SECTION 2: DISEASE SPECIFIC GUIDELINESThese guidelines should be used as a starting point if the patient has one of the followingdiseases:(Click on each disease to learn more) Cancer ALS Alzheimer’s Disease Heart Disease HIV /AIDS Liver Disease Lung Disease Kidney Disease Stroke ComaEXIT Next
ABOUT THIS SECTIONIf a patient has one of the disease wejust listed, he or she needs to meet theguidelines in Section 2 AND theguidelines for his or her specific diseasein Section 3 in order to be eligible forhospice care.HOME Next
A. CAN THE PATIENT PERFORM NORMAL DAILY TASKS WITHOUT HELP? Doctors measure a patient’s ability to perform normal daily tasks using a scale called the Karnofsky Performance Status Scale . Another type of scale that could be used is the Palliative Performance Scale. Both of these scales go from 100% to 0%. 100% means the patient is able to perform normal daily tasks without any help. 0% means the patient has died. If the patient scores less than 70% on either the Karnofsky Performance Status Scale or the Palliative Performance scale, they meet this guideline for hospice eligibility. Does the patient meet this guideline? YES NOHOME Next
B. DOES THE PATIENT NEED HELP PERFORMING THESE TASKS? YES Walking YES Going to the bathroom Moving from one position to YES another YES Getting dressed YES Eating Taking a bath or shower YESHOME Next
C. OTHER DISEASES The next set of slides will describe several diseases that the patient might have. These diseases would be in addition to the disease that causes the patient the most trouble. Additional diseases, called co- morbidities, can limit how long a patient will live.HOME Next
COPDCOPD stands for Chronic Obstructive Pulmonary Disease.COPD is a group of lung diseases in which something (likean inflamed esophagus, mucus, or something else) blocksthe patient’s airway and makes it difficult for them tobreathe. COPD is most common in heavy smokers. Does the patient have COPD? YES NOHOME Next
CONGESTIVE HEART FAILURECongestive heart failure happens when thepatient’s heart has become weak and cannotpump enough blood to the rest of the body. Thiscauses the patient’s kidneys to make the bodyhold on to more water, making the body“congested.” Does the patient have Congestive Heart Failure? YES NOHOME Next
ISCHEMIC HEART DISEASEIschemia means “not enough blood.” In Ischemic heartdisease, the heart itself is not getting enough blood towork properly. This is usually because the patient’sarteries are blocked by cholesterol or blood clots, butother problems could keep blood from getting to theheart too. Symptoms of ischemic heart disease arechest pain and weakness. Does the patient have Ischemic Heart Disease? YES NOHOME Next
DIABETESDiabetes, also known as diabetes mellitus, is a disease inwhich the patient’s blood sugar is too high. This can bebecause the patient’s pancreas doesn’t produce enoughinsulin (the chemical that regulates blood sugar) orbecause the patient’s body doesn’t respond to the insulinthat the pancreas makes. Symptoms of diabetes includehaving to urinate more often and being hungry andthirsty very frequently. Does the patient have diabetes? YES NOHOME Next
PARKINSON’S DISEASEParkinson’s disease is a brain and nerve diseasethat causes shaking and inability to controlmovement. It happens when the brain cells thatproduce dopamine die off. Dopamine is thechemical that allows nerves to control how musclesmove. Does the patient have Parkinson’s disease? YES NOHOME Next
MULTIPLE SCLEROSISMultiple sclerosis is a disease that happens when the patient’simmune system attacks her nerves and destroys the protectivecovering on the nerves. Multiple sclerosis causes the sufferer tohave trouble controlling the part of the body that is beingattacked. For instance, if the leg muscles are attacked, thepatient would have difficulty walking. If the bladder isattacked, the patient would lose control of their bladder. Does the patient have multiple sclerosis? YES NOHOME Next
LOU GEHRIG’S DISEASELou Gehrig’s disease is a common name foramyotrophic lateral sclerosis, or ALS. ALShappens when the patient’s nerve cells die overtime. This causes the patient to slowly lose controlof their muscles and become paralyzed. Does the patient have Lou Gehrig’s Disease? YES NOHOME Next
STROKEA stroke happens when part of the brain doesn’tget enough blood and the brain cells die. Strokesymptoms depend on what part of the brain thestroke happens in, but can include loss of musclecontrol or paralysis in the parts of the bodycontrolled by the part of the brain that lost blood. Has the patient had a stroke? YES NOHOME Next
KIDNEY FAILUREKidney failure is when the kidneys cant filterwaste out of the patients blood well enough.The build up of waste chemicals in the patientsblood causes damage to other parts of thebody as the kidney failure gets worse.Does the patient have kidney failure? YES NOHOME Next
LIVER DISEASEIn this case, liver disease could be anydisease that mostly affects the liver andcould limit the patient’s life to six monthsor less. Does the patient have liver disease? YES NOHOME Next
NEOPLASIA Neoplasia is the growth of tumors throughout the body, or the growth of abnormal cells in the patients body. Does the patient have neoplasia? YES NOHOME Next
DEMENTIADementia is when the patient loses the use of parts oftheir brain. This causes the loss of the ability tothink, reason, and remember. Patients with dementia mayalso have trouble speaking and understanding what isbeing said to them. There are several diseases that cancause dementia, including Alzheimers disease.Does the patient have dementia? YES NOHOME Next
HIV/AIDSHIV stands for human immunodeficiency virus. HIV isa virus associated with acquired immunodeficiencysyndrome (AIDS). HIV/AIDS weakens the patient’simmune system so that the patient’s body can’t fightoff other illnesses. AIDS is the final stage of an HIVinfection. Does the patient have HIV/AIDS? YES NOHOME NEXT
LUPUS Lupus is a disease in which the body attacks its own healthy tissue, including skin, joints and organs. The cause is not known. Symptoms include chronic pain and swelling in the affected areas. Does the patient have lupus? YES NOHOME Next
RHEUMATOID ARTHRITIS Rheumatoid arthritis is the long term inflammation (swelling and pain) of joints. This happens when the body attacks its own tissues near the joints. Does the patient have rheumatoid arthritis? YES NOHOME NEXT
Yes to StrokeNext On your worksheet, write: “The patient also has had a stroke” When ready, select, “Next”
Yes to help with transferBack On your worksheet, write: “The patient needs help transferring from one spot to another.” Select “Back” when ready
Yes to Kidney FailureNext On your worksheet, write: “The patient also has kidney failure” When ready, select, “Next”
Yes to help getting dressedBack On your worksheet, write: “The patient needs help getting dressed.” When ready, select “back”
Yes to DementiaNext On your worksheet, write: “The patient also has dementia” When ready, select, “Next”
Yes to NeoplasiaNext On your worksheet, write: “The patient also has neoplasia” When ready, select, “Next”
Yes to HIV/AIDSNext On your worksheet, write: “The patient also has HIV/AIDS” When ready, select, “Next”
Yes to Liver DiseaseNext On your worksheet, write: “The patient also has liver disease” When ready, select, “Next”
Yes to LupusNext On your worksheet, write: “The patient also has lupus” When ready, select, “Next”
Yes to help bathingBack On your worksheet, write: “The patient needs help bathing.” Select “Back” when ready
Yes to rheumatoid arthritisNext On your worksheet, write: “The patient also has rheumatoid arthritis.” When ready, select, “Next”
Yes to trouble eatingBack On your worksheet, write: “The patient needs help eating.” Select “Back” when ready
Yes to help with bathroomBack On your worksheet, write: “The patient needs help going to the bathroom.” Select “Back” when ready
Yes to Trouble WalkingBack On your worksheet, write: “The patient needs help walking” Select “back” when ready.
Palliative Performance ScaleBack The Palliative Performance Scale (PPS)See an is similar to the Karnofsky PerformanceExample Status Scale but it is used for patientsLearn More receiving care to relieve pain (palliative care).
Karnofsky Performance Status ScaleBack The Karnofsky Performance Status ScaleSee an (KPS) is a questionnaire that doctors useExample to figure out how much the patient’sLearn More disease keeps them from performing daily tasks.
Yes on Karnofsky ScaleNext On your worksheet, write “The patient scored less than 40% on the Karnofsky Performance Scale.” Choose “Next” when ready
CancerBack Cancer is a group of diseases in whichLearn More diseased cells grow out of control in the patient’s body. Cancer comes in a lot of different forms and can affect a specific part of the body or lots of different parts of the body. It can start in one part of the body and spread to other parts. Different types of cancer cause different symptoms, and are treated differently.
ALSBack ALS stands for Amyotrophic LateralLearn More Sclerosis. It is also known as Lou Gehrig’s disease, after a famous baseball player who suffered from it. ALS causes nerve cells to die off so that they can’t control muscle movement any more. This causes the patient to become paralyzed overtime.
Alzheimer’s DiseaseBack Alzheimer’s disease is a form ofLearn More dementia that gets worse over time. Dementia is a condition in which the brain loses its ability to think, reason, and remember things. Scientists don’t really know what causes Alzheimer’s disease yet.
Heart DiseaseBack In this case, heart disease could be anyLearn More kind of disease that mostly affects the patient’s heart and could limit the patient’s life to six months or less.
HIV/AIDSBack HIV stands for human immunodeficiencyLearn More virus. HIV is a virus associated with acquired immunodeficiency syndrome (AIDS). HIV/AIDS weakens the patient’s immune system so that the patient’s body can’t fight off other illnesses.
Liver DiseaseBack In this case, liver disease could be anyLearn More disease that mostly affects the liver and could limit the patient’s life to six months or less.
Lung DiseaseBack Diseases that affect the lungs are alsoLearn More called pulmonary diseases. In this case, lung disease could be any disease that mostly affects the lungs and could limit the patient’s life to six months or less.
Kidney DiseaseBack Diseases that affect the kidneys areLearn More also called renal diseases. In this case, kidney disease could be any disease that mostly affects the kidneys and could limit the patient’s life to six months or less.
StrokeBack A stroke happens when blood stopsLearn More flowing to part of the patient’s brain. This causes brain cells in that part of the brain to die. Depending on where in the brain the cells died, patients can lose their bodies’ abilities to perform different functions.
ComaBack A coma is when a patient has beenLearn More unconscious for more than six hours, can’t be awakened, doesn’t respond to things that should case pain, doesn’t have a normal sleep cycle and can’t feel, speak, hear or move.
Yes to COPDNext On your worksheet, write: “The patient also has COPD” Select “Next” when ready.
Yes to Congestive Heart FailureNext On your worksheet, write, “The patient also has congestive heart failure.” When ready, select “Next”
Yes to Ischemic Heart DiseaseNext On your worksheet, write: “The patient also has Ischemic Heart Disease” When ready, select “Next”
Yes to DiabetesNext On your worksheet, write, “The patient also has diabetes” When ready, select “Next”
Yes to Parkinson’s DiseaseNext On your worksheet, write: “The patient also has Parkinson’s disease” When ready, select, “Next”
Yes to Multiple SclerosisNext On your worksheet, write: “The patient also has Multiple Sclerosis” When ready, select, “Next”
Yes to Lou Gehrig’s DiseaseNext On your worksheet, write: “The patient also has Lou Gehrig’s disease” When ready, select, “Next”
NEXT STEPS This is the end of Section 2. In order for the patient to be considered eligible for hospice care you must also complete the section 3 component that matches the patient’s disease. You may either go on to Section 3 now, by selecting the patient’s disease from the list below, or exit and come back later by selecting “EXIT”. You may also restart Section 2 by selecting “HOME” Section 3 Components (Select patient’s disease) Cancer Liver Disease ALS Lung Disease Alzheimer’s Disease Kidney Disease Heart Disease Stroke HIV /AIDS ComaHOME EXIT
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