A nurse is caring for a client who has terminal cancer and is receiving hospice care. Click to highlight the information from the nurses' notes that indicate the client is actively dying. Heart rate 42/min, irregular Blood pressure 62/48 mm Hg 2000: Called by family requesting to visit the client. Client does not respond to verbal, tactile, or painful stimulation. Cheyne-Stokes breathing, noisy respirations. Bowel sounds are present in all 4 quadrants. Family reports no urine output in the last 4 hrs. Skin intact, no breakdown noted. Family gathered around client. Update on client's condition provided.

Active dying is characterized by progressive physiological decline due to multisystem failure. Common signs include decreased level of consciousness, changes in breathing patterns such as Cheyne-Stokes respirations, reduced cardiac output with hypotension and bradycardia, and decreased urine output. These findings reflect the body’s natural process of shutting down. Rationale: A. A heart rate of 42/min with an irregular rhythm indicates significant cardiovascular decline. Bradycardia and arrhythmias commonly occur as the heart loses the ability to maintain effective circulation. This is a classic sign of active dying. B. A blood pressure of 62/48 mm Hg reflects severe hypotension and poor perfusion. As the body shuts down, cardiac output decreases, leading to critically low blood pressure. This is consistent with the dying process. C. Lack of response to verbal, tactile, or painful stimulation indicates a decreased level of consciousness progressing to unresponsiveness. This occurs as cerebral perfusion declines and neurological function diminishes. It is a key indicator of active dying. D. Cheyne-Stokes breathing and noisy respirations are hallmark end-of-life respiratory patterns. These irregular breathing cycles and airway secretions (often called the “death rattle”) indicate loss of respiratory control. This is strongly associated with imminent death. E. Presence of bowel sounds in all four quadrants indicates ongoing gastrointestinal activity. While function may slow near death, the presence of bowel sounds alone does not specifically indicate active dying.