case discussions challenges in end of life care 15/11/14 mrs b
TRANSCRIPT
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Case Discussions Challenges in End of Life
Care15/11/14
MRS B
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Visit requestMon Afternoon (temp resident)
From daughter: Brought Mum to stay with me
Has Renal cancer Tired/SleepyNot Eating/drinking Just not herself
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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
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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
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Discussion with Mrs B and daughter
Daughter strugglingMrs B will consider
admission to Hospice but nowhere else
BUT NO FEMALE BEDS IN HOSPICE
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WHAT DO YOU DO NOW?
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Discussion
Differential diagnosisPatient’s wishes Carer’s wishes
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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 ?
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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
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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
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TREATMENT:
IV Fluids IV Bisphosphontes
Confusion settledMobility improvedDischarged to own home.