Case Presentation palliative- Dr Arjun D.pptx

Case presentation power point

1. Name of Case Presenter : Dr Arjun D Designation : Palliative Care Physician Organizational Affiliation : Pallium India Trust CASE PRESENTATION

2. PATIENT DETAILS AGE: 39 GENDER: Male DIAGNOSIS: Traumatic Quadriparesis with Stage IV pressure sore on sacral region and left gluteal region

3. PRESENTING COMPLAINTS Constipation(2 day) Bed sore over sacral region and gluteal region Moderate pain over the hip region Urinary leakage.

4. HISTORY OF ILLNESS He had history of fall while carrying weight followed by neck pain and weakness of both limbs and was diagnosed with Traumatic Quadriparesis in August 2015. Admitted and got treatment from one of the government hospital and discharged after one month. After 6 month he developed a bed sore over the sacral and gluteal region (stage IV). History of pain over the hip and wound site for more than 2 weeks. Pain over the hip region (5/10- intermittent burning type pain) B/L and wound site(4/10-continuous throbbing type of pain) Due to this sometimes they keep the wound open. Disturbed sleeping pattern. Decreased oral intake.

5. EXAMINATION Conscious and oriented Temp: 98̊ F Pulse: 82 b/min Respiration: 20 breath/min BP: 120/70 mmHg Systems- WNL

6. Pressure Sores Warmth and tenderness Exudates present Tunneling present Irregular in shape Foul smelling

7. TREATMENT AND SIGNIFICANT INVESTIGATION Routine Investigation done: Routine investigations done Hb-10 g, TC-34,000, P- 80%, L-18%, E-2% Platelet- 1.6 lakhs/ microL , Serum Creatinine-0.9 mg/dl, Serum Sodium -132 mg/dl, Potassium- 4 mg/dl

8. PSYCHOSOCIAL ASPECTS 39 year old unmarried man living with his 65 year old mother in a rented house. He has one siblings and he is married and living separately and not caring and helping them He was a manual laborer and was the breadwinner his family. Now his mother is a manual laborer and she is taking care of him. Now the main source of income is from mother’s daily wages, her pension and some of his friends. Have taken Rs.1.5 Lakhs from private finance bank for the treatment purpose. Devout Christian, now unable to go to Church , this makes him very sad. He communicates through cell phone. He says to his mother like, "I don’t think I can walk so please don’t spend money over my treatment“.

9. MAIN CONCERN Pressure sore Pain Financial problems

10. SUMMARY 39 year old man with traumatic Quadripresis with bed sore present over sacral and left gluteal region (stage IV) with pain over the hip region.

11. DISCUSSION POINTS (Points to be discussed in class based on the patient’s story) Do we need to provide palliative care for this patient? What are the problems faced by this patient? What all can be done for this patient and his mother?

12. Yes this patient needs Palliative care. We can see the various aspects of his suffering, not just physical, but emotional, social and spiritual. The care should be delivered at his home. His mother needs support to take care of him He needs rehabilitation support – both physical and vocational His bed sore would ideally need a surgical management which may not be possible many a times. Then giving the best possible care at home through the family and community would be best Being a burden to mother, financial needs to be taken care of – we can help him to find meaning of being there even if he is not as functional as before A good communication, follow up, support from community are to be developed. Management of bed sores, communication to patient and family, decision making about treatment, community support development will be dealt in upcoming sessions

13. Dr Arjun D Palliative Care Physician Pallium India THANK YOU