James Thibodaux

Hospice Item Set (HIS)

Diagnoses

• J44.9

  Chronic obstructive pulmonary disease, unspecified

  terminal

• F32.1

  Major depressive disorder, single episode, moderate

  2025-01-07

• J96.10

  Chronic respiratory failure, unspecified whether with hypoxia or hypercapnia

  2024-02-18

• I50.32

  Chronic diastolic (congestive) heart failure

  2022-08-04

• I10

  Essential (primary) hypertension

  2020-11-20

• E11.9

  Type 2 diabetes mellitus without complications

  2019-06-10

Visit notes

• social servicesMSW8/14/2025, 7:00:00 PM

  Visit conducted with patient, wife Celeste, and son Marcus who traveled from Baton Rouge. Mr. Thibodaux noted to be significantly weaker than MSW's visit two weeks prior — bed-bound today, minimally verbal, but responsive to family voice and touch. Family meeting facilitated to align understanding of disease progression consistent with end-stage chronic obstructive pulmonary disease. Provided psychoeducation on signs and symptoms of active dying. Marcus expressed anger and guilt regarding geographic distance; normalized feelings and encouraged present-moment connection with father. Celeste tearful but composed; reiterated her commitment to honoring patient's wish to die at home. Discussed funeral home pre-arrangements — family has not contacted one yet; provided local resource list. Chaplain visit coordinated for tomorrow at family's request; Catholic priest also confirmed for visit. Bereavement plan initiated in chart. Will increase visit frequency in coordination with RN team. Hospice social work available 24/7 reinforced with family.

• nursingRN8/10/2025, 4:00:00 PM

  Follow-up visit post-dyspnea crisis of 8/7. Mr. Thibodaux resting in recliner, appears more comfortable than prior visit. Dyspnea 3/10 at rest today. SpO2 84% on 4L NC, RR 20, no accessory muscle use noted at this time. New scheduled morphine regimen appears to be working; Celeste demonstrating correct technique and timing with medication administration — praised for her attentiveness. Skin assessment: mild dependent edema bilateral ankles, no breakdown noted. Mouth care performed; oral mucosa slightly dry. Instructed caregiver on oral hygiene frequency. Patient engaged briefly in conversation about his garden and grandchildren; appropriate affect. Appetite minimal — taking only sips of ensure and occasional broth. Coordinated with RD for dietary consult to support Celeste with realistic nutritional goals in the setting of COPD-related anorexia-cachexia. Son Marcus plans to visit this weekend; patient visibly brightened at mention. Next visit in 3 days.

• incidentRN8/8/2025, 3:45:00 AM

  Received urgent call from Celeste Thibodaux at 2215 reporting acute dyspnea crisis. Arrived at residence at 2245. Patient found seated upright in recliner, visibly distressed, RR 32, SpO2 81% on 4L NC, diaphoretic, unable to complete sentences. Per wife, patient had missed two scheduled morphine doses due to family confusion regarding new dosing schedule. Administered morphine concentrate 0.25mL SL per PRN order and lorazepam 0.5mg SL. Reassessed at 20 minutes: RR 22, patient reports dyspnea decreased to 4/10, visibly less distressed. SpO2 83%. Reinforced medication schedule with Celeste verbally and via written chart posted in kitchen. Contacted on-call MD; orders confirmed and updated. Stayed at bedside 90 minutes until patient stable and sleeping comfortably. Will notify primary RN for follow-up visit first thing tomorrow morning. Incident documented per agency protocol.

• physicianMD8/4/2025, 2:00:00 PM

  Face-to-face encounter completed per hospice certification requirements. Mr. Thibodaux presents with terminal end-stage COPD. Clinical findings support continued hospice eligibility: resting dyspnea with minimal exertion, SpO2 86-89% on 4L NC, FEV1 estimated <25% predicted based on prior PFT history, weight loss of 8 lbs over past 60 days, ECOG performance status 3-4. Patient is bedbound greater than 50% of the day. Reviewed current comfort medication regimen; increased morphine concentrate to scheduled q4h dosing with PRN breakthrough for dyspnea episodes given poor control over past 48 hours. Discussed prognosis with patient and wife in plain language. Both verbalized understanding that goal is comfort and quality of remaining life. DNR confirmed. No acute interventions indicated. Certifying diagnosis remains J44.9. Will follow via phone and revisit as clinically indicated.

• social servicesMSW8/1/2025, 6:30:00 PM

  Psychosocial assessment visit conducted with Mr. Thibodaux and his wife, Celeste, at the family home. Patient verbalized acceptance of his chronic obstructive pulmonary disease trajectory but expressed significant distress about becoming a 'burden' on his wife. Celeste identified as primary caregiver; she is 71 years old with her own cardiac history. Assessed caregiver burden — moderate to high. Discussed community resources including volunteer respite care and home health aide scheduling. Advanced directive on file; patient confirmed DNR/DNI wishes and desire to remain at home through death. Identified adult son, Marcus, in Baton Rouge as key family contact. Provided psychoeducation on anticipatory grief. Referred to hospice chaplain for spiritual support per patient's request — states he is Catholic and would welcome a priest visit. Follow-up scheduled in one week.

• nursingRN7/30/2025, 3:15:00 PM

  Initial nursing visit completed following hospice election yesterday. Patient James Thibodaux is a 74-year-old male with end-stage chronic obstructive pulmonary disease presenting with marked dyspnea at rest, SpO2 88% on 4L NC, RR 24, using accessory muscles. Pain 2/10, dyspnea 7/10 per patient report. Morphine concentrate 20mg/mL ordered for air hunger; educated patient and wife on proper dosing and frequency. Lorazepam 0.5mg SL also on hand for refractory dyspnea episodes. Head of bed elevated to 75 degrees. Fan positioned at bedside per patient preference for comfort. Medication reconciliation completed; furosemide and tiotropium continued for symptom management. Patient alert, anxious but cooperative. Wife tearful; provided emotional support and reviewed hospice philosophy of care. Will return in 48 hours.