Vital Signs and Skin Color begins to Change

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This is an example of “mottling,” the bluish/purplish coloring you may see when your friend, loved one or patient is in his or her actively dying stage (last few days of life). This discoloration may travel up the legs, to the knees. You may see it on the elbows, earlobes, shoulders, and on other bony prominences or dependent places of the body where circulation has slowed or stopped during the final days or hours of life. Those parts of the body will naturally feel cold to the touch.

As the body systems begin to shut down, blood is shunted from peripheral organs like skin and muscles to keep circulation going through vital organs like the brain, heart and kidneys. This brings about changes in temperature and color of the skin

This is an example of mottling on the legs of a dying patient. The circulation has slowed and this is a sign that the patient is coming closer to the end of his or her life.

This is an example of mottling on the legs of a dying patient. The circulation has slowed and this is a sign that the patient is coming closer to the end of his or her life.

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This is an example of mottling in a terminally ill patient’s hands and nails. 

especially in the hands and feet (most distant from the heart). This also effects the temperature regulatory systems of the body and sometimes the body may become paradoxically hot and other times cold and clammy without a fever. However the skin starts losing its turgor and color. “Mottling” is a common phenomenon seen hrs to days prior to death where an individual’s ankles, knees, elbows, or earlobes develop small areas of bluish/purplish discoloration suggesting another sign of poor circulation.

What you can do to assist: 

-You may feel one part of your patient’s body cold to touch, such as their feet for example, and another part, such as the torso or head, warm to hot. In this case, you can place a warm blanket over his or her feet to keep them warm while only placing a sheet over the torso and upper body to keep that part cool.

– Keep the patient clean and dry under all circumstances sometimes by frequently changing the linen and patient’s clothes if the patient is actively perspiring  You may use a small towel on the pillow to help absorb perspiration from the back of his or her head and the neck. Change the towel often if perspiration is perfuse.

– Give patient a tepid bed bath which may be quite refreshing. Gently dry the skin thoroughly with a soft towel by patting dry.

– In case the body temperature drops down, the patient may be cold and clammy and may benefit from warm blankets. Do NOT use electric blankets since these may burn your patient.

– Be sure to continue repositioning your patient at least every two hours with soft bed pillows unless contraindicated with their illness.

 

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