hospice worksheet for determining prognosis, pulmonary disease

Introduction

Worksheet:

• signs & symptoms of severe pulmonary disease
  • signs
    • cyanosis; blue lips, fingertips
    • pulmonary hyperinflation; barrel-chested
    • pursed-lip breathing
    • using accessory muscles of respiration
    • retractions, supraclavicular
    • increased expiratory phase; forced slow expiration
    • wheezing
    • diminished breath sounds
    • depressed diaphragm
  • symptoms
    • dyspnea at rest
    • dyspnea on exertion
    • housebound; chairbound
    • oxygen-dependent
    • copius/purulent sputum
    • recurrent infections
    • severe cough
• other features of severe pulmonary disease
  • poor response to bronchodilators
  • FEV1 (after bronchodilator) < 30% predicted
  • increased visits to the Emergency Department
  • increased hospitalizations for pulmonary infections/respiratory failure
  • decrease in FEV1 on serial testing of > 40 mL/year
  • presence of cor pulmonale or right heart failure
    • electrocardiogram (EKG)
    • echocardiogram
    • chest X-ray
    • physical signs of right heart failure
  • hypoxemia at rest on supplemental oxygen
    • pO2 < 55 mm Hg on supplemental oxygen
    • O2 saturation < 88% in supplemental oxygen
  • hypercapnia (pCO2 > 50 mm Hg)
  • unintentional weight loss > 10% of body weight in past 6 months
  • resting tachycardia (heart rate > 100/minute)

Additional terms

• cyanosis
• dyspnea (shortness of breath {SOB})
• forced expiratory volume in 1 second (FEV1)
• hypercapnia
• hypoxia
• right ventricular failure; right heart failure
• weight loss