DeathDeath is a irreversible cessation of circulatory, respiratory functionor the irreversible cessation of all functions of the entire brain,including the brainstem.Signs of DyingThis includes the following changes:Loss of appetiteDecreased oral fluid intake and decreased thirst.Increasing weakness and/or fatiqueDecreasing blood perfusion, including decreased urine output,peripheral cyanosis and cool extremities.Neurologic dysfunction, including delirium, lethargy and comaand changes in respiratory patterns.Loss of ability to close eyes.Noisy breathing as pharyngeal muscle relax.In particular, neurologic dysfunction can sometimes result interminal delirium. Which can include a mounting syndrome ofconfusion, hallucinations, delirium, myocardial jerks and seizuresprior to death.Pitting edema develops, especially of the extremities andsacrumMovement and sensation are gradually lost.Temperature elevation will be there, but the skin feels cold andclammy.Pulse becomes irregular, weak and fast.BP falls as the peripheral circulation decreases.The skin cyanosed as circulation decreases.Respiration become noisyReflexes disappearUrine decreasesPain usually subsidesMental alertness variesJaw and facial muscles relax with the expression becomingpeaceful.Stages of DyingAccording to Kubler- Ross, the five stages of dying are:
1.Denial. On being told that one is dying, there is an initialreaction of shock. The patient may appear dazed at first and maythen refuse to believe the diagnosis or deny that anything iswrong. Some patients never pass beyond this stage and may gofrom doctor to doctor until they find one who supports theirposition.2.Anger. Patients become frustrated, irritable and angry that theyare sick. A common response is “Why me? ” They may becomeangry at God, their fate, a friend, or a family member. The angermay be displaced onto the hospital staff or the doctors who areblamed for the illness.3.Bargaining. The patient may attempt to negotiate withphysicians, friends or even God, that in return for a cure, theperson will fulfill one or many promises, such as giving to charityor reaffirm an earlier faith in God.4.Depression. The patient shows clinical signs of depression-withdrawal, psychomotor retardation, sleep disturbances,hopelessness and possibly suicidal ideation. The depression maybe a reaction to the effects of the illness on his or her life or itmay be in anticipation of the approaching death.5.Acceptance. The patient realizes that death is inevitable andaccepts the universality of the experience. Under idealcircumstances, the patient is courageous and is able to talkabout his or her death as he or she faces the unknown.