C.A.R.E.S.: A Tool for the Care of the Dying

Bonnie Freeman, RN, DNP, ANP, ACHPN, Compassionate Person-Centered Care for the Dying


The use of supplemental oxygen during the dying process is often ineffective but may help to minimize the family’s fears of their loved one suffering.

  • Review goals of care established by the patient and family for supplemental O2.
  • Consider use of a fan.
  • Provide nasal cannula per M.D.’s orders.
  • Reposition patient as needed.

The dying process results in irregular breathing with periods of apnea. Secretions often pool in the back of the patient’s throat resulting in loud congestive sounds. Patients can become restless and anxious. Consider obtaining orders for:

  • Glycopyrrolate, scopolamine patch or Atropine 1% ophthalmic solution.
  • Morphine IV or Sub-q: The patient is dying and will stop breathing due to their disease and the dying process, and not from receiving morphine.
  • Consider using anti-anxiety agents and/or antipsychotics.
  • Provide family education as needed. Some common issues to address are:
    • Breathing patterns of the dying. Breathing becomes progressively irregular, shallow and slowed. Episodes of apnea will extend. This is all from brain stem activity. It is involuntary and the patient is not suffering.
    • Emphasize the calming effects of touch and talking to the patient.