Hi there, I work at an ALF and I have a resident who has pretty severe Parkinson's. 87 years old, has had pneumonia twice in the past 3 months, 95 lbs soaking wet, can't do any of her ADL's besides feed herself and even then we usually have to step in and feed her. She can still get up and walk (or shuffle, rather) on her own, when the mood strikes her. Sleeps all the time. She's actually not appropriate for our ALF as we only have a standard license, but that's another story..
She was hospitalized a few weeks ago with pneumonia, but has been doing better since returning to our facility. Today, she was very lethargic, difficult to rouse, resting tremors seemed worse. Rubs in bilat lungs, sometimes sounding like she had phlegm caught in her throat. Percussed her back, tried to get her to cough up secretions but she couldn't. V/S and SpO2 WNL. Mainly, she was just zonked out all day. No apparent respiratory distress. Her husband is freaking out.. I don't think her neurologist or primary MD has been completely honest as to what to expect with Parkinson's Disease and the progression, or the complications (recurrent pneumonia being one). As of the time I left work today we were still waiting to hear back from her primary and hopefully get an order for at least a CXR.
She is a full code, which freaks me out. I can't imagine doing CPR on this tiny lady.. her ribs would crack in half. Her primary MD ordered physical therapy for her last week.. I guess to palliate her husband. Surely her doc knows no amount of PT will help her get better. She also saw her neurologist last week, who merely bumped up her Aricept dosage. You'd think as a physician that deals with this disease all the time, they would notice her decline and speak to her husband about it..
I know only MD's can order a hospice consult, but would I be out of line to suggest this to her doctor? Honestly, to me she looks like she is dying already, albeit slowly. I feel, at least if hospice is a no-go, she should be made a DNR.