. P., & Cleary, J. F. (2008). Materials to prepare hospice families for dying in the home. JOURNAL OF PALLIATIVE MEDICINE 11(7): 969-972.
Shinjo, T., & Okada, M. (2010). Palmar petechiae (black spots on palms) in terminally ill patients with cancer: a sign of impending death. JOURNAL OF PALLIATIVE MEDICINE 13(5): 615-618.