Teaching is most effective before the final hours, when family members can hear the explanation and ask questions. Prepare them for reduced consciousness, poor performance, difficulty swallowing, falling oral intake, periodic breathing with apnea, jaw-drop breathing, declining urine output, peripheral cyanosis, nonreactive pupils, and eyelids that may not fully close. Explain what the team will do for comfort and invite the family's specific fears; uncertainty often causes more distress than the physical sign itself. Death rattle results from pooled secretions in a person who can no longer swallow or clear them. It occurs in about half to three-fifths of dying patients and usually alarms family members more than it distresses the patient. Start with an explanation, repositioning, mouth care, and review of whether IV hydration remains consistent with the goals of care. Do not make deep suctioning the automatic response: it does not restore swallowing and may be burdensome. Randomized evidence has not shown scopolamine, hyoscine, atropine, or glycopyrrolate to be better than no treatment. If an antimuscarinic is selected, glycopyrrolate is generally preferred because it crosses the blood-brain barrier...