End of Life Care Case Study

1
End of Life Care Case Study

• 
  
  
  
• A 78 year old male with Stage
  III Multiple Myeloma, is accompanied to the
  clinic today by his daughter, who reports
  concerns with her fathers steady decline in
  health, including nausea, loss of appetite, and a
  marked increase in confusion and difficulty
  thinking. At todays visit, the client appears
  pale, thin, drowsy and uncomfortable. Client
  reports that his pain has increased to an 8/10
  and is present in his back and chest wall.
  Client reports numbness and tingling in both his
  arms and legs, with the tendency for them to
  give out. Since his last clinic visit, the
  client has had multiple falls, with the most
  recent fall occurring en route to his radiation
  therapy, which resulted in a 4 day
  hospitalization for a minor fracture and
  rehydration. In reviewing the recent hospital
  notes, there appears to be extensive osteolytic
  lesions, which are likely the cause of the
  clients pain. Recent bloodwork shows a high
  elevation in his Red Blood Count (RBC), Lactate
  dehydrogenase (LDH), Beta2-microglobulin (â2M)
  and a C-reactive protein (CRP), all indicating
  extensive myeloma disease as well as poor
  prognosis. Most notably, the clients Creatinine
  levels are now elevated, indicating that his
  kidneys are beginning to fail. Daughter claims
  she is overwhelmed and distraught at the sudden
  change in her Fathers illness, claiming she is a
  single mother of two and a business owner and
  snaps that she does not have time to care for
  him. The client has 3 other children, however,
  has not spoken to them in over 30 years. Chart
  history indicates this estrangement is due to
  significant family issues revolving around the
  clients past alcoholism and aggressive
  behaviour. Only the youngest daughter, seen here
  today, speaks with the client and she is the sole
  POA for Property and Personal Care.
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ThinkGeriatrics, Inter-professional,
Inter-organizational Collaboration

• (cont.) Client remains capable for decision
  making and indicates that he wants to die at
  home, however daughter feels she cannot
  facilitate this as it is too costly and
  time-intensive. The client has been dating a
  fellow building tenant, whom he sought immediate
  companionship with following his wifes death 4
  years ago. Daughter has voiced concerns to the
  team Social Worker in the past around the lady
  friends inability to manage her fathers care
  needs and perhaps most importantly, administering
  medication. When Social Work initiated referrals
  to Meals on Wheels, CCAC Community Homemaking,
  Nursing and Social Work, the client refused entry
  to the care providers. Daughter is notably upset
  and states You cant let him die this way!.
  
  
• Who, Where and Why?
  
  
  
  Who is responsible? Who should be involved in
  this clients care? Why?
  How will this
  clients choices and values be respected?
  
  Who will advocate?
  
  
  Should all
  health care professionals be educated re
  Palliative Care? Why?
  What?
  
  
  
  What is the goal of care?
  
  
  What factors should be
  considered re clients wishes vs clients
  quality of life?
  
  What are the existing barriers to good practice?
  
  What
  challenges does this situation pose in working as
  a team?
  What would improve
  inter-agency working?
  
  What are the benefits of
  working as a team in palliative care?
  
  What are the challenges you face in
  your specific discipline related to caring for
  terminally ill patients?