petechia/purpura during dying

[queenjulie, RN]

I had a patient recently who was actively dying, and during her last few days, she developed petechiae and purpura essentially all over her entire body. It was more than usual, but I know that petechia is very common in the elderly. Her family asked me why it was happening, and I realized that I didn't have a really good answer for them (I'm a relatively new nurse, and I rarely work with hospice or palliative patients). It's because of weakened capillary walls that allow blood to seep through, right? Or am I totally off base?

[MomRN0913]

I just saw this I. A patient. Came on all of a sudden on hands and feet only. He died within a week. The doctors didn't even give an answer to it. Perhaps you are current

[tewdles, RN]

This is likely related to the disease process and the system failure the patient is experiencing. Hospice rarely checks labs at end of life, but when we do they are often very abnormal. All signs of organ failure are possible during the dying process.

[leslie :-D]

sounds like a slow, internal bleed somewhere...

which can and does happen quite often when systems are shutting down.

your 'best' answer to a family, is as stated above: multi-organ system failure.

leslie

[Linda Luchtenburg]

This happens within a week of death, sometimes sooner, sometimes later. The heart can no linger pump blood and the blood begins to pool in the extremities, or capillaries break. It usually appears at feet and moves up, but sometimes you just see on arms and hands, or trunk, or on backside. It is normal sign.

[Jack Hazz, BSN, RN]

It is more likely mottling. Cells die mostly due to lack of oxygen at EOL, especially if they are imminent and they develop purplish...or sometimes looks like bruising...on their extremities and can sometimes spread all over, though I only saw that once.

[amoLucia]

The post is from 2013.

I saw it quite freq in LTC; I considered it like another vital sign. When a pt was doing poorly, it was like I'd do a body check. Esp discolored would likely be feet, lower legs, posterior thighs; buttocks & back could also be involved.arly moribund. The dependent body parts. That was my gauge of imminent death, esp if the pt was moribund. Earlobes, nose tip and fingertips can also start to discolor .prominently

To family, I would just explain it as 'poor & slowing circulation' and that we'd add some extra blankets.

Just note there is a condition 'livedo reticularis' that exhibits the lacey, mottled appearance. Causes can be minor (like just being chronically cold)but it can also be serious like in autoimmune disease & drug reax. It is circulatory/vascular. I called it 'speckles'. Cause should be determined.