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Case 2

Case 2. Dr. M. Ganeshananthan. Case 2. 84 yr female NH resident for 3 yrs Long standing schizophrenia with limited communication Change in personality and deterioration in memory over the last year Dependent on staff for personal care and feeding Poor swallow on a soft diet. Case 2.

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Case 2

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  1. Case 2 Dr. M. Ganeshananthan

  2. Case 2 • 84 yr female • NH resident for 3 yrs • Long standing schizophrenia with limited communication • Change in personality and deterioration in memory over the last year • Dependent on staff for personal care and feeding • Poor swallow on a soft diet

  3. Case 2 • On a good day can take a few steps (Has wheelchair) • Otherwise needs help of 2 to transfer from bed to chair • 4 admissions in the last year with chest sepsis due to aspiration pneumonia • Recent admission with pneumonia, but was not back to her baseline • Daughter had written a letter to the care home that in the event of deterioration, for patient not to be sent into hospital(Community DNAR form)

  4. Case 2 • Admitted to hospital in 25/12/13 • Decreased oral intake for 2 days and cough with expectoration • Lethargic • O/E GCS 7 (E2, M4, V1) • Chest clear • No obvious signs of sepsis

  5. Case 2 • Bloods indicated dehydration and potassium was elevated • Other investigations-Normal • My feeling • Patient was dying • Plan • Discuss with family and keep patient comfortable • Treat hyperkalemia and start IV fluids awaiting discussion with family

  6. Case 2 • Daughter arrived on boxing day morning. Wanted mother kept comfortable • Patient started on LCP • Went back to NH for end of life care and died in NH

  7. Case 2 • Spoke with nurse at care home • Issues • No plan in place for end of life care • Aspiration pneumonia is usually preceded by a bout of choking with copious secretions. This distresses both patient and nursing home staff. Concerned that she will choke to death.

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