1 / 10

Pediatric Palliative Care Key Elements in an Emerging Discipline

Pediatric Palliative Care Key Elements in an Emerging Discipline. Moderator: Russell K. Portenoy, MD Panelists: John M. Saroyan, MD Debra F. Fox, APRN, FNP-BC, CHPN Katherine Leonard, MD Erica Rosenbaum, LMSW. Case #1. 11 month old female Epidermolysis bullosa, junctional type

jayme
Download Presentation

Pediatric Palliative Care Key Elements in an Emerging Discipline

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Pediatric Palliative Care Key Elements in an Emerging Discipline Moderator: Russell K. Portenoy, MD Panelists: John M. Saroyan, MD Debra F. Fox, APRN, FNP-BC, CHPN Katherine Leonard, MD Erica Rosenbaum, LMSW

  2. Case #1 • 11 month old female • Epidermolysis bullosa, junctional type • Extensive skin & gastrointestinal lesions • Failure to thrive • Significant developmental delay • PE: Extensive desquamation to arms, legs; scapulae and sacrum • Comfort care; DNR

  3. EpidermolysisBullosa

  4. Management Epidermolysisbullosa • Pain management • Methadone 0.1 mg po tid +Morphine prn • Parental concern over “addiction” • Principle of double effect • Dressing changes • Management of other symptoms • Pruritis, irritability, dyspnea • Feedings • Medications • Formulations with and without feeding tube

  5. Management Epidermolysisbullosa • Psychosocial support in • Recessive autosomal inheritance • Well, “unaffected” sibling • Multiple loss bereavement • Home health nursing + palliative care • Opportunities for collaboration with industry and national organizations

  6. Case#2 • 10 y/o girl • ALL • s/p standard chemotherapy, not a BMT candidate, Phase I and II trials exhausted • Transfusion dependent • Referred to hospice on discharge from hospital

  7. Management of Advanced Cancer in children • Symptom control • pain, nausea, dyspnea, fear and anxiety, insomnia • Goals of care • transfusion, feeding, antibiotics, code status • Transition to Home • Family, Patient and Community Support at end-of-life and through bereavement

  8. Concurrent Care for pediatric hospice patients • Brief overview • ~. State and Federal guidelines • ~. Incorporating Pediatric hospice and palliative care within the guidelines of concurrent care

  9. Case #3 • 6 y/o boy • temperature and blood pressure abnormalities • dystonic posturing • diaphoresis and erythroderma • severe neurologic impairment following meningitis/encephalitis • generalized tonic-clonic seizures • Multiple ED visits • ICU admissions over three years with multiple prolonged intubations, sepsis work-up (including spinal taps), many pneumonia

  10. Case #3 • Diagnosis • Neuroirritability • Treatment • Clonidine • Clonazepam • Diazepam PR • Goals of Care and Home Services

More Related