Mottling death timeline

Mottling death timeline

Sep 25, 2023 · Here is a breakdown of the different stages of the end-of-life journey: Months Before Death. Clinical definition. Extreme tiredness and weakness. Breathing may stop briefly then restart again. Symptoms also vary. It's all right to ask questions and share your concerns; they are there for you to lean on. Any waste matter in the bladder or rectum may be released. 5%) with almost 39% of patients in cardiogenic shock presenting Jan 5, 2018 · A death rattle is a crackling, wet sound that is heard at varying levels with each breath. The median survival was two days. Sep 7, 2023 · Transitioning in hospice is the initial process of dying while receiving end-of-life hospice care. It may result from reduced blood flow to the skin, for example, because of a health Changes in Muscle Function. You may be unable to wake your loved one. Auditory hallucinations that may feel scary or peaceful to them and may be confusing to witness as a bystander. The active stage of dying has two phases. Moderate: More body muscles begin to harden, and it Dec 17, 2020 · Mottling with the yellow-tan center of the infarct: Coagulative necrosis, with absent nuclei and striations, interstitial neutrophilic infiltrate 3-7 days: Central yellow-tan softening with hyperemia at the borders: Myofibers begin to disintegrate; dying neutrophil; macrophages phagocytose necrotic cells 7-10 days Jun 26, 2023 · Death rattle is a strong predictor of imminent death, and nearly 80% of people die within 48 hours after its onset (Wildiers & Menten, 2002). It can be emotionally very difficult to watch someone go through these physical changes. Type 1 myocardial infarction. not breathing. As the moment of death comes nearer, breathing usually slows down and becomes irregular. However, its predictive value on mortality according to prognostic covariates such as vasopressor dose and other tissue perfusion parameters remains unknown. Myoclonus is not painful, but the abrupt onset of these uncontrollable muscle spasms can be distressing. Before 4000 BC. Condition of body Time since death. Heart rate may become fast, faint, or irregular. Your loved one’s mouth may fall open slightly as the jaw relaxes. caregivers who understand this can help relieve the worries and stresses of the person who is dying. You may see shades of red Dying can be a gradual process when someone has a terminal illness. It is most often first seen in the feet, from where it then travels up the legs. The limbs may become cool and perhaps bluish or mottled. Some people believe that a mottled skin is a sign before death due severe illness such as sepsis. Less Than 2 Days Before Death. We analyzed time of death according to the mottling score. This can include: Vivid hallucinations that they may attempt to engage with. The deep, rapid breathing may be followed by a pause before breathing begins again. Norma Jeane Mortenson later took her mother’s name, Baker. It can also appear because of several serious underlying conditions. occurs when there is a mismatch between oxygen supply and demand (due to, e. Mar 4, 2011 · Fourteen-day mortality according to the H6 mottling score increased from 13% for a score of 0–1 to 70% for a score of 2–3 and 92% for a score of 4–5 ( χ 2 test for trend p < 0. Expect eyes and mouth to remain open. occurs when an unstable. Actively dying patients are very close to death, and exhibit many signs and symptoms of near-death. Nov 29, 2010 · 9. neck, voluntary and longer in winter. Sepsis is a systemic response to infection, manifested by two or more of the SIRS criteria as a result of infection. In the hours or minutes before death, blood circulation draws back from the periphery of the body to help the vital organs. When it is confirmed that a person has died, their loved ones Oct 31, 2017 · End-of-life stage. Terminal agitation typically occurs in the days or hours leading up to death, but it’s difficult to predict the exact timeline as it depends on the underlying conditions, the person’s overall health status, and how symptoms are managed. It might stop and then start again or there might be long pauses or stops between breaths . The mottling comes from the skin temperatures going from highs to lows repeatedly, making the skin pale and moist. #endoflifecare #deatheducation #nursingstudent Mottling of skin is a normal end of life sign of approaching death. Jun 1, 2023 · Here are the signs that someone has died: They are no longer breathing. , 1997 ). Although these signs may be associated with impending death, they had lower diagnostic utility for impending death compared to the 8 signs identified above. When does mottling occur? Mottling is typically seen in the last week of life, although there is no exact timeline. Jul 24, 2023 · Kennedy terminal ulcers are often a sign of impending death. Often referred to as "agonal breathing," Cheyne-Stokes respirations may be a sign of a serious lung, brain, or circulatory problem like a Timeline of significant events during and after the Black Death pandemic, from the arrival of the plague in Europe in 1347 to its subsequent spread throughout the continent over the next four years and the periodic recurrences of the plague in later decades of the 14th century. Apr 13, 2021 · Mottling of the skin is a common symptom that occurs near the end of life. Genesis 3. " The death rattle appears to be slightly more common in females but can appear in people of any age dying of any cause. An irregular breathing pattern may be seen. Other end-of-life symptoms of include: problems swallowing. Primary livedo reticularis is diagnosed when underlying conditions have been ruled out. This might mean that other signs are imminent. Confusion and sleepiness may occur in the last hours. The plague enters England through the port of Melcombe Regis, in Dorset. Let your hospice professionals know what you observe and let them explain to you what it all means. plaque. As it spreads through the town, some escape by fleeing inland, inadvertently spreading it further. Guarding, lack of mobility. Though it Mar 3, 2015 · For instance, the positive LR for diastolic blood pressure <60mmHg, mottling, hemoptysis and cool skin temperature were between 4-5 (Table 2). Nov 12, 2020 · A person near the end of life experiences physical symptoms, such as end-of-life breathing and reduced urine output, as well as emotional and spiritual signs of the end of life. Some people become physically weak, even though their cognitive functions are strong, and for others vice versa. 001). If you’re taking a dying person’s blood pressure regularly, you’re likely to see it drop in the days and weeks before death. Mottling is not painful. It starts near the bottom parts of the body, such as This is the body's natural response to the dying process. You might notice mottling first on your family member’s feet or legs, but it can appear on her hands and arms, too. Table 3 shows the relationship between the probability of 28-day survival, mottling score, skin microcirculatory indices, and biomarkers of endothelial activation modeled While these symptoms can happen at any stage of disease progression, they may become more pronounced within the final days or hours before death. Grief is a normal response when a loved one is dying. This type of transition can be a time of intense grief and uncertainty as the patient and their family members grapple with the reality of eventual death. Low or high blood pressure. We found that death occurred earlier in patients with a higher score ( p < 0. Dr Deb Cohen-Jones, who lives in Perth, Western Australia, said Jun 10, 2019 · Background Mottling score, a tissue perfusion parameter, is correlated with outcome in septic shock patients. Type 2 myocardial infarction. Genesis 1. Sep 7, 2023 · Signs That Death is Near. Understanding vascular dementia end-of-life symptoms as well as the final stages of death from Alzheimer’s or any other form of dementia helps ensure these patients receive appropriate care. but no rigor mortis Died within Rigor If rigor mortis mortis fully established present 3 hours. Jun 26, 2023 · This noisy breathing often causes psychological distress to families, since dying persons are often unconscious when they experience death rattle ( Watts et al. The depth of breaths may decrease and become more shallow. Minimal: The body's muscles will start to stiffen in this stage. If the victim is moved during the first six hours after death the purplish discoloration can shift, causing the new, lowest Dec 8, 2018 · Keep the lines of communication open. Their muscles are completely limp. You may observe various shapes and sizes as the ulcer spreads. If a person is near death, they will go through certain changes as the organs of their body start to shut down. During active dying, the body’s systems Dying people and their family members should also be prepared for the characteristic physical signs that death is near. Their eyes are not moving, and their pupils no longer change size. Jan 31, 2022 · Mottling of the Skin and Cold Hands and Feet. It can occur in the final week or not until the final hours. These signs include: Increased physical weakness. Identifying the transition to imminent death is crucial for educating patients and families about the natural dying process. But they are part of a natural dying process. Irregular breathing. It can be hard to think about what to expect at the end of life with lung cancer. The changes that commence immediately after death continue to occur over a prolonged period at different rates for different organs. This can last for a short time or long time before breathing finally stops. The symptom of “coolness” refers to a noticeable decrease in the body temperature of a person approaching death. Sep 11, 2019 · A mottling score of 2 or more was predictive of death with a sensitivity of 80% and a specificity of 65%, whereas a μHbSO 2 cutoff of 26% was 84% sensitive and 78% specific. Patients should be made as comfortable as possible and the environment Jun 26, 2023 · Skin on arms, legs, hands, and feet may darken and look blue or mottled (blotchy) Other areas of the body may become either darker or paler. While mottling can be one Mar 20, 2024 · The duration between the onset of terminal agitation and death can vary widely among individuals. Sudden, involuntary muscle movements called myoclonic jerks and the loss of reflexes in the legs and arms are additional signs that death is near. Blood pressure may get lower and become hard to hear. eyes remaining fixed. Aug 17, 2023 · 12 Signs That Someone Is Near Death. Slow or fast heart rate. As the patient becomes weaker and/or loses consciousness, they can lose the ability to clear their throat or swallow. also known as a "heart attack". Sep 10, 2020 · Accessed June 12th, 2024. Consciousness may decrease. Tags Death and Dying Subjects. , 2021; Morita et al. Other times it’s loud and sounds like snoring or gargling Jun 4, 2008 · Livor Mortis (lividity) can help investigators determine the time of death. Mottling is caused by poor circulation; the patient’s heart can no longer pump blood effectively. death of myocardial tissue secondary to prolonged and severe ischemia. Sometimes their skin can be clammy and Jun 24, 2023 · Cheyne-Stokes respirations are an irregular pattern of breathing consisting of a period of long, labored breathing followed by a period of shallow, rapid breathing and moments of no breathing at all (apnea). This causes deprivation in the outer Dec 25, 2020 · What is mottling for those nearing death? Mottling often comes around one to four weeks before the end of life. The following can also occur as a person nears death This discoloration is due to the heart not being able to effectively pump the blood to those areas. At the time of your loved one’s death. The second stage is the active stage of dying. A mottling skin is also called Livedo reticularis. The skin may have red and purple marks, streaks, or spots. Your loved one cannot be aroused. Among the 772 enrolled patients (mean age 65. Your loved one’s eyelids may be partially open with eyes in a fixed stare. The blood will start pressing on the skin leaving red/purple marks on the body. As someone gets within hours of death, they may experience some psychological shifts. May 6, 2024 · The most common underlying cause is. Changes in body Sep 9, 2022 · A doctor has pointed to the Queen's frail appearance at her final royal appointment as a sign that she was going to die within days. Disposing of Belongings and Arranging for the Funeral. Your breathing may become less regular. Monroe had been one of the most popular Hollywood stars Terminal respiratory secretions, commonly known as a “death rattle,” occur when mucous and saliva build up in the patient’s throat. Normal respirations of 16-20 breaths per minute may increase to 50 or decrease to as low as 6 breaths per minute. Expect gasping breathing. Generally, the distress from death rattle is frequently managed by repositioning and clearing the upper airways of fluid via mechanical suctioning or with anticholinergic drugs (Wee & Hillier, 2008). The dying person may breathe faster or slower than usual. Marilyn Monroe. as the reality of approaching death sets in, people tend to experience a variety of emotions ranging from anger The Creation. When Murray found the door locked and Marilyn unresponsive to her calls, she called Monroe’s Dec 10, 2021 · Introduction. Livor mortis is fixed in the legs and distal upper extremities because these were the dependent parts. Saying Final Goodbyes. 5% male), 660 had skin mottling assessed at admission (85. S. A person will start to detach from social activities and spend more time sleeping. Livedo reticularis, commonly known as mottled skin, causes patterned areas to appear on the skin. 6 stages of rigor mortis. FRENSHOCK is a prospective multicenter observational registry conducted in French critical care units between April and October, 2016. Nov 28, 2023 · People in the actively dying phase may also experience mottling, which is when the skin changes color to become a little more red or purple, usually around the fingers, the toes, the knees, and Sep 5, 2019 · 6. Heartbeat ceases. Mar 26, 2024 · This is often a temporary, harmless phenomenon that is the result of exposure to cold temperatures or stress. Postmortem lividity ( livor mortis) is the settling of blood in the lowest part of the body due to gravity. What to do: Allow your loved one to choose when and what to eat or drink, even if this means he or she will consume little or nothing at all. 3%) died within 14 days of diagnosis while 3/28 (10. There are 4 stages that the body moves through after death: pallor mortis, algor mortis, rigor mortis, and livor mortis. These and other substances pass through the placenta that connects the baby to its mother in the womb. The Garden of Eden. IDD is a critical skill for palliative care physicians to make an advance care plan. Mechanism: Fluidity of blood due to stasis and Incoagulability (by ½-1 hr) due to release of fibrinolysins. A “rattling” sound may be present in the lungs and upper throat due to congestion. The process involves complex cellular and biological phenomena. Studies have shown that the death rattle is heard to some degree in roughly half of dying people. This drop in temperature often manifests as a cool sensation in the extremities, such as the hands, arms, feet, and legs. When death is very near, you might notice some physical changes such as changes in breathing, loss of bladder and bowel control and unconsciousness. Their bodies will find it hard to heal wounds. The muscles are still soft and movable. ago. This transition period is marked by significant changes in the body that indicate the person is preparing to die soon. By the mid-1900s, they also recognized that fluoride intake was related to lower caries incidence. Postmortem changes refers to a continuum of changes that occur in a dead body following death; these changes include livor mortis, rigor mortis, decomposition and taphonomy ( StatPearls: Evaluation of Postmortem Changes [Accessed 1 July 2020] ) Given the postmortem changes and the rate of change Livor mortis. Her body was discovered before dawn the following morning, on August 5. If someone is receiving good palliative care, it can be quite a peaceful time — a time during which the body lets go of life. Before 3000 BC. The Fall of Man. . This process immediately starts at the onset of death since the blood is no longer actively pumped through the body. However, one study found that 92% of Changes in breathing. 7. The facial muscles are the first to be affected. However, proper care can help ease this process by providing support and resources to make Oct 13, 2012 · Livor mortis (Darkening of Death)/PM Hypostasis or Lividity: Definition: Dark purple discoloration of skin resulting from gravitational pooling of blood in veins and capillaries in dependent parts of the corpse. being unconscious or delirious Nov 8, 2022 · Primary livedo reticularis: This type of mottled skin occurs when blood vessels just below your skin’s surface suddenly constrict for unknown reasons. Mottling is typically seen on the earlobes and the soles of the feet before other areas. Knowing that one’s loved one is nearing the end of their life or has a terminal illness is a difficult concept to grasp for anyone. 2-3 Days Before Death. Apr 18, 2006 · From 12–24 hours the myocardium appears as dark mottling; from days 1–3, the mottling is centred by a yellow‐tan core; from days 3–7 the central yellow‐tan softening area is surrounded by hyperaemic borders; from days 7–10, the infarction area is yellow‐tan and soft, and the margins are red‐tan and depressed; from 10–14 days both the dying person and the caregiver. Methods Mottling score and tissue perfusion parameters were recorded at ICU admission (H0), H-6, H 12, and H-24 and used to Jun 22, 2018 · Mottled skin doesn’t hurt, but it is an indication that your family member’s circulation is slowing way down. 10 signs death is near in dementia patients. Mottling does commonly happen in the days and hours before death, but as with everything else, it’s hard to say for sure. Our study showed a high degree of accuracy of prediction of fourteen-day mortality in PCU patients. In the hours after death, their muscles will start to stiffen. Mar 21, 2019 · Temperature >38°C or <36°C; heart rate > 90 beats per min; respiratory rate > 20 breaths per min or PaCO 2 < 32 mmHg; and white blood cell count > 12,000/cu mm, <4000/cu mm, or >10% immature (band) forms. Lips may turn purple as well. Jan 10, 2024 · The "death rattle" is the name for the sound the fluid makes a sound as air passes through it. The first stage is known as pre-active dying. The final stages of the end-of-life timeline can be difficult. When a person is close to dying, mottled skin may appear. Last updated date: April 29, 2020. Some need oxygen, for instance, while others don't. With each breath, a person may make a moaning, snoring, or rattling sound. When this change happens, our skin color may change, resulting in paleness or appearing like marble with purple lines, which is called mottling. The mottled extremity may also be cool to the touch and the extent of it can vary or come and go. ST-segment elevation myocardial infarction (STEMI) an acute coronary syndrome (ACS) with ST-segment elevations found on electrocardiogram (ECG) biomarkers of myocardial necrosis are present. 0001). Headaches, seizures, or other neurological problems if the cancer has spread to the brain. People's needs may also vary. Broadly speaking, mottled skin is divided into Apr 28, 2022 · Mottling is one sure sign of death, but it does not give a precise and definitive timeline. “There is a phenomenon of skin breakdown that is unavoidable at the end of life,” notes Joyce Black, PhD, RN, FAAN, NPIAP Board Executive Jun 23, 2017 · Mottled skin or mottling refers to blood vessel changes in the skin that cause a patchy skin discoloration, reflecting reduced skin blood flow 1) and low tissue oxygen saturation 2) and has been suggested as a tool for clinical evaluation of tissue perfusion in patients with severe infection 3) . You may develop Cheyne-Stokes breathing, when periods of shallow breathing alternate with periods of deeper, rapid breathing. As they can appear suddenly, it may not be easy to cope with your feelings. The skin of the knees, feet, buttocks, ears, and hands may become purplish, pale, grey, and blotchy or mottled and usually signal that death will occur within days to hours. • 5 mo. Palliative care aims to keep those with a terminal illness comfortable and includes treatments to relieve pain. Dec 31, 2023 · Causes. Mottled skin doesn’t necessary occur in each elderly person, but it is a fairly common end-of-life sign. Coolness. You may also Depiction of a body after suicide hanging. Their skin appears pale or waxy. Breathing ceases. It lasts for about 18-24 hours Died between in summer Died 9 hours 3-9 hours previously probably In of the limbs. Weeks Before Death. Skin affected by livedo reticularis usually has reddish-purplish discoloration with web-like, mottled, or blotchy circular patterns on legs or arms. Verbal signs of pain: Rank the pain on a scale of 0-10, with 0 being no pain and 10 being the worst pain that can be imagined. lower Arne Svensson, limbs. g. Excessive sweating. The six stages of rigor mortis include: Absent: The body can still get a small amount of oxygen anaerobically. Probable suicide. Jul 6, 2017 · How we reviewed this article: These 11 signs may indicate that death is near: sleeping more, decreased appetite, being less social, changes in vital signs, decreased body waste, cool skin, muscle Oct 29, 2021 · The skin may therefore become mottled and discolored, which is normal before death and a sign that it is imminent. The end of life stages timeline can help you and your loved one know what to expect in the weeks, days, and hours before death. 4-6 Days Before Death. Breathing may become irregular. In the moments very near death, our skin may appear darker, gray, or bluish. Skin may feel cold and either dry or damp. —died August 5, 1962, Los Angeles) was an American actress who became a major sex symbol, starring in a number of commercially successful films during the 1950s, and is considered a pop culture icon. Sep 6, 2023 · Methods and results. 9 years; 71. The baby becomes dependent on the drug along with the mother. 7 ± 14. This stage of death is referred to as the “Glasgow Coma Scale – Death Phase”, or “Stage 5”. before death presents as a red or purple marbled appearance. Red and purples spots appear on the toes, feet, and fingers and spread slowly up the arms and legs. To harness the protective effect of fluoride while limiting the occurrence of fluorosis, dental researchers have recommended that the fluoride level in drinking water be 1 part per million or May 25, 2017 · As people near death, their limbs, hands and feet may get cold, and the colour of their skin may change from a healthy pink to a sallow, grey or mauve tinge. Coolness in the tips of the fingers and toes. 2. cold to the touch. Types. The staining of tissue normally begins within the first two hours after death. This may be seen first in the nailbeds, legs, and arms. bowel or bladder releasing. What stage of death does mottling occur? Mottling is the observed process of discolored patches and blotches caused by extreme hypoxia, or lack of oxygen, in the body’s tissues and occurs during the final stage of death. Livor mortis ( Latin: līvor – "bluish color, bruise", mortis – "of death"), postmortem lividity (Latin: postmortem – "after death", lividity – "black and blue"), hypostasis ( Greek: ὑπό Apr 16, 2020 · June, 1348. On the evening of August 4, 1962, American actress Marilyn Monroe died at age 36 of a barbiturate overdose inside her home at 12305 Fifth Helena Drive in Brentwood, Los Angeles, California. Talk with your family member’s doctor to determine what else May 1, 2023 · Postmortem changes constitute the natural progression of the body’s decomposition after death, beginning at the cellular level. Secretions in the throat or the relaxing of the throat Mar 9, 2020 · Psychological Fluctuations. Difficulty swallowing. (Photo Credit: Pexels) Dec 27, 2021 · Active Stage Of Dying. Problems breathing. When death approaches, the skin will allow blood elsewhere – to the lungs, the heart, or the brain. Additionally, the color of the skin may change and become mottled. Visions. no muscle tension. Genesis 2. Pain, Shortness of Breath, Bowel Changes, Fatigue, and More. Apr 13, 2022 · The dying person will feel weak and sleep a lot. Not everyone experiences mottled skin at end of life, but when it is noted, it’s a strong indicator that the death is near. Your breathing may also become more noisy as a result of the build-up of Nov 24, 2009 · After midnight on August 5, 1962, her maid, Eunice Murray, noticed Monroe’s bedroom light on. , 2004 ). Muscle loss and weight loss. refusing water and food. ruptures, leading to occlusion of a coronary artery. These changes are irreversible and signal that death is imminent, likely within hours or days. Why does mottling occur during tablet production? Mottling occurs when the dye migrates during the . This will lead to common symptoms like anxiety, fatigue, constipation, and changes in bowel movement before progressing to end-of-life Minutes until end of life. Medication may be given to minimize jerking or twitching at the Dec 19, 2023 · The death rattle is a sign that a person is approaching death. Crime Scene Investigations. coronary artery disease. In most people who are dying, the body May 26, 2018 · Skin pale in color. Oct 24, 2023 · Takeaway. Mar 8, 2019 · The initial spot may grow rapidly. Shallow or irregular breathing. When mottling occurs you'll notice skin co Pathsleadingaway. Scientists have noted an association between mottled enamel and fluoride exposure since the early 1900s. In addition to mottled skin, there are many other signs that death is near. Decreased appetite and thirst. Their eyelids may be fully or only partially shut. Lung congestion. It’s temporary and unrelated to temperature changes. Death is never pleasant. Typical signs of active dying include: • blood pressure drops significantly. Blood pressure drops and heart rate changes. Active dying is the final phase of the dying process; it lasts roughly three days. But upon closer inspection or even post-mortem, it becomes clear that the characteristics don’t match the textbook pressure injury. Animals Apr 24, 2024 · The longer the PMI, the larger the time of death window will become, and the harder it will be to determine an accurate time of death. The hospice nurses who are work with your loved one might be able to look at all the signs and give you a better answer. • Breathing patterns may change as the body tries to conserve energy. • The skin may turn a bluish or purple color (mottling). They will also lose appetite. 4 days ago · Marilyn Monroe (born June 1, 1926, Los Angeles, California, U. Nov 13, 2023 · Other signs of death include: not having a pulse. Secondary livedo reticularis: Skin mottling occurs 1. However, it is not always the case and will vary per individual. Color. It is the reticulated vascular pattern on the skin that may appear as lace-like purplish discoloration. This results in a wet, rattling sound as the patient breathes in and out through the Aug 1, 2020 · In the IDD group, 25/28 (89. Permission and Communication. Hi there. It is impossible to predict the time of death, it may take hours or even days. Nail beds may also look more pale, or bluish. Kennedy ulcers can have a range of colors, similar to a bruise. , systemic. These include: Slowing heart rate. At first, the skin condition might appear to be a pressure injury. Studies have shown that death rattle occurs in 25%−50% of people who are imminently dying ( Lokker et al. NAS may occur when a pregnant woman takes drugs such as heroin, or medicines such as codeine, oxycodone (Oxycontin), methadone, or buprenorphine. Conclusions. "Puffing” of the lips when exhaling may be noticeable. Feeling agitated, confused, and disconnected. Mottling is livedo reticularis in Latin, is skin that has patchy and irregular colors. The body is indicating that eating and drinking are no longer helpful—that the body can't use food and fluid properly anymore. The process reaches it’s full peak in eight to twelve hours. in the final 6 to 12 months of life, people often go through emotional changes as well. Mottled skin before death presents as a red or purple marbled appearance. Nov 15, 2022 · Mottling is one sure sign of death, but it does not give a precise and definitive timeline. The onset and extent of these changes are affected by multiple Jul 24, 2023 · Active dying is the final phase of the dying process as the body begins shutting down. Verdict. 3%) died after 14 days. May 21, 2024 · Fatigue. Refusing to eat or drink. Sometimes, the sound is soft and moan-like. It may also occur due to extreme cold, affecting your legs, arms or even face. For some, death may approach suddenly, whereas for others, end-of-life symptoms may linger for days, weeks, or even months. This is known as Cheyne-Stokes breathing. Definition / general. Keep an open mind about what your hospice professionals are telling you. As this happens, the extremities (hands, feet, fingers, toes) become notably cooler. hh ou hx ep ir ak ha db hr hb