Pathophysiology
Clinical meaning
End-of-life care encompasses the final days to weeks of a patient's life when curative treatment is no longer effective or desired, and the focus shifts to comfort, dignity, and quality of life. As death approaches, predictable physiological changes occur as organ systems progressively fail. The cardiovascular system demonstrates decreasing cardiac output with weakening peripheral pulses, mottling of the extremities (beginning with the knees, feet, and hands), and progressive hypotension. The respiratory system undergoes characteristic changes including Cheyne-Stokes respirations (a cyclical pattern of increasing then decreasing respiratory depth with periods of apnea), terminal congestion or the 'death rattle' caused by accumulation of secretions in the pharynx that the patient can no longer clear, and eventual respiratory failure. Neurological changes include progressive somnolence, withdrawal from environmental stimuli, decreased responsiveness, loss of reflexes, and eventual coma. Hearing is believed to be one of the last senses to be lost, which has important implications for family communication. Renal function declines with decreased urine output progressing to oliguria and anuria as blood flow to the kidneys diminishes. The gastrointestinal system slows dramatically with loss of...