Case Studies In Palliative And End Of Life Care Pdf


By Alphonsine A.
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09.04.2021 at 23:05
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case studies in palliative and end of life care pdf

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Case-based learning: palliative and end-of-life care in community pharmacy

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Andrew was a 23 year-old car mechanic who had been suffering from indigestion for some months before the GP referred him to a hospital consultant, who after a series of tests diagnosed cancer of the colon, with liver secondaries. Because the treatment which Andrew had agreed to involved a long recovery, he decided to move back home with his parents for a while so that he would have someone to look after him and help him to recover from the planned surgery.

As a consequence, Andrew found himself giving a lot of support to Divya, particularly since they had planned to marry later that year and some of the wedding arrangements had already begun. They felt that the hospital staff would not refuse to let them see Andrew if they were physically present in the hospital.

The surgeon had performed extensive radical surgery to the large bowel, called an abdomino-perineal excision of rectum, leaving Andrew with a permanent colostomy.

Because of the time Andrew had spent in theatre and the shock of the surgery he needed to have some ventilator support and therefore instead of going to the ward he was taken to the intensive therapy unit ITU. The family were asked to visit for a short time only and were told to return the next day when it was felt that Andrew would be much stronger and in need of their company.

That night the family thought that Andrew might die. Therefore the sight of him looking much better the next day served to raise their hopes again and instilled them with a conviction that Andrew was strong enough to overcome the cancer. Five days after the surgery Andrew was on the main general surgery ward and was moving about well. His drips and drains were removed and he was eating a light diet. The ward staff had developed a good relationship with Andrew and were quite often found laughing and joking with him.

All of the biopsy results were back and following an ultrasound, the consultant came to discuss the future prognosis with Andrew. It was confirmed that the cancer had spread to the liver and that although this meant that it was potentially fatal, the consultant thought that Andrew could make a reasonable recovery in the short term. He told Andrew that he felt confident that the cancer in the large bowel had been removed, but suggested a course of radiotherapy as an extra measure.

Although the future was uncertain Andrew did not receive this news as a death sentence. He was prepared to wait and see, and to use what time he might have left in living, and even overcoming the cancer. Andrew was very keen to go home where he felt he would make a quicker recovery. He had a lot of concerns about the management of his colostomy and was very disappointed that the consultant did not mention reversing this at a future date.

It was a much thinner, pale and tired Andrew who returned home to face what he hoped was a period of recovery. He had refused to let Divya cancel the wedding and therefore she had continued to make plans, albeit with some caution. The wedding was a goal for Andrew, and because of this it became one which they were both determined to achieve.

It was a symbol of life, although privately Divya had a lot of doubts about the future. If Andrew had concerns he did not voice them, and conversations between the family and he and Divya began to feel strained by the pressure of having to be positive at a time of such doubts. The recovery was long and his adjustment to the colostomy was very difficult.

Divya and Andrew talked about the colostomy as if it was something they could overcome, but privately they each had a lot of doubt. Andrew was able to talk to his mother about this and she agreed that they should seek some specialist help.

Andrew was still not pain free some 12 weeks after the surgery and the GP suggested it would be useful to contact the Macmillan Nurses, who began to visit on a regular weekly basis. Divya was now extremely concerned about the wedding arrangements and was hoping to persuade Andrew to postpone the wedding.

One evening late at night Andrew became very distressed. He had been unable to pass urine since that morning and suddenly the pain in his bladder had become unmanageable. His mother called the hospice number which the Macmillan Nurse had left with her and they suggested that Andrew go to the local Accident and Emergency department.

This brought immediate relief to Andrew, but this relief was short because the medical staff wanted to admit him back into the surgical ward to investigate the cause of his urinary retention. Andrew agreed to go in the next day, but that evening everyone felt very low and full of dread of what this development could mean. The worst predictions, which they all privately made and dreaded most, were correct. Andrew was found to have secondaries in his bladder and a continued infiltration in the remaining bowel above the colostomy site.

After the news had been given, it was suggested that Andrew should go to a hospice for the management of his remaining time, which could be very short. The ward staff were very upset, because everyone had found Andrew to be a very special person. Divya was able to talk to one of the young senior nurses quite openly about her concerns and she turned to her now to help her to understand what was going to happen.

The first week spent in the hospice Andrew was very depressed and could hardly bear to speak to anyone. Rather than being positive, as he had been previously, he was very critical of everything that was done for him, and seemed to spend all day complaining.

The family needed a lot of support from the staff, and found the hospice staff provided this. Despite the involvement of a large team of home care specialists and carers, the bulk of the care was going to fall to the family. In many ways this was what the family wanted, but it was also very frightening.

She also felt that Andrew was the key person in this in that everyone was taking their lead for how to be with him from how they thought he wanted them to be. Andrew had withdrawn and seemed unwilling to talk about anything but his physical needs. Divya had very mixed feelings about the amount of physical caring she wanted to do, but Andrew had very clear feelings that he did not want her to do any of the personal caring.

Now that everyone knew that Andrew was dying Divya felt she had a clear role in talking to Andrew about his needs at the end of his life. Most of the time she found this unbearably painful and turned to friends who were not directly involved for her escape and support.

The next day Andrew experienced breakthrough pain and a lot of nausea. Plans for his discharge home were abandoned as attempts to control these symptoms were made. His medication was being changed on a regular basis and every day seemed to bring a small crisis. Being with him on these last few days became very important to everyone and something that they were each pleased to have, because they felt it was an opportunity to let Andrew know that they loved him. The night before Andrew died, he dozed and woke up with a start as if he was afraid to let go.

Despite feeling exhausted his mother sat with him all the time and when he was upset held him in her arms. Andrew died with his mother and father beside him late the following evening.

Divya had gone home for a break and was intending to return to spend the night. When she said goodnight to Andrew she felt he stared really hard at her as if he was seeing through her. She was extremely upset that he died when she was not there. Making the decision to study can be a big step, which is why you'll want a trusted University.

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Anyone can learn for free on OpenLearn, but signing-up will give you access to your personal learning profile and record of achievements that you earn while you study. Start this free course now. Just create an account and sign in. Enrol and complete the course for a free statement of participation or digital badge if available. Andrew was a 23 year-old car mechanic who had been suffering from indigestion for some months before the GP referred him to a hospital consultant, who after a series of tests diagnosed cancer of the colon, with liver secondaries.

The World Health Organization defines palliative care as a holistic, multidisciplinary team-based approach for patients and their families [1]. There are several diagnoses that lead to palliative care, with the primary being terminal cancer. Over 20 million people are estimated to require palliative care at the end of their life every year. Cross culturally, we see ebbs and flows of successful palliative care as well as global organizations, such as WHO, that are establishing policies to ensure care. Different ethics are to be considered when integrated palliative care across the globe, but one similarity that is universally established is the wish and desire to end life comfortably.

Case Studies in Palliative and End-of-Life Care

All rights reserved. This article examines the integration of palliative care in a community cancer center-an example of how one program integrated palliative care. There is no standard method for integrating palliative care into outpatient oncology practices, and no examples of how cancer centers are doing it. The edition of the Commission on Cancer standard 2.

People living with dementia deserve to experience the benefits of receiving palliative care and end-of-life services and supports, yet they often do not receive this care compared to those with other terminal diseases. People living with dementia in rural areas often face additional challenges to accessing such care. The purpose of this scoping review was to systematically review and synthesize the literature on palliative and end-of-life care for people with dementia living in rural areas, and to identify and describe key findings and gaps in the literature. A collaborative research team approach was used in an iterative process across all stages of this review. Systematic, comprehensive searches were conducted across ten databases and eight targeted websites for relevant peer-reviewed, original research and other less formal literature, published in English, which yielded a total of results.

End of life - Ideas for practice: Case study

Case studies

This resource has not been updated since July It may not reflect current policy but still provides valuable practice guidance. Kate is a 51 year old woman with late stage ovarian cancer. She is a single mother with five children aged 24, 23, 17, 15 and She is also guardian for her 13 year-old grandson. Kate first became known to the palliative care team before her diagnosis two years ago when her daughter was at the hospice dying from ovarian cancer.

The following case vignette provides key concepts that could be considered when developing a plan of care for a patient who may require a controlled substance to manage their health concerns. As with any clinical situation, there are many patient variables that must be considered, including comorbid conditions, social determinants of health and their personal choices. Danny is reviewing the patient history outside the house or in the car before visiting the patient. Joshi Kamakani is a 70 year old retired engineer that the Palliative Care home care team and I have been looking after at home for the last two months.

Integrating Palliative Care Into Outpatient Oncology: A Case Study

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About two years ago patient noted a silvery patch on his tongue but did not immediately seek medical attention. He continued to smoke and use chewing tobacco. The malignancy progressed rapidly despite treatment and resulted in extensive tissue necrosis resulting in the following distressing symptoms:. Halbert did quite well on this regimen for several weeks, but as the disease progressed, his pain worsened secondary to extensive local tissue necrosis culminating in admission to the hospital for symptom control. Upon admission, numerous interventions were attempted in an effort to assuage Mr. At this point, a family meeting was held to elicit goals of care and it determined the following:. He was clearly suffering greatly and this caused severe distress to his dear wife and loving children who could not bear to see him suffer in this manner.

Explore the latest in end-of-life care, including hospice and palliative care, estimating prognosis, palliative sedation, and more. This randomized effectiveness trial evaluates whether a nurse navigator—led advance care planning pathway combined with primary care professional—facing electronic health record interface facilitates use of advance care planning for vulnerable older adults. This randomized clinical trial assesses the effect of integrated palliative and oncology care on patient-reported and end-of-life outcomes in patients with acute myeloid leukemia. This study from the Netherlands looks at the association between having multiple geriatric syndromes and requesting euthanasia or physician-assisted suicide. In this narrative medicine essay, a critical care and palliative care physician draws a valuable lesson about the limits and beauty of last-ditch interventions after failing to save a fledgling hummingbird chick in its nest.

Community pharmacists encounter patients at all stages in their life; however, patients who require palliative care require dedicated time and special consideration. The World Health Organization WHO defines palliative care as an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness. This is achieved through the prevention and relief of suffering by means of early identification and impeccable assessment, and treatment of pain and other problems [1]. Palliative care is often considered to be only for patients with cancer, but it also incl udes patients with conditions such as organ failure e. The same can be said when considering symptoms see Table [5].

 - Идем, - сказала она, вставая.  - Выясним, права ли .

Сьюзан слушала молча. - Как ты могла догадаться, - продолжал он, - вскоре я собираюсь выйти в отставку. Но я хотел уйти с высоко поднятой головой.

Ежедневно тысячи сообщений и разговоров перехватывались и посылались экспертам АНБ для дешифровки. Разведданные, поставляемые агентством, влияли на процесс принятия решений ФБР, ЦРУ, а также внешнеполитическими советниками правительства США. Беккер был потрясен.

Стратмор опустил глаза и тут же все понял. Время для него остановилось. Он услышал, как стучит его сердце.

Танкадо прошел проверку на полиграф-машине и пережил пять недель интенсивного психологического тестирования. И с успехом его выдержал. Ненависть в его сердце уступила место преданности Будде.

 Нисколько.  - Беккер взял подушку с соседней койки и помог Клушару устроиться поудобнее. Старик умиротворенно вздохнул. - Так гораздо лучше… спасибо .

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