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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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