Why is death rattle incurable
Accompaniment in the dying process
1. The most important things in a nutshell
The most important thing in accompanying dying people is to respond to their individual needs and wishes. To achieve this, care for the dying should be discussed with this person in advance - if possible with the involvement of the relatives and all those who are involved in this process.
2. Dying process
Almost everyone is afraid of dying: patients as well as relatives. It can be helpful to know what is coming so that you can adjust to it and not be alarmed by certain symptoms or changes. Sudden death is common in palliative care patients rather seldom. Most of the time, there are significant changes in the last 1–2 days and especially in the last few hours.
Experienced nurses and doctors often recognize this dying process in incurable diseases based on symptoms, e.g .:
- Progressive weakness
- Increasing restlessness and agitation
- Deep need for sleep, up to and including unconsciousness
- Change in breathing
- No cough reflex
- Transition to rattle breathing (see below)
- Failure of kidney function
- Most recently respiratory and cardiac arrest (clinical death)
3. Open communication
The accompaniment in the dying phase should be specifically discussed in advance. If possible, wishes and rituals should be established for this phase. It is important that all wishes and ideas can be changed and adapted to the situation at any time, right up to the end.
The prerequisite for this is that all relatives and friends or, if available, the entire caring team deal openly with one another and with the issue of dying. The last hours are of great importance: they are usually difficult for everyone involved, but later, after death, they are a valuable memory that can also ease the grief.
Conversely, relatives can seek advice in advance in care facilities for the dying. These offer dying care at home or inpatient and accompany the relatives even after death.
With neighbors, e.g. in a nursing home or hospital, it should be clarified in advance whether they want to stay with them recently. You should then be included or be able to leave the room in good time, depending on the possibility and request.
Patients can specify their wishes for the dying phase in writing in a living will, health care proxy or care will.
4. Shaping the last phase of life
In any case, the aim is to shape the patient's final phase of life according to his / her ideas:
- If he did not have a specific desire to die alone, he should not be left alone, even if he is no longer conscious. However, too many people present can cause great unrest - this should be avoided.
Designate a relative as the main contact person. He can provide all the important information to the outside world and, for example, coordinate the number and times of visitors.
- If there are no relatives or there are no relatives on site, other people, e.g. pastors, nursing staff or voluntary visiting services, should take over the last escort in consultation with the patient.
- If the dying person wishes certain rituals, religious or pastoral accompaniment for the last hours, this should be observed and made possible.
- Dealing calmly with the dying person through physical contact and conversation, showing him that he is not alone.
- The patient should be allowed to die with dignity and in compliance with the desired medical assistance (living will).
The living will can also contain a kind of emergency plan, in which the last expected problems / symptoms and their consequences are regulated. This makes the situation easier for everyone involved and relieves them of the fear of difficult decisions such as: Should the dying person still be admitted to a hospital, should he still be ventilated, he should be artificially fed, should he "only" be given the best possible pain medication.
- Also note: what wishes he has expressed for his surroundings (music, lighting, etc.).
5. Nursing aspects
The nursing priorities (palliative care) are changing:
- The intake of food and fluids takes a back seat or is completely stopped. If necessary, replace it with good oral care to prevent dehydration, pain and discomfort.
- Ensure comfortable and relaxed storage. Reduce or stop regular repositioning.
- Customize skin care and washing as desired, also depending on the necessity (e.g. profuse sweating) and the strength of the patient.
- Reduce the changing of incontinence pads to a reasonable level, if necessary accept wet lying. Only empty your bowels if you have symptoms such as constipation.
- In the event of pain and other stressful symptoms, inform the doctor so that they can be alleviated with the best possible medication. If you have difficulty swallowing, switch the medication from oral (tablets and capsules) to other forms of administration (e.g. drops, injections, plasters or pain pumps via veins).
6. Rattle breathing
The rattle breathing is noisy and often combined with longer breathing pauses. It is a clear sign of approaching death and occurs in more than half of the dying. It is therefore also called "terminal rattle" or "death rattle".
The rattle breathing is no Signs of shortness of breath. But the rattling sounds excruciating to outsiders and especially scares relatives. The patient himself hardly notices the rattling.
Rattle breathing is usually caused by thickened saliva or secretions that collect in the area of the glottis. It rattles when the breath sweeps past it. The patient himself is already too weak to cough up or swallow the liquid.
6.1. Relief from rattle breathing
Rattle breathing can be alleviated to some extent:
- Raise the patient's upper body and, if possible, lay the head to one side so that saliva does not run backwards.
- Pat your mouth dry if there is a lot of saliva.
- Do not give anything to drink and stop artificial hydration. As a rule, dying people are no longer thirsty and more fluids stimulate the formation of saliva and secretion.
- Take care of your mouth and lips so they don't dry out and crack.
- Do not suck off secretions in the last hours of life, because this is uncomfortable to painful for the patient and stimulates the production of mucus.
- Medicines can reduce the formation of saliva and secretions.
7. What helps relatives and how they can help
For relatives, terminal care is the very last time with the patient, it is difficult and valuable at the same time. Ideally, they will find support from doctors, pastors, employees of the nursing and / or hospice service and (if available) a palliative care team.
Experience has shown that after death it is a valuable memory to have been there:
- The last help is important for the dying person and for the relatives themselves.
- Relatives can help fully with the care, more details under palliative care by relatives.
- If patients are cared for at home, the general practitioner should leave a brief note about the diagnosis, prognosis and last therapy. This provides information security in the event that another doctor has to be called in in an emergency.
But: Relatives shouldn't be overwhelmed either.
- There are illnesses and dying situations that are difficult or even unbearable. Then the relatives should get help to cope with the upcoming tasks.
- After years of illness and ever more intensive care, some are at the end of their strength and have hardly any strength left for the last few days. Every person has individual limits of resilience. To protect against overload, retreat options should be used, e.g. "guest rooms" in the hospice, or helpers who step in and, for example, take on a night watch: other relatives, hospice helpers, caregivers.
- It is possible that the patient's wish to die at home cannot be fulfilled because of the overwhelming demands of the environment. Then a bed in an inpatient hospice or in a palliative ward can be an alternative.
8. Related links
Palliative care guide
After death> organizational matters
After death> say goodbye
Forms of funeral and funeral parlors
Funeral expenses social assistance
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