Finally found this

I have been wanting to post something on here that could serve as a sort of reference tool for those of you who have not yet cared for a patient at the end of their life.  It can be difficult to know exactly what to do for the patient and/or the family if you have no idea what to anticipate (as was the case for me when I cared for my first end of life patient and family).  While this site is geared more toward patients being cared for at home, it does provide some useful information for beginning nurses as well.

"Caregiving in the final stages of life

While the symptoms in the final stages of life vary from patient to patient and according to the life-limiting illness, there are some common symptoms experienced near the end of life that caregivers can provide comfort for. It’s important to remember, though, that experiencing any of these symptoms does not necessarily indicate that the patient’s condition is deteriorating or that death is close.

Common Symptoms in End-of-Life Care
Symptom	How to provide comfort
Drowsiness	Plan visits and activities for times when the patient is most alert.
Becoming unresponsive	Many patients are still able to hear after they are no longer able to speak, so talk as if he or she can hear.
Confusion about time, place, identity of loved ones	Speak calmly to help to re-orient the patient. Gently remind the patient of the time, date, and people who are with them.
Loss of appetite, decreased need for food and fluids	Let the patient choose if and when to eat or drink. Ice chips, water, or juice may be refreshing if the patient can swallow. Keep the patient's mouth and lips moist with products such as glycerin swabs and lip balm.
Loss of bladder or bowel control	Keep the patient as clean, dry, and comfortable as possible. Place disposable pads on the bed beneath the patient and remove them when they become soiled.
Skin becoming cool to the touch	Warm the patient with blankets but avoid electric blankets or heating pads, which can cause burns.
Labored, irregular, shallow, or noisy breathing	Breathing may be easier if the patient's body is turned to the side and pillows are placed beneath the head and behind the back. A cool mist humidifier may also help.
Source: National Cancer Institute" Retrieved from http://helpguide.org/elder/alzheimers_disease_dementia_caring_final_stage.htm One thing I always try to do is leave the patient's hands out from under the blankets so families can hold the patient's hands.  I find that families always seem to do that, and it makes me feel better to allow them that access to their loved one, even once the patient has passed away.  Another useful site is http://www.hospicefoundation.org/pages/page.asp?page_id=62884 which also gives signs/symptoms at the end of life that the caregiver (nurse or otherwise) may see.  What are your thoughts after reading and visiting these sites?  If you have cared for a dying patient, have you witnessed any of the signs/symptoms?