Your small team case analysis will Include. 1 medical indications (part 1) 2 patient preferences (part 1) Segment 1 will include analysis of medical indications and patient preferences.
Medical Indications
Case 9 (2nd ed)/Case 6 (1st ed)
67 yo woman
Presenting problem/s (PP): Sepsis, probably caused by entero-bacteria passing through portions of the colon wall weakened by the CA
Medical history (Hx):
Non-resectable (i.e., inoperable) colon cancer since 6 mo ago
Recurrent episodes of sepsis
Signs/Symptoms (S/S) on admission:
Generalized edema (swelling)
Emaciated appearance/wasting
Skin excoriations (abrasions)
Paralysis of lower extremities; limited movement of upper extremities
Diagnoses (Dx):
Sepsis
Colon CA
“Spinal disease”
Characterization of condition(s):
The colon CA is “terminal” in the general sense of causing death.
The recurrent episodes of sepsis are critical and possibly end-stage terminal.
Initial goal(s) of care
Note: Goals of medical care should not be confused with patient preferences for care; the goals of care are what medicine could reasonably hope to accomplish in terms of benefit and avoidance of iatrogenic (i.e. health care caused) harms.
Providing relief and support near time of death
Avoidance of harm to the patient in the course of care
Education and counseling of patient re her condition and prognosis
Or
Prolongation of life
Maintenance of quality of life through relief of pain and suffering
Maintenance of compromised status
Education and counseling of patient and family re her condition and prognosis
After 3 days:
New Signs/Symptoms (S/S):
Acute shortness of breath
Acute GI bleed
Lethargy
Confusion
New Diagnosis (Dx):
Either CHF (Congestive Heart Failure) or a PE (Pulmonary Embolism)
Note that “differential diagnosis” means that the diagnosis is either one or the other.
After transfer from the ICU to the step-down unit:
New Signs/Symptoms (S/S):
Intermittently improved mental status
Abdominal pain
Signs and Symptoms (S/S) over several days:
Declining awareness, frequent disorientation and unconsciousness
Pleural effusion
Atrial arrhythmia
Severe hypotension, refractory to intervention
Anuria
Massive generalized edema
Oozing serous fluid from skin and puncture sites
Fixed and dilated pupils
New Diagnosis (Dx):
Possible metastasis to brain
Later, possible “brain death”; permanent loss of higher brain function
Prognosis (Prx):
Pt is actively and irreversibly dying and any intervention will only prolong life a short while
Goals of treatment
Note: Goals of medical care should not be confused with patient preferences for care; the goals of care are what medicine could reasonably hope to accomplish in terms of benefit and avoidance of iatrogenic (i.e. health care caused) harms.
Allow natural death; because the pt has lost higher brain function, the patient can no longer experience pain or its relief, so “relief and support” is not an attainable goal.
Education and counseling of patient re her condition and prognosis
