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Symptom Cases

Symptom Cases. Frank D. Ferris, MD Medical Director, Palliative Care Standards C ENTER F OR P ALLIATIVE S TUDIES San Diego Hospice and Palliative Care “Education and Research in the Art and Science of Palliative Care”

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Symptom Cases

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  1. Symptom Cases Frank D. Ferris, MDMedical Director, Palliative Care Standards CENTER FOR PALLIATIVE STUDIES San Diego Hospice and Palliative Care “Education and Research in the Art and Science of Palliative Care” Department of Family and Preventative Medicine, UCSD School of Medicine Department of Family and Community Medicine, andJoint Center for Bioethics, University of Toronto

  2. Maria, 6 year old ♀

  3. Maria, 6 year old ♀ • Perinatal HIV • Orphaned • Cared for by mother’s family –Aunt, uncle, grandmother • PCP Rx’d x 2, good recovery • Admitted w. difficulty breathing, weakness • Dx = PCP again

  4. Maria, 6 year old ♀ • IV Rx • Deterioration • Intubation / ventilation • 2 days • Improvement • Extubation

  5. Maria, 6 year old ♀ • 3 days • Deterioration • Family chooses no further intubation • Desires best available comfort

  6. Maria, 6 year old ♀ • Oxygen • Opioids • Human presence for comfort • Family • Child life specialist – responds to developmentally appropriate needs • Play at the end of life • Non-pharmacological

  7. André, 29 year old ♂

  8. André, 29 year old ♂ • IV DU • CD4 = 50, RNA = 150K • Nausea, odynophagia, wasting, fatigue • 1.75 m (5’ 9”), 54.5 kg (120 lb.) • Dx: • Opportunistic infection • HIV Wasting

  9. André, 29 yo ♂ • Rx: • Fluconazole • AZT / 3TC / Nevirapine

  10. André, 29 yo ♂ • 2 weeks •  Odynophagia •  Weight 55.5 kg (122 lb) • Fatigue, nausea persist • Unable to take Rx

  11. André, 29 yo ♂ • Rx • Prednisone • Megestrol acetate • Fluconazole • AZT / 3TC / Nevirapine • Haloperidol or chlorpromazine

  12. André, 29 yo ♂ • 4 weeks •  Weight 59 kg (130 lb) • Fatigue, nausea improved • CD4 = 80, RNA = < 400 • Adherence improved

  13. Symptom Cases Summary

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