Symptom One: Need for food and drink decreases as body naturally conserves energy for metabolic functions.

Treatment:  Provide light meals with high calorie and protein content; supplements may be used.  Accept decrease appetite as normal and avoid forced feeding.

Symptom Two: Sensation, power of motion, and reflexes are lost first in the legs and then in the arms.

Treatment:

1. Assist patient with daily activities
2. Use wheel chair and bedside commode
3. Protect patient from falling
4. When bedfast, turn every two (2) hours to prevent pressure sores and increase comfort

Symptom Three: More frequent sleep and difficulty arousing.

Treatment:  Plan your time with patient during times of greater alertness.

Symptom Four:  Voice weakens and patient talks less

Treatment:  Avoid tiring patient with prolonged visits and conversation

Symptom Five: Swallowing becomes more difficult

Treatment:

1. Semi-liquids are tolerated better than liquids
2. Give small amounts
3. Elevate head of bed

Symptom Six: Increasing confusion about time, place, and identity of friends, relatives, and other familiar people.

Treatment:

1. Mention day and time frequently
2. Identify yourself when entering the room
3. Refer to people in the room by name

Symptom Seven: Increased restlessness, pulling at bed clothes, and seeing people or things not visible to others.

Treatment:

1. Speak calmly and with assurance
2. Do not startle or frighten
3. Accept "unseen" people and things

Symptom Eight:  Breathing patterns change.  Periods of apnea lasting 10-30 seconds.  Respiration becomes rapid and shallow.

Treatment:  Elevate head of bed slightly.  Reassure family this is common

Symptom Nine:  Decrease clarity of hearing and vision

Treatment:

1. Keep room well lit
2. Speak to patient from head of bed
3. Do not say anything you do not want the patient to hear

Symptom Ten:  Oral secretions may become more profuse and collect in back of throat

Treatment:

1. Elevate head of bed
2. Reassure family patient is not in discomfort
3. Keep mouth moist
4. Use humidifier

Symptom Eleven: Decreased urine output

Treatment: 

1. Irrigate catheter to prevent blockage
2. Reassure family this is an expected symptom

Symptom Twelve:  Arms and legs may become cool  Underside of body may become much darker.  Hands, knees, and feet may become mottled.

Treatment:

1. Keep patient warm
2. Avoid use of electric blankets

Symptom Thirteen: Lower jaw may relax and eyelids remain slightly open

Treatment

1. Keep mouth moist
2. Use humidifier, ice chips, moist cloths, small drops of water, artificial salvia

Symptom Fourteen: Incontinence of urine or bowel

Treatment:

1. Place pads under patients
2. Use good hygiene techniques

Symptom Fifteen:  Patient reports vivid dreams or visions sometimes of deceased relatives.

Treatment: Listen and reassure patient and family this is a common occurrence

Symptom Sixteen:  Relaxation of earlobe and/or entire ear

Treatment:  Reassure family this is a common occurrence

Signs of Death

1. No breathing
2. No heartbeat
3. Loss of bowel and bladder control
4. No response to shaking or shouting
5. Eyelids lightly open
6. Eyes fixed
7. Jaw relaxed and mouth slightly open