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Determining levels of consciousness – part 1

These notes of guidance are to help you recognise that your loved one is becoming drowsier, is in a deep sleep or has lapsed into unconsciousness. This will help you to maintain their dignity and comfort, and understand better the changes in alertness that people go through in the last few days and weeks of life. This guide is in two parts so don’t miss part two once you’ve finished here.

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Why is it important to determine your loved one’s level of consciousness?

As your loved one is deteriorating, you may have noticed that they are becoming sleepier, and less in touch or interested in what is happening around them. Their levels of alertness can vary from:

  • being drowsy but easy to wake
  • being in a deep sleep in which it is more difficult to wake them
  • to being unconscious, an unconsciousness from which your loved one will not respond or wake up.

This change in alertness is a normal pattern but your understanding of what is happening to them is likely to affect how you feel or how confident you feel about delivering care for your loved one. Recognising a change in your loved one’s level of consciousness may indicate that death is approaching and can help you to prepare for this.

Determining your loved one’s level of consciousness is important because the way you provide care to them should vary according to how alert and responsive they are. For the purposes of drinking and taking medications, it is important that your loved one is awake and aware of what you are doing. If they are difficult to wake properly, they will not be able to swallow safely.

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Try to offer drinks and medications when your loved one seems at their most alert and can tolerate an upright as possible position. If you are at Cottage Hospice, you can speak to a member of the team for advice before you give a drink or medication.

Likewise, if they are in a deep sleep or unconscious, moving them will become difficult as they will be unable to help you. You will notice that they appear to be much heavier. You will have to move them in a different way, so raising the bed to a different height, and using the special sheets called ‘slide‘ or ‘E-TAC’ sheets, will make it easier to move your loved one. This will also help reduce the amount you have to bend and will help avoid back strain for you. The video which accompanies this topic will help to show you how to move your loved one.

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The topic on Moving your loved one in safety and comfort will also help you more with this.

As your loved one moves through the different levels of consciousness, it is important that you check their skin where it comes into prolonged contact with the bed, for signs of redness – this may be an early sign of a pressure sore. You may wish to look at ‘helping your loved one feel as fresh and clean as they would want”, which talks more recognising and managing pressure sores.

Mouth care is also very important. Your loved one’s mouth may become dry particularly if they are breathing mainly through their open mouth. It is important that you continue to provide regular mouth care to keep their mouth and lips moist and comfortable. There is no set regime for how often this should be done, it is based on individual comfort.

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Take a look at the topic on Mouth care for more.