REDUCED FOOD & FLUID INTAKE:
Loss of appetite and decrease in thirst are common. The body is beginning to shut down and does not need nourishment. People commonly feel it is necessary to encourage the person to eat in the hope of sustaining life; however, food and fluid may cause discomfort. The person may ask for ice chips, popsicles, ice cream or some other food choice. Do not be surprised if only a mouthful or two is taken. When swallowing is no longer possible, mouth care provides moisture and comfort. Do not offer a fluid if swallowing is not possible.

ELIMINATION:
Output of urine and stool will decrease as the food and fluid intake decreases. Urine and stool may also change colour, be passed less frequently and in smaller amounts. Other factors such as immobility and medication may contribute to this.

Your loved one may lose control of bladder or bowel function as the muscles begin to relax. In this instance it may be necessary to use an incontinence brief.

Ask the health care professional about the management of these symptoms. It is important to provide skin care and cleansing on a routine basis.

SLEEPING:
Sleeping an increased amount of time is common. It may become more difficult to waken the person. As death nears, the person may slip into a coma and become unresponsive.

RESTLESSNESS AND DISORIENTATION:
Confusion as to time, place and recognition of people, even family members and close friends is common.

At times your loved one may become restless. For example, he/she may reach out to unseen objects, pull at bedclothes or try to get out of bed. This can occur for many reasons such as lack of oxygen circulation to the brain or changes in condition or medications. It would be helpful to discuss these changes with a health care professional.

CHANGES IN BREATHING:
Regular breathing patterns may change. Breathing may stop for 10 to 30 second periods or there may be periods of rapid, shallow panting. These breathing patterns are normal and indicate the natural progression towards death.

A moaning sound occurs as the breath passes over the relaxed vocal cords.

CONGESTION:
Gurgling sounds, often loud, occur when a person is unable to cough up normal secretions. This does not normally cause pain or discomfort. It may be helpful to turn the person to one side and gently wipe away secretions with a moist cloth. As secretions build up, keeping the head of the bed elevated (by using pillows) will make breathing easier. Sometimes medications can be ordered to help dry up secretions.

Oral suctioning may be done, however, this usually causes an increase in secretion production.

SKIN:
You may notice the skin begin to change colour and become cooler to touch.

The face may be pale and the feet and legs a purple-blue mottled colour. The circulation of the blood is slowing down.

Although your loved one is cool to touch, he/she is usually comfortable. Offer a warm blanket but avoid using an electric blanket to prevent the risk of skin burns.