case discussions challenges in end of life care 15/11/14 mrs b
TRANSCRIPT
Case Discussions Challenges in End of Life
Care15/11/14
MRS B
Visit requestMon Afternoon (temp resident)
From daughter: Brought Mum to stay with me
Has Renal cancer Tired/SleepyNot Eating/drinking Just not herself
MRS B History from daughter
Age 77 , Temp Resident RENAL CANCER, LUNG METS
Diagnosed 8/12. Palliative Rx , 12/12 prognosis PMH
Hypothyroid Medication
Levothyroxine, Oxycontin/Oxynorm Allerg: Dexamthazone
History and exam Mrs B
Feeling generally unwell Hardly eating/drinking/ no nausea Left rib pain few weeks Aware prognosis- Preferred Place of
Care = Hospice Pale, looks dry, bit confused Obs normal, abd mass A/E chest,
urine NAD
Discussion with Mrs B and daughter
Daughter strugglingMrs B will consider
admission to Hospice but nowhere else
BUT NO FEMALE BEDS IN HOSPICE
WHAT DO YOU DO NOW?
Discussion
Differential diagnosisPatient’s wishes Carer’s wishes
WHAT HAPPENED NEXT?
Urgent bloods requested (done next day)
Referred to ERT Next day
Increased confusion and reduced mobility
Still no Hospice bed available
WHAT NEXT ?
Patient Admitted to hospital Calcium 3.34 (2.20-2.60) Albumin 32 (35-60) ALP 245 (30-130) Bilirubin 9 (<21) ALT 7 (< 35) GGT 62 (<35) CRP 38 (<5) Urea 9.3 (2.5-7.8) Creat 90 (50-130) Egfr 47 (>60) Hb 94 (118-148) WBC 25.6 (3.5-11) NEUTS 22 (2.0-7.5)
Then bloods phoned through
Other tests in Hospital
CT Head – normal CT Chest/Abdomen/Pelvis –
Increase in renal mass and pulmonary metastases
MRI Spinal Cord-No spinal cord compressionEvidence of rib invasion from
metastases Urine/ Blood Cultures – negative
TREATMENT:
IV Fluids IV Bisphosphontes
Confusion settledMobility improvedDischarged to own home.