All About Nursing · Hospice & Palliative Care

Determining Prognosis: Patients with End-Stage Cardiac Disease (Reading & Sharing)

The principles for determining when patients with end-stage cardiac disease require end-of -life care, are actually similar to those for determining prognosis of patients with advanced pulmonary disease.

Disabling Dyspnea or Chest Pain

    • Dyspnea or chest pain with rest or minimal exertion and can therefore classified as New York Heart Association class IV (NYHA class IV)
    • Ejection fraction less or equal 20%, if available
    • Persistent symptoms despite optimal medical management with vasodilators and dialectics, or
    • Inability to tolerate optimal medical management due to hypotension and/or renal failure

Continue reading “Determining Prognosis: Patients with End-Stage Cardiac Disease (Reading & Sharing)”

All About Nursing · Hospice & Palliative Care

Determining Prognosis: Patients with End-Stage Lung Disease (Reading & Sharing)

Disabling Dyspnea 

Defined by:

    • Dyspnea at rest or with minimal exertion
    • Dyspnea poorly responsive or unresponsive to bronchodilator therapy
    • Dyspnea results in other debilitating symptoms such as decreased functional activity, fatigue, and cough
    • FEV-1< 30% predicted post-bronchodilator, if available

Continue reading “Determining Prognosis: Patients with End-Stage Lung Disease (Reading & Sharing)”

All About Nursing · Hospice & Palliative Care

Determining Prognosis: Patients with Malignant Diseases (Reading & Sharing)

Cancer patients who require hospice or palliative care generally suffer from advanced disease, which is defined as metastatic spread of the malignancy from the primary site to other areas of the body and/or massive tumor growth at the primary site.

The malignant illness are divided into five categories as follows:

Continue reading “Determining Prognosis: Patients with Malignant Diseases (Reading & Sharing)”

All About Nursing · Hospice & Palliative Care

Predicting Prognosis: Declining Nutritional Status (Reading & Sharing)

A decline in a patient’s nutritional status is another key indicator of poor prognosis. This is best expressed as an unintentional weight loss of 10 percent of normal body weight over a period of about 6 months, with the loss of weight usually due to the patient’s life-limiting condition.

  • Reversible cause of weight loss, such as depression and metabolic disturbances (diabetes, thyroid disease), should be excluded prior to assuming that the weight loss is due to the terminal illness and a true indicator of the patient’s prognosis.
  • However, terminally ill patients may still have reversible cause of weight loss. Thus, for terminally ill patients with reversible cause of weight loss, weight loss will be less helpful in determining prognosis.

Continue reading “Predicting Prognosis: Declining Nutritional Status (Reading & Sharing)”

All About Nursing · Hospice & Palliative Care · Uncategorized

Predicting Prognosis: Activities of Daily Living (Reading & Sharing)

The most common method of assessing the functional status of patients with diagnoses other than cancer is by the evaluation of the activities of daily living (ADLs).

The original six activities, defined by Katz in the 1960s were bathing, dressing, toileting, transfer, continence, and feeding.

A patient’s ability to perform each of these activities, the evaluation of ADLs on a serial basis has been found to be an important indicator of patient prognosis.

Continue reading “Predicting Prognosis: Activities of Daily Living (Reading & Sharing)”