Death, Dying, and End-Of-Life Care

End-of-life care is not a single diagnosis or a predictable timetable. It may involve months of palliative care, the final weeks of declining function, or the last hours of life. The purpose changes from curing disease or prolonging life at any cost to relieving suffering, preserving dignity, supporting informed choices, and helping the patient and family prepare for death. The practical nurse asks a different question as illness advances: not simply, “What treatment is available?” but, “What is causing distress, what outcome does the patient want, and which intervention fits the documented goals of care?” A treatment that may be appropriate earlier—repeated blood tests, intravenous fluids, hospitalization, or aggressive monitoring—may become burdensome when it no longer improves comfort or meets the patient’s wishes. The dying process produces recognizable physiological changes. Appetite and thirst often decline because the body requires less energy and the gastrointestinal system slows. Urine output falls as renal perfusion and intake decrease. Circulatory changes cause cool or mottled extremities, while altered brain perfusion, medication effects, metabolic changes, and disease progression contribute to increasing sleepiness or confusion. These...