All About Nursing · Hospice & Palliative Care

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

The three major subgroups: Alzheimer’s disease and other dementia, cerebrovascular disease, and amyotrophic lateral sclerosis (ALS) and related motor neuron disorders.

Alzheimer’s disease and other dementia

    • Inability to ambulate without assistance (FAST 7-C)
    • inability to speak or communicate meaningfully with speech limited to approximately a half-dozen or fewer intelligible or different words (FAST 7-B)
    • Loss of ADL functions including bathing and dressing (FAST 6)
    • Incontinence of bowel and bladder (FAST 6)
    • one or more of the following comorbid conditions in last 3-6 months
      • Aspiration pneumonia
      • Pyelonephritis or upper urinary tract infection
      • Septicemia
      • Decubitus ulcers, usually multiple and stages II or IV
      • Fever, recurrent after antibiotics
      • An altered nutritional status as manifested by:
        • difficulty swallowing or refusal to eat such that sufficient fluid or caloric intake cannot be maintained and the patient refuses artificial nutritional support
        • OR
        • If the patient is receiving artificial nutritional support (NG or G-tube or parenteral hyperalimentation), there must be evidence of an impaired nutritional status as defined in the General Guidelines (greater or equal 10% loss of body weight)

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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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