Hospice & Palliative Care

End Stage Disease Progression and Complications – Cardiac Disorders (Learning Hospice)

Regardless of etiology, many chronic cardiac disease have a common end-point of right, left, or biventricular heart failure (HF). According to Center for Disease Prevention and Control (CDC) data, in 2010, 57,757 deaths were caused by HF in the United States, making cardiac disease or heart failure (HF) was listed as the most common cause of death in the United States.

Death is often sudden. Some people with advanced coronary disease die quickly and without warning from arrhythmias. However, many live for prolonged periods of time with HF managed by medical and surgical interventions. Yet, reversal of HF is rare, unless a surgical intervention is available. It is therefore difficult to predict the end of life.

The disease course can be one of chronic illness with a long period of general decline in function, interspersed with exacerbation and partial recovery. The degree of HF is not clearly correlated with life expectancy or symptoms; because of those with very poor ventricular function can live with only minimal symptoms, whereas others with similar ventricular function can be very symptomatic.

The patient who is dying of advanced heart failure are those who are no longer respond to drug therapy, not a candidate for further invasive procedures, and present with significant symptoms due to the underlying pathophysiology.

End stage disease progression of cardiac disorders often includes:

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Bipolar Disorder 躁狂抑郁性精神病 (Reading & Sharing Again)

Bipolar disorder is a complex and challenging brain disorder in which moods range from periods of mania followed by episodes of depression, from sadness to euphoria (Ferri, 2018). Bipolar disorder used to be called manic-depressive because of these two symptoms.

During a manic phase you will usually see a decreased need for sleep, an inflated self-esteem, pressured or fast speech patterns, flight of ideas, racing thoughts, distractibility, risky behaviors or an increase in goal-directed activities (Ferri, 2018). It is possible for individuals to develop delusions or hallucinations during the manic phase (INSA, 2017). Followed by the manic phase will be a depressive episode. During the depressive episode individuals will feel feelings of worthlessness, thoughts of suicide, disinterest in work, family, or friends (INSA, 2017). It is during the depressive phase that most people seek medical assistance.

Unfortunately, the management of the disease has no specific combination of psychosocial and medication regime that works well for everyone’s mood instability. So, therefore, the right combination to manage a particular patient’s mood instability takes time and can change over time due to the patient’s noncompliance with medication and frustration with treatment. However, as with any chronic health condition the bipolar patient has to learn how to be compliant and make lifestyle changes to manage symptoms.

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Hospice & Palliative Care

End Stage Neurological Disorders – Multiple Sclerosis 多发性硬化症 (MS) (Learning about Hospice)

Multiple sclerosis (MS) is the most frequent inflammatory demyelination disorder of the central nervous system. The clinical picture reflects the pathological mechanism of inflammation, demyelination, and axon degeneration.

Specific challenges in MS patients:

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Hospice & Palliative Care

End Stage Neurological Disorders – Stroke 中风 (Learning about hospice)

Stroke is the 3rd leading cause of death in the United States, making the need for hospice care for many victims essential.

A stroke takes time to manifest its full effect, and some early symptoms might be transitory. The physician might consider a referral to hospice if the patient remains comatose or has a severely reduced level of consciousness (obtundation) with abnormal muscle contraction (myoclonus) for 3 days or longer.

Patients who survive 4 weeks and regain significant function during that time are more likely to need active rehabilitation than palliative care.

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Hospice & Palliative Care

End Stage Neurological Disorders – Amyotrophic Lateral Sclerosis 肌萎缩侧索硬化 (ALS) (Learning about Hospice)

ALS is a rapidly progressing degenerative neuromuscular disease with an unknown origin, results in muscle weakness, disability, respiratory insufficiency, and eventually death. The median survival duration for patients is approximately 3 years, yet 10% will survive for > 10 years.

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