Death, Dying, and End-Of-Life Care

The dying process involves progressive, predictable physiological changes across all organ systems as the body transitions from active cellular metabolism toward cessation of function. Understanding these changes at the cellular level allows the practical nurse to anticipate symptoms, provide appropriate comfort care, and educate families about what to expect. The cardiovascular system deteriorates as the myocardium weakens and peripheral vascular resistance drops. Cardiac output decreases, leading to reduced perfusion of vital organs. The kidneys receive less blood flow, resulting in decreased urine output (oliguria progressing to anuria) and accumulation of metabolic waste products (azotemia). Reduced renal clearance contributes to elevated blood urea nitrogen, which can cause terminal restlessness, confusion, and myoclonic jerking. Peripheral circulation diminishes in a predictable centripetal pattern: extremities become cool and mottled first (acrocyanosis), then cyanosis progresses centrally. Mottling typically appears on the knees, feet, and hands before progressing to the trunk. Blood pressure drops progressively, and the pulse becomes weak, thready, and irregular. The respiratory system undergoes characteristic changes as respiratory muscle strength declines. Cheyne-Stokes breathing (cyclical pattern of gradually increasing tidal volume followed by gradually...