Criteria for Pediatric Palliative care Flashcards Preview

Nurp 503 exam 3- Pediatric Palliative > Criteria for Pediatric Palliative care > Flashcards

Flashcards in Criteria for Pediatric Palliative care Deck (13):
1

General Referral Criteria


Automatic
Conflicts regarding use of medical nutrition/hydration in cognitively impaired, seriously ill, or dying patients

Suggested
New diagnosis of life-limiting/threatening condition

Three or more hospitalizations within six months

Difficult pain or symptom management
Patient, family, or physician uncertainty regarding prognosis Family with limited social supports
AND (Allow Natural Death)/DNR order or other ethical conflicts
Complex care coordination and/or home-going needs Prolonged hospitalization for more than three weeks
Need for hospice resource utilization

2

Malignant Disease Criteria

Automatic
Progressive metastatic cancer
Bone marrow/stem-cell transplant
Diffuse intrinsic pontine glioma Stage IV neuroblastoma
Relapsed malignant disease following stem-cell/bone marrow transplant


Suggested
Any newly diagnosed malignant disease with an EFS of

Any relapsed malignant disease
Metastatic solid tumors

New diagnosis with complex pain or symptom management issues

3

Pulmonary Criteria


Pulmonary Criteria

Automatic
Patients with CF considering lung transplant/at the time of transplant

Patients with CF with FEV1 < 30%

Patients with CF with vent dependence or those ineligible for lung transplant

Bronchiolitis obliterans

Suggested
Patients with CF with multiple hospitalizations
Patients with CF with pain, dyspnea, or other symptoms who would benefit from symptom management
Central hypoventilation syndromes
Patients who are chronically ventilator-dependent

4

Genetic Criteria

Automatic
Trisomy 18, 13, 15 Asphyxiating thoracic dystrophy
Severe forms of osteogenesis imperfecta (type 3 or 4) Potter syndrome
Epidermolysis bullosa


Suggested
Rett's syndrome

Other rare chromosomal anomalies with known poor neurologic prognosis

5

Neurologic/Neuromuscular/Neurodegenerative Criteria

Automatic
Progressive neurodegenerative conditions
Muscular dystrophy
Spinal muscular arophy
Severe traumatic brain injury
Persistent vegetative state
Batten disease
Metachromatic
Leukodystrophy/ALD

Brain reduction syndromes:
Anencephaly
Hydranencephaly
Lissencephaly
Severe schizencephaly

Suggested
Static encephalopathy
MRCP with comorbidities
Severe anoxic brain injury (not neonatal)

6

Metabolic/Inclusion Disease Criteria

Automatic
Krabbe's disease Hunter's/Hurlerí's disease Niemann-Pick disease Menke's disease
Pompe disease Sanfilippo syndrome Tay Sachs disease Fabry's disease Sandoff's disease

Suggested
Severe mitochrondrial disorder

Severe metabolic disorders for which BMT is a therapeutic consideration

7

Infectious Disease Criteria

Automatic
HIV/AIDS resistant to antiretrovirals Severe combined immune deficiency

Suggested
Congenital CMV/toxoplasmosis with neurological sequelae Severe encephalitis
Severe immunodeficiency syndromes, particularly those for which BMT is a consideration

8

Orthopedic Criteria

Automatic
Thanatophoric dwarfism


Suggested
Severe progressive scoliosis

Severe forms of dwarfism

9

Renal Criteria

Automatic
Neonatal polycystic kidney disease


Suggested
Renal failure, not transplant candidate

10


Gastrointestinal Criteria

Automatic
Multivisceral organ transplant under consideration Biliary atresia
Total aganglionosis of colon

Progressive hepatic or uremic encephalopathy


Suggested
Feeding tube under consideration for any neurological condition Long-segment Hirshsprung's
Short-gut syndrome with TPN dependence

Severe feeding intolerance (autonomic enteropathy/chronic intestinal pseudoobstruction)

11



Neonatal Criteria

Automatic
Extreme prematurity with concomitant severe BPD, Grade IV IVH, PVL, etc.
Severe birth asphyxia

Hypoxic ischemic encephalopathy (moderate to severe)


Suggested
VLBW infants

12


Cardiac Criteria

Automatic
Single ventricle cardiac physiology Severe pulmonary hypertension
Down syndrome with significant cardiac abnormality Ebstein's anomaly
Eisenmanger's syndrome

Cardiomyopathy: hypertrophic or severe dilated

Pulmonary atresia (especially if associated with hypoplastic pulmonary arteries) Ongoing discussion of cardiac transplant
Combination of cardiac diagnosis with underlying neurologic/chromosomal diagnosis


Suggested
Complex congenital heart disease ECMO candidate
Severe myocarditis

13

Intensive Care Criteria

Automatic
Prolonged or failed attempt to wean mechanical ventilation Multiorgan system failure
Compassionate extubation Severe head injury following NAT

Suggested
PICU stay longer than two weeks

Irreversible brain injury that will impact functional status Immersion injury