Lillian Nguyen

Hospice Item Set (HIS)

Diagnoses

• G30.9

  Alzheimer's disease, unspecified

  terminal

• R63.3

  Feeding difficulties

  2025-09-18

• R41.3

  Other amnesia

  2023-08-10

• F02.80

  Dementia in other diseases classified elsewhere, without behavioral disturbance

  2021-03-15

• I10

  Essential (primary) hypertension

  2020-06-22

• E11.9

  Type 2 diabetes mellitus without complications

  2019-11-04

Visit notes

• social servicesMSW12/22/2025, 1:20:00 PM

  Urgent supportive visit following overnight aide report that Lillian Nguyen is in active dying phase. Met with family unit in the home. Mai and Hieu Nguyen tearful but calm; expressed gratitude for hospice team support over the past weeks. Family shared that their Buddhist monk visited yesterday evening and performed spiritual rituals, which brought comfort to all present. Discussed practical matters gently: funeral home pre-arrangements confirmed, death certificate process reviewed, and after-death care instructions provided. Family denied need for crisis counseling at this time but accepted bereavement follow-up contact post-death. Reinforced that hospice team is available 24/7 and that they should call immediately at time of death. Noted family's deep love and devotion to Lillian throughout her illness with Alzheimer's disease. Bereavement plan initiated in chart. Will remain on standby for family support.

• nursingRN12/19/2025, 4:00:00 PM

  Skilled nursing visit. Pt Lillian Nguyen, end-stage Alzheimer's disease. Pt increasingly unresponsive over past 48 hours per family report. No purposeful movement noted; mottling observed on bilateral knees and lower extremities. Extremities cool to touch. Respirations irregular with periods of apnea up to 10 seconds — Cheyne-Stokes pattern beginning. Oral secretions present; hyoscine administered by family as instructed, with good effect. Skin: stage 1 erythema noted right heel; heel protectors applied. Family present at bedside — Mai, Hieu, and two grandchildren. Emotional support provided; normal signs of active dying explained in calm, compassionate manner. Family encouraged to speak to Lillian as hearing is believed preserved. Chaplain notified of imminent status. Continuous home care criteria assessed; family requesting overnight aide support — order placed. Bereavement resources reviewed. MD notified of current status; no medication changes at this time.

• incidentRN12/14/2025, 9:45:00 PM

  Incident report: Caregiver Mai Nguyen called hospice triage line at approximately 1530 reporting acute increase in pt's respiratory distress and audible moaning — assessed as acute symptom crisis. RN arrived within 45 minutes. On arrival, pt Lillian Nguyen with Alzheimer's disease, end-stage, found with labored respirations 26/min, accessory muscle use, PAINAD score 6/10 consistent with moderate distress. Administered morphine sulfate 2 mg SL per existing PRN order. Repositioned pt to semi-Fowler's. Reassessed at 20 minutes: respirations 18/min, PAINAD 2/10. Lorazepam 0.5 mg SL given for associated restlessness. MD on-call notified; orders received to increase scheduled morphine and add hyoscine hydrobromide 0.4 mg SL Q4H PRN secretions. Family educated on medication administration and signs of imminent transition. Family declined inpatient transfer; wishes to keep Lillian at home. Aide hours increased per plan of care adjustment.

• physicianMD12/10/2025, 2:00:00 PM

  Face-to-face encounter conducted per hospice regulatory requirement. Pt Lillian Nguyen examined in her home. Primary terminal diagnosis remains Alzheimer's disease, G30.9, end-stage, with functional decline consistent with FAST Stage 7c-d. Pt nonverbal, bedridden, contractures noted bilateral upper extremities. Weight not obtainable; family reports no measurable food intake for 3 days, minimal fluid intake. Skin warm, dry; no fever. Lung sounds diminished bibasally without frank congestion. Heart rate 74, irregular. No signs of acute distress at time of visit. PAINAD 0 at rest. Current medications reviewed: lorazepam 0.5 mg SL PRN agitation, morphine sulfate 2 mg SL PRN pain or dyspnea. Orders updated to increase morphine PRN frequency. Prognosis consistent with six-month terminal trajectory. Hospice eligibility recertified. Family counseled regarding expected disease progression.

• social servicesMSW12/7/2025, 7:30:00 PM

  Psychosocial and bereavement support visit conducted in the home with primary caregiver Mai Nguyen and her brother Hieu Nguyen. Family expressed grief and guilt surrounding the decision to elect hospice for their mother, noting cultural and familial expectations around 'doing everything.' Provided education on the goals of comfort care in the context of end-stage Alzheimer's disease, emphasizing quality of life and dignity. Explored family strengths and support systems; family attends local Vietnamese Buddhist temple and found spiritual community helpful. Chaplain referral offered and accepted. Family denied immediate financial concerns. Plan to continue weekly supportive contact; will coordinate with RN regarding family coping as Lillian's condition progresses.

• nursingRN12/3/2025, 3:15:00 PM

  Initial hospice nursing assessment completed in patient's home. Pt is Lillian Nguyen, 84 y/o female with primary dx of Alzheimer's disease (G30.9), end-stage. Pt nonverbal, responds minimally to tactile stimulation. FAST scale Stage 7c. Oral intake markedly decreased — accepting only small sips of thickened liquids per family. Skin intact; coccyx monitored, no breakdown noted. Respirations unlabored at rest, 16/min. Pain assessment via PAINAD score 1/10. Comfort-focused care plan reviewed with daughter, Mai Nguyen, who is primary caregiver. Repositioning schedule reinforced; pressure redistribution mattress topper recommended and order placed. Family verbalized understanding of hospice goals. Follow-up visit scheduled in 48 hours.