Findings suggesting death in days to weeks:
(1) progressive, profound weakness and fatigability
(2) bed bound
(3) sleeps much of the time
(4) disinterest in food and fluids
(5) difficulty swallowing (not related to obstruction)
(6) weakening of the voice
(7) loss of ability to close eyelids
(8) urinary incontinence
(9) oliguria
(10) falling blood pressure (not related to hypovolemia or bleeding)
(11) disorientation to time
(12) decreasing attention span
(13) vivid dreams or nightmares
(14) reports by patient of seeing previously deceased individuals important to them
(15) speech content containing references to home or travel to a final destination
Findings suggesting death within hours:
(1) respiratory changes with Cheyne-Stokes respirations or apneas (not related to opioids)
(2) mottling and coolness of the skin, particularly in the pretibial and dependent portions of the body
(3) somnolence, obtundation, coma
(4) restlessness, agitation, delirium
(5) audible secretions in lungs ("death rattle")
(6) falling blood pressure
(7) tachycardia
