Common Indicators Of End Stage Disease In Hospice Patients
In this article, we will identify common indicators of end stage disease in hospice patients. The patient may exhibit ONE or more of the following:
Heart Disease – CHF
- Symptomatic despite maximal
- Medical management with diuretics and vasodilators
- NYHA Class IV
- Ejection fraction < 20%
- History of cardiac arrest
- *Pacemaker/AICD
Pulmonary Disease – COPD
- Disabling Dyspnea at rest, bed to chair existence
- Recurrent pulmonary infections
- Unintentional weight loss
- Resting tachycardia >100/min
- FEV1 <30%
- pO2 <55mm Hg
- O2 sat <88% (on room air)
- pCO2, 50mm Hg
Stroke and Coma
- Level of consciousness down, comatose
- Post-stroke dementia
- Palliative Performance Scale, 40% or less
- Predominately bed bound
- Unable to do self care w/o assistance
- Dysphagia
- Co-morbidities: Aspir. pneumonia, URI, sepsis
![High-Quality-Education-Optimized_result High Quality Hospice Education for Nurses](https://continuagroup.com/wp-content/uploads/2023/04/High-Quality-Education-Optimized_result.webp)
CONTINUA LEARNING
Simplify Your Hospice Team’s Training and Skill Building
A complete solution for your agency: more than 125 hospice courses, caregiver in-services, training plans, and more.
Alzheimer’s & Dementia
- Fast score of > 7
- Urinary and fecal incontinence
- Speech limited to <6 words/day
- Unable to sit up or hold head up
- Dysphagia
- Not responding to nutritional support
- Weight loss
- Co-morbidities: Aspir. pneumonia, UTI, sepsis, decubiti
Debility Unspecified
- Multiple co-morbidities with no primary diagnosis
- Emphasis on Core Indicators
Amyotrophic Lateral Sclerosis
- Unable to walk, needs assistance with ADL’s
- Barely intelligible speech
- Difficulty swallowing
- Oral intake insufficient to sustain life
- Significant dyspnea, on O2 at rest
- Co-morbidities: pneumonia, URI, sepsis
- Feeding tube
- *Assisted ventilation
Failure to Thrive
- Declines enteral/parenteral support
- Not responding to nutritional support
- Palliative Performance Scale 40% or less
- Body Mass Index < 22 kg/m2
Core Indicators
- Physical Decline
- Weight Loss
- Serum Albumin <2.5 gm/dl
- Not Responding to Nutritional support
- Palliative Performance Scale
(PPS), 40% or less - Multiple Co-morbidities
- Frequent Hospitalizations
- Loss of Will to Live
Liver Disease
- Hepatic encephalopathy refractory to treatment
- Recurrent variceal bleeding
- Ascites despite maximum therapy
- Peritonitis
- Hepatorenal syndrome
- Serum albumin <2.5g/dl
- PTT >5sec above control
- *Liver transplant
Renal Disease
- Signs of uremia (confusion, nausea, pruitis, restlessness, pericarditis)
- Intractable fluid overload
- Oliguria <400cc/24hrs
- Creat. Clear. <10cc/min
- Hyperkalemia >7mEq/L
- *Dialysis, Renal transplant
HIV/AIDS
- Wasting syndrome
- CD4 <25/mcl
- CD4 >50/mcl
- Viral load >100,000/mil despite therapy
- Viral load <100,000 mil plus complications
- AIDS dementia
- Current substance abuse
- Co-morbidities
- Non-adherence to antiviral, chemotherapeutic and prophylactic drug therapy
*Adapted Medical Guidelines for Determining Prognosis in Selected Non-cancer Diseases, 2nd ed. National Hospice Organization, 1996 and Palmetto GBA Local Coverage Decisions
If you found this article informative and useful share it with your friends and colleagues.
Attachments
Views: 502