Common Guidelines at the End-Stage  Disease

Patient may exhibits one or more of the following core & disease specific indicators :

 

CORE INDICATORS

Physical Decline

Dependence in most ADL’s

Weight Loss >10% in last 6 months

Pt/family wants palliative care

Multiple Comorbidities

Serum Albumin <2.5 gm/dl

Complications — pneumonia, UTI, sepsis, decubiti

 

 RENAL DISEASE

Discontinuing or refusing dialysis

Signs of uremia (confusion, nausea, pruritis, restlessness)

Chronic or acute illness that precipitated renal failure

 

 

DIABETES

History of diabetes >20 years

Severe vascular disease

Frequent infections

 

LIVER DISEASE

Documented history of specific liver disease

Abnormal liver enzymes

Abnormal coagulation

Serum albumin <2.5g/dl

Ascites

Recurrent variceal bleeding

 

 

HIV/AIDS

Wasting syndrome

Pt not receiving TPN

History of successive opportunistic infections

Pt not receiving active tx other than for pain relief

AIDS dementia

 

NEUROLOGICAL DISEASE

(Parkinson’s, ALS, Multiple Sclerosis)

Unable to walk, needs assistance with ADLs

Barely intelligible speech

Difficulty swallowing

Nutritional status down

Declines assisted ventilation

Complications — pneumonia, UTI, sepsis, decubiti

 

 DEMENTIA — ALZHEIMER’S

Unable to walk without assistance

Urinary and fecal incontinence

Speech limited to <=6 words/day

Unable to dress without assistance

Complications — pneumonia, UTI, sepsis, decubiti

Difficulty swallowing/eating

Weight loss

4Complications — pneumonia, UTI, sepsis, decubiti

 PULMONARY DISEASE

O2 dependent; dyspnea with min. activity

Multiple pulmonary medications

Recurrent pulmonary infections

Weight loss

Resting tachycardia >100/min

 

                                                  

CARDIAC DISEASE

NYHA Class IV

Discomfort with physical activity

Symptomatic despite maximal medical management

Arrhythmias resistant to treatment

 

CVA and COMA

Chair or bedbound

Paralysis

Dysphagia

Decreased appetite, < food/fluid intake

Age >70

Post-stroke dementia

Complications — pneumonia, UTI, sepsis, decubiti

 

SEVERE PROTIEN MALNUTRITION

Weight loss despite food/fluid intake

Weight loss due to decreased appetite

Multiple comorbidities with no primary diagnosis

Emphasis on Core Indicators

Serum Albumin <2.5

 

CANCER — MALIGNANCY

Diagnosis confirmed through pathology or radiology

Pt no longer receiving curative treatment

Evidence of end-stage disease and/or metastasis

Lab/diagnostic studies that support disease progression