Mortality related to diabetes is due to end-stage renal disease, cardiovascular disease, and cerebrovascular disease. Diabetes is the leading cause of end-stage renal disease. Diabetics are at increased risk of these mortal conditions due to the impact of metabolic defects on selected body tissues, particularly the blood vessels.
Dementia is a neurocognitive syndrome with persistent intellectual and functional decline. Patients with advanced progressive dementia due to Alzheimer’s or multiple infarcts can live a long time until they finally develop complications that take their lives. They are considered close to death when they are functionally incapacitated and complicating conditions develop.
Like heart disease, prognostication for those with chronic lung disease is extremely difficult. The terminal stage is marked by increasing visits to the emergency department and hospitalizations for infections and failing respiratory function.
Respiratory failure occurs when the lungs cannot oxygenate the blood (hypoxemia) and cannot eliminate elevated levels of carbon dioxide (hypercapnia).
- Hypoxemia causes deteriorating mental status and cyanosis; pulse and blood pressure are initially increased and then diminish as death nears.
- Hypercapnia has a sedative effect (carbon dioxide narcosis) and increases respiration and air hunger.
End-stage progression of pulmonary disorders often includes:
TNM staging system:
T: size and extent of the primary tumor
N: presence or absence of lymph node
M: presence or absence of distant metastasis
Example: T4, N3, M1 Colon Cancer is considered Stage IV Cancer with Metastasis
End-stage progression of GI disorders may vary according to the type of disorder but may include: