Admission Guidelines

Admission & Recertification Guidelines for Hospice Terminal diagnosis, Life expectancy of six months or less; Certified by 2 physicians Patient must give consent (DPOA or family if patient is...

Disease specific guidelines

Protein calorie Malnutrition PPS <40% mostly in bed, dependent on > 2 ADL; Descriptive score of 20 or less BMI < 22 BMI (kg/m2 = 703 x (weight in pounds) / (height in inches)2 patient /...

Pain Management

Part I: PAIN MANAGEMENT IN HOSPICE *** PAIN: subjective unpleasant physical & emotional experience ***pain what patient says "hurts"; believe the patient **pain is not : due to old age, a last ditch,...

Gastroenterology

GASTROENTEROLOGY ***BAD TASTE: *Less meat *dairy ok * increased fluids *Zinc sulphate *vit C chewable ***HALITOSIS: *Poor oral hygiene, *infection, *Lung abscess, *ENT cancers *Rx: Routine oral hygiene,...

Genitourinary

GENITOURINARY URINARY-FREQUENCY/INCONTINENCE: (urge incontinence) # >7 during daytime, > 2-3 times/night # increases : with age, Diuretics & Hypercalcemia (large volume, urine), Infection...

Bedsores/Skin

*** PRESSURE SORES • Turn in bed Q2-4 hrs • Avoid pressure/friction except in last few days • Use skin prep (Sween, Hollister, Bard) • Egg crate, thick foam, air-mattress • Do not massage • Clean, rinse,...

Cardio-Respiratory

*** ANGINA: • Chest pain, increases on exertion, relieved by rest/nitro • *Rx: ** sublingual nitroglycerine 0.4 mg q 5 min x3 or pain free ** O2 ** rest *** ACUTE MI: • Chest pain > 30 min,...

Nervous System

*** SEIZURES: 1% # CNS tumor & metastases, CVA, electrolyte abnormality, hypocalcema, hypoglycemia, drug, stopping anticonvulsants abruptly, sedative withdrawal, alcohol *Rx: ** Valium 5-10mg by slow...

Psychiatric S/S

PSYCHIATRY *** DELIRIUM: S/S: Mental status fluctuation, poor attention, hypervigilence, agitation, rage, visual / auditory hallucination, confusion, delusions, paranoia, disorganized thinking, disoriented...

Special Notes

*** Needs pain management specialist or physician who is experienced *** SUBCUTANEOUS INFUSION: • Change needle site weekly • use: Intractable pain, Nausea, Bowel obstruction, coma, debility, poor...

Gaps at end of life

***Medicine shift the focus During the second half of the 20th century. ***The science, technology, and communication has shifted the values and focus *** We started denying death-denying, *valuing :...

Additional Material

Futile Medicines in Hospice Futile meds in hospice: Percent mortality = age + burn % withholding futile meds or medical care does speed nor encourage the onset of death. Hippocratic oath :...
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Futile meds in hospice:

Futile meds in hospice: Percent mortality = age + burn % : treating a patient who very old, fragile and extensive burn, think twice. withholding futile meds or medical care does speed nor encourage the...

Last Hours of Living

  Dying patient Last hours of live Transitioning   Several patho-physiological changes occur as patient is transitioning Patient develops multiple signs & symptoms as they are...

Pointers

In elderly Trazodone is the safer first line medicine for sleep. Opioid conversion: calculate total daily dose of current med, use equivalent chart, convert to morphine then to new med, pay attention...

Miscellaneous

*** ANIMEA: • Haemoglobin < 7, or sudden blood loss # Light headedness, dizziness, palpitation, dyspnoea, fatigue, generalized weakness • 1 unit of blood raises HG 1 g/dl • Benefits lasts 1-2 days •...