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SamaritanNJ.org 25AS DEATH NEARSAS DEATH NEARSWeeks To DaysDays To HoursHours To MinutesDecreasing socialization, mental status changes, decreased oral intake, fatigue, and a decrease in functional status.Decreased urine output, little response to stimuli, secretions, changes in vital signs (temperature fluctuates), a %u201cRally Day%u201d (1-2 days of unexpected alertness and energy), glassy eyes, tearing, and near-death awareness experiences.Cooling and purplish/blotchy changes in skin color to the knees and feet, slow/weak heartbeat, changes in breathing pattern (periods of apnea), waxy appearance to the skin, non-responsiveness.CARDIOVASCULAR (CIRCULATION) RESPIRATORY (BREATHING) BIOLOGICAL (PHYSICAL)ColorCoolness Fever CongestionBreathingPatternCLINICAL SIGNS DESCRIPTION MANAGEMENT TECHNIQUES SYSTEMExtremities, lips look blue or purple, depended areas darkenHands, arms, feet, and legs become increasingly cool Fever may be commonNoisy breathing, gurgling sounds from the back of the throat (resembles snoring or liquid moving through a straw)Apnea (pauses), shallow breathing, Cheyne-Strokes (shallow/fast breaths that alternate with periods of apnea), panting, mandibular breathing (occasional deep breaths, sometimes between period of apnea)%u2022 Normal process, educate & support family%u2022 Keep the patient warm with a nonelectric blanket%u2022 Applying a cool compress, if sweating, keep dry%u2022 Medications: acetaminophen%u2022 Suctioning is usually ineffective, and may increase secretions %u2022 Position on their side, raise or lower head as tolerated%u2022 Medications: anticholinergics and antihistamines %u2022 Assess for signs of discomfort, if none, educate and support the familyFluid & Food IntakeDecreased appetite and thirst%u2022 Pleasure feeding%u2022 Ice chips%u2022 Oral care%u2022 Moisten lips%u2022 Lubricate eyes