3 stages of actively dying
Early, Middle & Late
Early dying
- Bed bound
- loss of interest and ability to eat/ drink
- cognitive changes
Middle dying
- decline in mental status- mild to moderate reduction in alertness
- death rattle- pooled oral secretions not cleared due to loss of swallowing reflex
Late dying
- coma
- fever- usually from aspiration pneumonia
- altered resp. pattern- periods of apnea, hyperpnea, irregular breathing
- Mottled extremities
4 mechanisms for fever at end of life
- Infection- hx of exposure, barrier violation and neutropenia- fever lower in CA, elderly
- Neoplastic fever- leukemias
- Medication induced (abx, antipsych, opioid withdraw)- stopping resolves
- DVT/ PE- inflammation
Whole-brain death
Total brain failure, including brain stem- regulation of respiration, movement and speech- cannot breathe on own
Higher brain death
Absent cerebral function- where memories and personality are- intact brainstem. Loss of capacity for consciousness. Permanent vegetative state= higher brain death
Agonal phase of dying
Stage prior to death- disoriented, can’t get comfortable, can’t catch breath, death rattle, convulsions, muscle spasms.
Algor mortis
Reduction of body temp following death. Steady decline until matching ambient temperature
Rigor mortis
Caused by chemical changes in muscle after death- limbs become stiff, rigid, difficult to manipulate
1-2 weeks till death- 9 signs
- Increased pain
- Change in BP, RR, HR
- Continued loss of thirst/ appetite
- Decline in bowel/ bladder output
- Changes in speed wake patterns
- Temperature fluctuations
- Constant fatigue
- Congested breathing from built up secretions
- Disorientation/ hallucinations
Hours of death- 8 signs
- No food/ drink
- No bladder/ bowels
- Pain through grimaces, groans, scowls
- glazed/ teary eyes
- drifting though consciousness
- Pulse & heart beat irregular/ difficult to detect
- Drop in body temp- extremities become blue- mottling= death in 24 hrs
- Breathing with gasping then slows to stop
Cause of death 1-24 yrs
- Unintentional injury
- Homicide
- Suicide
Cause of death 25-44
- Unintentional injury
- suicide
- Malignant neoplasms
Cause of death 45-64
- Malignant neoplasms
- Heart disease
- unintentional injury
Cause of death 65+
- Heart disease
- malignant neoplasms
- chronic lower respiratory disease
9 modifiable risk factors assoc with mortality
- Tobacco
- HTN
- obesity
- high sugar, cholesterol, sodium, trans fat
- alcohol
- low omega 3
- low fruits and veg.
Pathophys of fever
exogenous pyrogens (microbs) and pyrogenic cytokines (IL & TNF) -> prostaglandin E2 (PGE2)-> increase cAMP-> increase hypothalmic set point to febrile levels-> peripheral meager and arthralgia
