Stages of the dying process

	WHAT YOU SEE	WHAT IS HAPPENING	WHAT YOU CAN DO TO HELP
EARLY STAGE	A decrease in both eating and drinking which may last from days to weeks. Less interest in food; eating may become more of a burden than pleasure Occasional choking on fluids. Feeling "full" quickly	The body is conserving energy and requires less nourishment. This natural process of shutting down hunger does not cause pain or suffering. IV fluids and artificial feeding at this time of life cause physical distress in the body and will not prevent death.	Moisten the patient's mouth with toothettes & swabs frequently. Offer sips of fluid or chips of ice. Offer bits of food if desired. Follow the patient's wishes about taking the food and fluids.
MIDDLE STAGE	Changes in physical appearance may last a few hours or days.	Often the patient's hands and feet may feel cool and may darken in color. The circulation is slowing down and the blood is being reserved for the major internal organs	Offer or remove blankets or a sheet as the patient's circulation changes. Do not use electric blankets or heating pads. The patient cannot judge well if they are too hot
	Patients will respond less and less to you and his/her surroundings. Eventually the patient is completely unable to speak or move. This usually happens during the last few days of life.	Patient is preparing for release by detaching from surroundings and relationships. This is a physical and spiritual response to the dying process.	Assume that the patient can hear everything. Say your name. Talk softly. Touch gently but only if the patient likes to be touched. Do not ask questions which require answers. You may find prayers or meditation helpful at this time
LAST STAGE	Intermittent disorientation and restlessness may occur in most patients. This may increase in the last days.	This is due partly to the changes occurring in the patient's metabolism.	Touch gently but only if the patient likes to be touched Talk reassuringly Remain calm Medication may be needed for restlessness
	You will notice a gradual decrease in the patient's urine output. If the patient has a Foley catheter, the urine may appear very dark. The bowel movements may stop altogether or the patient may become incontinent during the last few days.	As the circulation decreases, kidneys and bowel function may be reduced. Muscles may relax causing incontinence for the patient.	Remain calm Patient may need underbody pads Patient may need diapers Patient may need or request a Foley catheter Let caregivers know when pads or diapers are soiled and need changing
	Breathing becomes more irregular. Breathing may be shallow and have long pauses, which become more frequent and longer in duration as death approaches, especially during the last few days. This is sometimes called Cheyne-Stokes respiration. Increasing sounds of congestion in the chest and a rattle in the throat may be heard during the last hours.	Circulation of blood to the internal organs, including the heart and lungs, will decrease. Throat muscles will begin to relax and the lungs will lose their ability to clear fluids.	Elevate the head of the bed or use pillows to elevate the patient's head Turn the patient on his or her side Oxygen does not help at this stage Medications will be useful Speak respectfully. Although the patient may not be responsive to you, he or she may still hear you Mouth care increases comfort Suctioning does not help Transdermal scopolamine patch or atropine drops may help to dry secretions

These are guidelines for what to expect. The timing and symptoms of each stage will vary from person to person.