Vital signs: T100 BP90/40, P120, RR 18, Temp 100.6, O2 saturation=90% with 2 L O2 nasal cannula.
She is very cachectic and minimally arousable. Sclera are icteric, mucus membranes are dry, and skin is jaundice. Lungs have coarse bronchial breath sounds and the abdomen is distended with hepatosplenomegaly.
Laboratory values: BUN 70 creatinine 3.6 Hct 22 ALT 280 AST 300 alk phos 410, total bilirubin 8.3.
Son and daughter are brought to a quiet family meeting room to talk. They are told that their mother appears to be in the active stages of dying process due to progression of her cancer.
Option of transfer to inpatient hospice, return to home with home hospice, or admission to hospital is discussed.
Mrs. G’s daughter is quite clear she wants her admitted to the hospital and her son agrees that is fine.