Wednesday, September 10, 2008

Fun-filled Funereal Facts

Death Rattle

The death rattle is a very common occurrence among the dying. It is a noisy gurgling sound that can be heard with the pt's breathing. The cause is fairly simple... As the dying process progresses, we lose our ability to swallow and cough. Because of this, oral secretions accumulate far back in the throat. With every breath the dying patient takes, air passes through or around these secretions and creates the rattling sound.There is no evidence, at all, that the rattle interferes with the patient's comfort. However, that cannot be said of the caregivers hearing the death rattle for the first time.

I've received many phone calls from caregivers that are obviously unaware of this common sign of impending death. They almost always tell me that the patient is "choking" or "drowning". I advise the caller on the use of atropine drops, under the tongue, to help dry up secretions and will also recommend repositioning the patient on their side. This is always followed by a healthy dose of emotional support and a review of the dying process. Caregivers will often ask about suctioning the patient. Removal of these secretions would require very invasive, deep suctioning and is rarely accepted in the hospice field.

The importance of educating caregivers about the dying process cannot be stressed enough. The booklets and pamphlets that hospices give their clients are excellent resources, but I suspect that they are often put aside and forgotten. Nothing can replace the information and continuous reinforcement that can be given by the visiting hospice nurse. Of course, not every caregiver is receptive to this information at first, but the education process needs to begin as soon as possible. The more that caregivers know about the dying process, the fewer "shocks" and "frights" they will have as they take this journey with their loved one.

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