The nurse is providing care to a patient who is approaching death. Which family member statement regarding the physical and psychological changes associated with death is reflective of the late stage?

• A. Respirations may sound loud and wet during this stage.
• B. A loss of appetite often occurs during this stage.
• C. I might notice that he will begin to sleep more during this stage.
• D. Confusion or disorientation may begin to occur during this stage.

Answer: (A)

In the final stage, the most recognizable physical change is the death rattle: secretions accumulate in the throat and airways as the swallowing and cough reflex weaken, and the patient may not be able to clear them. This produces respirations that sound loud and wet. This vocalized breathing change is a common, expected sign as death nears and helps clinicians and families recognize that the end is near.

Other common signs like loss of appetite or increased sleep can occur as illness progresses, and confusion or disorientation can occur with terminal delirium. However, the loud, wet-sounding respirations due to pooled secretions are most characteristic of the late stage of dying.