Breathing patterns change often for patients approaching death. It may be accompanied by individual’s inability to clear airway secretions which can sound very distressing like a “rattle” due to patient’s inability to clear his or her own saliva. Studies have shown that this “rattle” like breathing although very discomforting to hear for caretakers, family and friends may not be distressing to the patient. Patients breathing may vary from being normal to short and long periods of apnea (no breathing for several seconds–even up to 1 and 1/2 minutes) to rapid and shallow breathing to 40 breaths/min when an adult usually takes about 12-16 breaths per minute. These are within normal changes of breathing patterns for someone approaching death.
What you can do to assist: –
-Gently turning the patient to his or her side which helps gravity to drain the secretions. Raising the head of bed to a 45 – 60 degree angle may also help. – Certain medications included in comfort care kits provided by Hospice organizations help decrease the secretions. Please inquire about it from Hospice Nurse entrusted with patient care. This is extremely important for patient comfort!
– A patient this close to death often begins to breathe with his/her mouth open. You will notice the mandibular jaw open and shut with each breath. Frequent oral care is very important at this stage due to the mouth and lips becoming dry and uncomfortable. If the caregiver is unable to actually brush the patient’s teeth with a toothbrush, then a simpler, and more comfortable, method of using a “toothette” is recommended. A “toothette” is a soft, spongy tipped disposable stick that can be dipped into fresh, cool water and used to freshen the patient’s mouth. A small drop of mouthwash may be added to the water, if desired, for added comfort. Be sure to wipe in the upper palate where debris can collect, causing added bacteria and discomfort if not removed. Continue to clean the spongy tip and refresh in clean water until the patient’s mouth appears clean and fresh. These spongy-tipped sticks are disposable and each one should not be used more than one day. Some come unflavored and others come with a “minty” flavor added.
-If “toothettes” are not available in your area (at drugstores or medical supply stores) you may want to order them online OR simply use a clean, gauze pad to clean the inside of your patient’s mouth. Dip the gauze pad in clean, fresh water, wring out until simply damp, and wrap around your index finger. Gently wipe teeth and then sweep the upper palate to remove debris. You can add a drop of mouthwash in the cup of water to freshen his/her mouth even more.
-If the patient is NOT on oxygen, a type of “Vaseline” ointment may be lightly applied to his or her lips to keep them moist. If he/she is on oxygen, it is strongly recommended to use only a NON-petroleum type of lip moistener to keep the lips from drying out.
– For breathing difficulties, opioids may be offered by the Hospice RN/Physician to assist with labored breathing. (Most hospice doctors and nurses agree that a small amount of short-acting, liquid morphine, administratedvia a dropper under the tongue (sublingual) or on the inside of the mouth (specifically the buccal space near the inside cheek), or inhaled via a nebulizer treatment, is the drug of choice and routes of choice to relieve breathing difficulty in a patient struggling with this medical issue rather than an oral morphine pill or a rectally inserted suppository or even intravenous (IV) administered morphine.
– If oxygen is being administered, be sure the nasal prongs are in place, utilize a small electric fan, if available, place it on a low speed
and direct it towards your patient’s face from a comfortable distance. Be sure the patient has adequate, natural circulation of air in the room. Open a window if weather permits. Be sure your patient has adequate blankets so he/she does not become chilled. (The Final Journey, Pg. 192)