Category: Assessment

Articles pertaining to nursing assessment often pertaining to terminally ill patients and recognizing key areas to prevent avoidable distress.

Understanding Hospice Eval and Treat Orders

Provider Order To Eval And Treat For Hospice
In the world of healthcare, when a provider writes an order to "Eval and Treat" for hospice, they are asking for a thorough evaluation and a tailored treatment plan. This is specifically meant for patients who are being considered for hospice care. Let's delve into what this means and why it's crucial. What Does "Eval and Treat" for Hospice Mean?
Read MoreUnderstanding Hospice Eval and Treat Orders

Hospice Nursing Visit frequencies: A Guide for New Hospice Nurses

color coded hospice staff visit calendar
As a hospice nurse, determining the appropriate frequency of scheduled nurse visits for your patients is essential to providing effective and compassionate end-of-life care. Patients and their families often rely on your expertise to ensure their comfort and well-being during this sensitive time. In this article, we'll discuss suggested starting scheduled nurse visit frequencies, when to decrease or increase frequencies, and factors to consider based on patient acuity and changes in their condition.
Read MoreHospice Nursing Visit frequencies: A Guide for New Hospice Nurses

Understanding Hospice Eligibility for Terminally Ill Patients with Non-Alzheimer’s Dementia

As experienced caregivers, we know how crucial it is to accurately assess and determine hospice eligibility for our terminally ill patients. Today, let's focus on patients with non-Alzheimer's dementia. While the FAST scale is not applicable in these cases, there are other signs and symptoms we should be observant of to support and prove hospice eligibility. Let's dive in!
Read MoreUnderstanding Hospice Eligibility for Terminally Ill Patients with Non-Alzheimer’s Dementia

Understanding the Importance of the PAINAD Scale in Pain Assessment for Terminally Ill Patients

Paidad Scale To Assess For Pain Observationally
As experienced hospice nurses, our primary goal is to provide the best possible care and comfort to our terminally ill patients during their final journey. Pain management is a crucial aspect of hospice care, and it becomes even more challenging when dealing with patients who may have difficulty expressing their pain due to cognitive impairments or other factors. In such situations, the PAINAD scale emerges as a valuable tool for pain assessment. Let's explore why and when using the PAINAD scale is essential, particularly when patients consistently over or underreport their pain.
Read MoreUnderstanding the Importance of the PAINAD Scale in Pain Assessment for Terminally Ill Patients

Understanding Changes in Palliative Performance Scale in the Last Six Months of Life

Palliative Performance Scale Ppsv2
In the journey towards end-of-life care, understanding the Palliative Performance Scale (PPSv2) and its downward changes in the last six months can provide valuable insights for hospice caregivers, patients, and families. This article aims to break down these changes' month by month, offering guidance on what to expect during this crucial period.
Read MoreUnderstanding Changes in Palliative Performance Scale in the Last Six Months of Life

A Holistic Approach: Hospice Nursing Assessment vs. Hospital/Nursing Home Assessment

The Intersection Of Palliative Care Prior To End Of Life And End Of Life Palliative Care Especially In The Last Hours
As an experienced hospice nurse, I understand the importance of providing compassionate care that focuses on maximizing patient comfort and removing avoidable distress. The hospice nursing assessment differs from assessments conducted in hospitals or nursing homes, where the focus is often on normal versus abnormal vital signs and lab values. In this article, I will compare the hospice nursing assessment to assessments done in other healthcare settings, providing examples that highlight the unique approach of hospice nursing.
Read MoreA Holistic Approach: Hospice Nursing Assessment vs. Hospital/Nursing Home Assessment

Significant Signs a Terminally Ill Patient may be Close to Dying

Signs of imminent death
There are typical visible/audible signs that a person may have less than two weeks to live. There are times when we are so close to someone, we may miss the forest for the trees. Please allow me to go over some significant signs that a person with a terminal illness may have two weeks or less to live. If there is sudden onset, within the past 24-hours, any of the following signs and symptoms, please do an evaluation for end-of-life determination as soon as possible (family members seeing these signs should reach out to their hospice provider's 24x7 number):
Read MoreSignificant Signs a Terminally Ill Patient may be Close to Dying

Mottling of Skin Near Death

Mottling At End Of Life Lower Calves
As a caregiver or family member, it can be challenging to witness the changes that occur as a loved one approaches the end of their life. One such change that may occur is mottled skin, also known as livedo reticularis. Understanding what mottled skin is and its significance in the dying process can help you provide the best care and support to your loved one during this time.
Read MoreMottling of Skin Near Death

How to Use the Pain Assessment in Advanced Dementia Scale (PAINAD) to Determine Discomfort in Your Loved One with Dementia

Paidad Scale To Assess For Pain Observationally
If you have a loved one with dementia, it can be difficult to know if they are in pain or discomfort. The Pain Assessment in Advanced Dementia Scale (PAINAD) is a tool that can help you determine if your loved one is uncomfortable. The Pain Assessment in Advanced Dementia Scale (PAINAD) is different from other pain assessment tools for people with dementia in several ways:
Read MoreHow to Use the Pain Assessment in Advanced Dementia Scale (PAINAD) to Determine Discomfort in Your Loved One with Dementia

Understanding Heart Failure Stages and Assessment

Heart failure is a complex medical condition that can impact the quality of life of patients, especially those in hospice care. As a hospice nurse, it's crucial to assess the stage of heart failure accurately to provide appropriate care. In this article, we will explore the New York Heart Failure Classification System, its stages, and how to assess patients for their stage. Additionally, we will emphasize the importance of documentation in compliance with Medicare guidelines for terminally ill patients with heart failure.
Read MoreUnderstanding Heart Failure Stages and Assessment

Early Detection of Serotonin Syndrome in Dementia Patients: Three Case Studies

diagnosing serotonin syndrome
Serotonin syndrome is a potentially life-threatening condition caused by an excess of serotonin in the body. Detecting this condition early is crucial, but it can be particularly challenging when dealing with dementia patients due to communication barriers and the complexity of their symptoms. In this article, we will present three case studies that highlight the early detection and successful management of serotonin syndrome in patients with different types of dementia: Alzheimer's disease, vascular dementia, and Lewy Body Dementia.
Read MoreEarly Detection of Serotonin Syndrome in Dementia Patients: Three Case Studies

Understanding Serotonin Syndrome: A Comprehensive Guide

clinical presentation of serotonin syndrome
Hospice nurses assess the status of the patient's journey towards end-of-life every nursing visit. There are situations where a reversible condition arises that can drastically impact the patient, the hospice assessment, and if it is not caught, potentially mistreated leading to increased discomfort and a faster death often involving increased suffering. One of the common clues someone is getting closer to dying is increased agitation and restlessness. Are you aware of Serotonin Syndrome? A drug-induced condition whose early signs and symptoms can mimic that of someone getting closer to death? A situation that, unlike the natural dying process, is treatable and reversible?
Read MoreUnderstanding Serotonin Syndrome: A Comprehensive Guide

Trigger Words for Hospice Nurses: Assessing End-of-Life in Two Weeks or Less

Signs of imminent death
Hospice visits by a nurse should always include a discussion with the caregiver and family members or facility staff about any changes since the last nursing visit. This interviewing process is extremely important because vital signs do not always provide clear indications when a patient is two weeks or less away from death. If we hear or read certain words or phrases in the notes, we should be on high alert for the possibility that the patient is either transitioning towards actively dying or is otherwise close to transitioning.
Read MoreTrigger Words for Hospice Nurses: Assessing End-of-Life in Two Weeks or Less

Unmanaged Pain in Dementia Patients

Dementia is a condition that affects millions of people worldwide, and it can cause a range of symptoms, including pain and discomfort. Unfortunately, pain is often under-detected and undertreated in people with dementia, leading to significant suffering and a reduced quality of life. In this article, we will explore the prevalence of pain among dementia patients, the impact of unmanaged pain on their quality of life, behavioral changes that may indicate pain, and the use of the PAINAD pain scale as a tool for assessing and managing pain in dementia patients.
Read MoreUnmanaged Pain in Dementia Patients

Reviewing Hospice Eligibility

general hospice criteria
It’s important to familiarize yourself with the key local coverage determination (LCD) facts for different terminal illnesses to avoid admitting patients who are not eligible for services only to be required to refund the money back to Medicare otherwise only have the patient on for one benefit period then discharged for failure to decline. These determinations provide guidelines on the coverage of hospice services for specific conditions. Let’s explore some essential information for each terminal illness based on the provided PDF files as noted in the resources section below.
Read MoreReviewing Hospice Eligibility

Oh hi there 👋 It’s nice to meet you.

Sign up to receive updates on new articles to your inbox.

The emails we will send you only deal with educational articles, not requests to buy a single thing! Read our privacy policy for more information.