Case 2
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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

Case 2

Dr. M. Ganeshananthan


Case 21

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 22

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)


Case 23

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


Case 24

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


Case 25

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


Case 26

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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