Mr. Termine
Mr Termine is a 76-year-old man with Stage IV lung cancer with metastases to his ribs. All chemo options have been stopped. His only medication is two tabs of acetaminophen 325/oxycodone 5 every four hours. At this point, he spends almost all day in bed, taking sips of water only. His daughter – his only care-giver – is exhausted.
- Watch the video below and answer the questions that follow.
- What issues do Mr. Termine and his daughter identify that you can address in the ED?
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This is a patient who wants to be at home and has come to the ED looking for support to do so. This is a situation where the Emerg physician is being called on to provide basic palliative medicine interventions.
As you work through this module, you will develop skills in all of these areas.
Discussion: Mr. Termine
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ok
ok
ok
ok
yes yes
sure
yes
ok
ok
Pain management
Administer stool softener as/if prescribed
Assess caregiver role strain in order to identify supportive resources
Identify patient and family goals
yes
oj
symptom management will improve quality of life
ok
Agree.
ok
Ok
ok
.
.
I guess we all agree as to the care plan
.
Daughter needs support and respite.
Get the family help.
ok
the family needs palliative support
team approach to care
take care of presenting symptoms in terms of priority
palliative care
Client’s goal is to return home with better symptom control. In order to achieve his goal of going home the daughter will need increased support – palliative home care referral may be warranted.
Priority is patient’s goals of care rather than the disease.
= symptom relief,and support for the daughter and discharge
okay
ok
care giver needs to take a break and he needs more pain meds
yes
Needs a laxative, consider options for home release.
support
caregiver burden-frequently underestimated
interesting video
caregiver burnout. recommend respite care
agreed
interesting
agree
agree
agree
these concerns are shared by the majority of terminal patients at some point
Opiates without stool softeners can be bad news
..
noted that he is not on any medications other than paracetamol.
I would negotiate with him for some analgesia with symptomatic treatment for nausea and constipation. I will also offer him Pastoral care if he agrees to it. I f inclined with iffer THC to take care of nausea
Counselling early grief counselling to daughter
A discussion of palliative care options would be helpful at this time
Ok
noted
agree
agree
Treating the patient as a whole and treating the family members as well
excellent point of view
hay que tratar de abordar al paciente en forma integral
El cuidador nunca se toma en cuenta
yy
🙂
She needs help
learny
xx
cc
the family needs palliative care support
Who put him on an opioid but no laxative?
The concern to me is if the dtr will be able to support her father to the end even with supports, She probabily has her own fears of seeing a love one die
I guess we all agree as to the care plan