[Blackcat99]

My mother has been hospitalized twice in the past 2 months. She has CHF and always has a cough and problems with fluid retention. I do not think she is ready for hospice. I am just curious. How exactly do they determine that a patient is in end stage CHF? Thanks

[earle58]

hi blackcat,

end stage chf typically presents like chronic fatigue at rest w/noted difficulty in sleeping. there is typically persistent:
dry cough (could be from the ace inhibitors)
dry skin
palpitations
numbness
nausea- (? digoxin levels or dehydration)
anorexia (again, check digoxin levels or can be hypokalemia)
lower leg/foot pain

ef can be wnl but you'll need alot of subjective input from your mom. and when in doubt, get permission to talk w/her doctor. i hope things work out for you!!

leslie xo

[Blackcat99]

Thanks so much Leslie.

[doodlemom]

dyspnea at rest - increasing on mnimal exertion

[Blackcat99]

Thanks doodlemom. Mom does seem to be getting weaker but she still has a good appetite and good attitude.

[sarahenst]

I agree with Leslie and Doodlemom,
I have just completed an assignment on CHF and these signs and symptoms came up in my research. I also had the privelage to talk to a family whos loved one had entered into hospice care recently due to CHF. I asked them how did they know the time was right and their reply was "We didn't know She did" Your Mom will know when she is ready Then you can seek guidence from her Dr.
My best wishes to you both
Sarah

[NRSKarenRN]

Many homecare agencies have CHF programs that do intensive visits first 2 weeks (3x wk, some dailyx3) as most frequent rehospitalization is in first 21 days post discharge. Insist on this if not already receiving home care.

Heart Failure is graded on the extent of their fatigue and dyspnoea; a tool often used to assess their condition is the New York Heart Association Classification

New York Association Heart Failure Classification
Class 1 No Limitation. Ordinary activity does not cause undue fatigue, dyspnoea, or palpitations
Class 2 Slight limitation of physical activity. Comfortable at rest, but ordinary physical activity results in heart symptoms.
Class 3 Marked limitation of physical activities. Comfortable at rest, but less than ordinary activity causes heart failure symptoms.
Class 4 Symptoms of heart failure are present at rest. If any physical activity is undertaken, discomfort is increased.

Ejection fraction < or = 20% patients been managed on home care too. Homecare manages many patients in class 4 until patient decides it's their time, then we transtion to hospice. With vigilant diuretic use along with newer meds, many patients survive longer than expected. Minimal appetite despite meds to improve appetite usually tipping point...along with too tired to go on.


Telemedicine big in homecare for CHF pts too:
UC Davis Health System - CHF HOME CARE STUDY

Palliative care and chronic heart failure

The Role of the Heart Failure Specialist Nurse

Management of the Patient With Congestive Heart Failure Using ...


Here's hoping that she receives optimal care to maximize quality of her life.

[CseMgr1]

My Mom was diagnosed with terminal heart failure back in 1995, when an ECHO revealed that she only had 60% of her systolic ejection fraction left. She lost 15% of her cardiac function every year thereafter, until she died in 1998...one year ago today.

[Marie_LPN, RN]

This is exactly what happened to Grandma. Eventually, she had also gone into renal failure, but she refused dialysis (i didn't blame her) and started receiving hospice. I was in clinical at the time, and assigned on the nephrology/dialysis floor, so i asked the dialysis nurse questions about what might be expected. He said eventually she'll get tired, sleep more, maybe be confused, and chances are she'll go to sleep and not wake up. Which was exactly what happened. She woke up one morning, ate a couple of bites of food, took her medicine, told the hospice nurse she wanted to go back to bed and rest (she had been up for 30 mins). She went back to bed, went to sleep and never woke up.

[earle58]

Originally Posted by Marie_LPN

This is exactly what happened to Grandma. Eventually, she had also gone into renal failure, but she refused dialysis (i didn't blame her) and started receiving hospice. I was in clinical at the time, and assigned on the nephrology/dialysis floor, so i asked the dialysis nurse questions about what might be expected. He said eventually she'll get tired, sleep more, maybe be confused, and chances are she'll go to sleep and not wake up. Which was exactly what happened. She woke up one morning, ate a couple of bites of food, took her medicine, told the hospice nurse she wanted to go back to bed and rest (she had been up for 30 mins). She went back to bed, went to sleep and never woke up.

how very peaceful marie.