KARNOFSKY PERFORMACE SCALE
quality of life for the terminally ill and their
 Created by David A. Karnofsky used to assist
functionality on how pt. is able to carry out
activities of daily living. It is traditionally used for
cancer patients but is now used to variety of
health conditions. This scale comes in the form of
an 11 items index.
 In using Karnofsky Performance Scale saves time.
In order to use the KPS you need to indicate which
part of the scale your patient belongs. Tick the
rating that best describes your patient when you
are engaging with this scale. And determine what
goes into your care plan for the patient. This scale
comes In the form of an 11 items index starting at
100 which is normal there are no complications
and no evidence of disease. 90 in which there are
minor symptoms but patient is able to carry on
normal activity. 80 here there are some symptoms
and when doing some normal activity, they do it
with effort. 70 patients can care for themselves
but cannot do active work, they are unable to
carry on normal activity which means they can't
do some light Works. 60 here occasional
assistance is needed, patient requires personal
assistance. 50 in this considerable assistance is
needed, frequent medical care is a must. 40
patient may be disabled and requires assistance
and special care. 30 they can be severely disabled
and hospital admission is indicated although
death is not imminent. 20 patient is very sick,
hospital admission and active treatment is
present. 10 here patients Is fatal and is declining
rapidly. And lastly 0 which means patient is dead.
MODELS OF CARE AT END OF LIFE
HOSPICE CARE –
 Hospice - As defined in Blackwell’s Dictionary of
nursing, any shelter for the poor, sick, orphan
children, or travelers. Today, the term usually
refers to a caring community of professional and
nonprofessional people and aims to improve the
families. May be independently funded,
associated with the hospital, or based in the
patient's home.
 The term Hospice is frequently misunderstood
and is equated with imminent death and many
persons mine. On the contrary, Hospice care
focuses on quality of life on the wishes of the
patient and family an easing distress at the end of
life and the months preceding death.
 Hospice care teams are nurses, doctors, social
workers, spiritual advisors, and trained
volunteers. The team works together with the
patient who is dying, the caregiver, and/or the
family to provide the medical, emotional, and
spiritual support needed.
PALLIATIVE CARE –
 The word palliative as defined in Blackwell’s
Dictionary of nursing, anything which serves to
elevate but cannot cure a disease. Providing relief
but not cure.
 Palliative care is a specialized medical care for
people living with a serious illness. This type of
care is focused on providing relief from the
symptoms and stress of the illness.
 This type of care is provided by a specially trained
team of doctors, nurses and other specialists who
work together with the patients other doctors to
provide an extra layer of support. Palliative care is
based on the needs of the patient and not on the
patient's prognosis. It is appropriate at any age
and at any stage in a serious illness.
 Palliative care also improves quality of life,
relieves the suffering from symptoms and stress ,
helps you much the retirement options to your
goals, and can work together with your other
doctors.
SYMPTOMS MANAGEMENT FOR OLDER
ADULTS
 CONSTIPATION
 Constipation defined by Blackwell’s Dictionary of
nursing. An implied chronic condition of
infrequent and often difficult evacuation of the
feces; maybe due to lack of normal tone of the
intestine, insufficient food or fluid intake,
obstruction, the presence of tumor or diverticuli,
or to habitual failure to empty the rectum.
  Most Constipation patients are treated with
lifestyle modifications such as scheduled
toileting after meals, scheduled toileting after
meals, increased fluid intake and increase
dietary fiber intake (Beans, broccoli, berries,
avocados, apples, whole grains and more).
Adding five with your diet increases the
weight of your stool and speeds its passage
through your intestines.
 DEPRESSION
 Consulting healthcare provider may
 Depression is a diminution of power activity,
recommend a specific number of grams of
fiber to consume each day.
 Biofeedback therapy and digital rectal
stimulation can enhance bowel movements
but should be used under doctor's supervision
for optimal effectiveness.
 It biofeedback is one method/therapy nga na
teach people paano ig relax and strengthen
muscles habang na poop hehe.
 Feces softeners, such as docusate sodium, can
soften feces and help it pass more easily. Fiber
supplements, such as psyllium, can also be
used to boost fiber consumption.
 Suppositories and laxatives are last resort
treatments for severe constipation, typically
prescribed under medical supervision,
providing immediate relief.
 Stress, anxiety, or depression can exacerbate
constipation, necessitating the provision of
emotional support and addressing mental
health issues to effectively manage the
condition.
 DIARRHEA
 Diarrhea as defined in blackwell's Dictionary of
nursing is a loose or watery and frequent
evacuation of stools with or without discomfort.
 Diarrhea can be treated at home with plenty
of liquids to replace lost fluids and
electrolytes.
 bananas, rice, apple sauce and toast or what
we call the brat diet. Can help ease the
symptoms. Potatoes, peanut butter, and
skinless chicken or turkey are also other good
food choices.
 OTC meds: Loperamide (Imodium), guidance
of a healthcare provider is necessary as this
may not be suitable for all.
 Probiotics supplement
 Maintain good and proper hygiene
either mental or physical. In psychiatry,
depression states are now classified as neurotic
disorders and categorized as major affective
disorders, and further categorized as bipolar
disorders that are identified as mixed, manic, or
depressed, and as major depression, single
episode or recurrent. Depression is considered
neurotic when the condition follows an event or
situation that the individual can identify, and
psychotic when it is due to a dramatic situation
that the individual can identify and is
accompanied by severe functional impairment,
including insomnia, anorexia, weight loss,
impotence, and often delusions. This is defined by
Blackwell’s Dictionary of nursing.
 Managing depression in older persons
necessitates a holistic strategy that
addresses physical, emotional, and social
well-being.
 Assess for other medical disorders or
drugs contributing to depressive
symptoms. Consider psychotherapy like
(cognitive-behavioral therapy) CBT or
(interpersonal therapy) IPT for older
individuals, resolving harmful thought
patterns and providing emotional support.
 In cases where psychotherapy is
insufficient or symptoms are severe,
antidepressant drugs like selective
serotonin reuptake inhibitors (SSRIs) or
serotonin-norepinephrine reuptake
(SNRIs) may be administered.
 Medications should be closely monitored
for effectiveness and potential side
effects, particularly in older adults who
may be taking multiple medications.
 Encourage social
engagement/involvement in activities that
promote a sense of purpose.
  Assess for suicidal ideation, establish a
safety plan if necessary, and seek
emergency help if self-harm is imminent.
 PAIN
 Pain according to the Blackwell’s Dictionary of
nursing is a physical or mental suffering. A state of
localized or generalized discomfort that ranges
from mild distress to acute agony; Usually caused
by injury to apart or disturbance of the normal
condition or functioning of a part of the body.
 Assess the pain thoroughly, taking into
account its location, intensity, quality, and
any aggravating or relieving
circumstances. To quantify pain severity,
use a pain scale such as the Numeric
Rating Scale (NRS) or the Faces Pain Scale.
 Select appropriate medications: non-
opioids (acetaminophen), NSAIDs
 Monitor for potential drug interactions, &
adverse effects
 Physical therapy/rehabilitation programs
 Fall prevention

SIGNS OF DYING
 Pain - can also be determined by the factors like
emotional distress, interpersonal conflicts, and
the non-acceptance of one's own death. Pain is
not only determined by medical conditions.
 Shortness of breath - this is one of the most
common end of life symptoms also known as
dyspnea. Even if a person doesn't have lung
disease, dyspnea can occur because the organ
systems of the body are interconnected.
 Anxiety - is normal at the end of life as a person
contemplates their own death or struggles
through the stages of dying. This is commonly
expressed as agitation, worrying, sweating,
stomach upset, nausea, sleeping problems,
shortness of breath, and heart palpitations
 decreased appetite and thirst - As a body starts to
shut down, it no longer needs as many calories
and nutrition to function at such lower levels.
Although it is normal for people to refuse food
and drink near the end of life either because they
have no desire for it or find the effort of eating or
drinking to be too much.
 nausea or vomiting - nausea may be due to
Constipation, having a reduced appetite, or
certain medicines they are taking. It could also be
caused by emotional distress.
 Constipation - Medications used to treat pain and
shortness of breath it can cause Constipation.
Other causes include a lack of physical activity,
dehydration, decreased fiber intake, and the
progression of the underlying terminal illness.
 Fatigue - Fatigue is one of the common symptoms
in end of life.
 isolation and drifting away - some people that are
near in death, they naturally start to focus inward
and may separate from the world around them,
including friends and family . It is important to
remember that any and all emotions are normal
when someone is dying this doesn't mean that
you should back away.
 Incontinence - both urinary incontinence ( loss of
bladder control) and fecal incontinence( loss of
bowel control ) are common near the end of life .
This can be a result of surgery or illness, or
because the person is simply too weak to go to
the bathroom.
 Skin changes - hands and feet may become colder
and the skin may look blotchy, purplish, and
mottled as person nears. These changes happen
because the heart is no longer able to pump blood
as effectively to the limbs.
 delirium - confusion, agitation, and restlessness
are common near the end of life. Delirium
(sudden confusion and disorientation) can be
caused by the progression of the terminal disease,
a failing respiratory system (providing less oxygen
to the brain), or medications they are taking),
there may even be episodes of hallucinations
where they see or hear things that are not there
 death rattle - is a sign that death is near. Also
known as “end stage wet respirations,” it is when
saliva and mucus build up in the airway due to the
weakening of the muscles in the lungs and the
trachea. With each breathe, the passing of air
through these fluids causes a rattling sound. At
this stage, the focus will be placed on preventing
 the patient from choking, this may involve turning loosen their power to clear out fluids as well as
them into their side or elevating their head. the relaxation of the throat muscles

STAGES OF DYING
 Early stage of dying – a patient we'll begin eating
and drinking more quickly less. This period can
last anywhere from a few days to several weeks.
For many patients, eating becomes more of a
burden than a joy at this point. During at this
stage, the body starts conserving energy and does
not need as much nourishment as it did in the
past. To provide comfort. You can offer
basements bits of food, sips of fluid or ice chips,
but it is important to respect the patient’s wishes
when it comes to eating and drinking.

 Middle stage of dying - this is marked by changes

in the patient's physical appearance that could
last a few hours or several days. Patient will
become increasingly less responsive to their
surroundings and those around them. As the
body's circulation slows down, blood is reserved
for helping major internal organs function. The
patient's hands and feet might feel cold and could
become darker in appearance during this stage,
loved ones can offer blankets to increase comfort
as the patient's circulation changes. However,
heating pads and electric blankets are not advised
because the patient will be unable other charge if
they are becoming too hot. Loved ones should
assume the patient can hear everything they say.
Experts suggest speaking softly to the patient and
touching them gently only if they normally like
being touched. This is a good time for prayer or
meditation. It is not recommended to ask the
patient questions that requires answers.

 Last stage of dying - during the final stage of

dying, disorientation and restlessness will grow.
There will be significant changes in the patient's
breathing and continence. Patients bowel
movements may stop entirely, or they become
incontinent. Their breathing may become shallow
and irregular come out with long pauses so that
grow frequent as death approaches . There may
also be sounds of chest congestions and throat
rattling in the last hours. The restlessness noted in
the stage is attributed to changes in metabolism,
while the kidney and bowel functions are affected
by this decreasing circulation. Relaxing muscles
can lead to incontinence. The slowing of blood
circulation internal organs causes the lungs to