Palliative and End-of-Life Pearls

Palliative and End-of-Life Pearls

by John E. Heffner, Ira Byock

ISBN-10: 1560535008

ISBN-13: 9781560535003

Pub. Date: 04/15/2002

Publisher: Elsevier Health Sciences

This addition to the popular Pearls Series® presents 71 case presentations of clinical interest related to end-of-life and palliative care for both hospitalized patients and patients receiving home care. The patient vignettes highlight considerations of pain and symptom management at the end of life, ethical issues related to life-supportive care, and

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This addition to the popular Pearls Series® presents 71 case presentations of clinical interest related to end-of-life and palliative care for both hospitalized patients and patients receiving home care. The patient vignettes highlight considerations of pain and symptom management at the end of life, ethical issues related to life-supportive care, and approaches to assisting patients and families with the difficulties that surround death and dying.

Product Details

Elsevier Health Sciences
Publication date:
Pearls Series
Product dimensions:
7.06(w) x 10.00(h) x 0.47(d)

Related Subjects

Table of Contents

1A 78-year-old man with a ruptured aortic aneurysm and unfinished business1
2A 62-year-old man with lymphoma who develops respiratory failure, renal failure, and hypotension after bone marrow transplantation4
3A 14-year-old boy with cystic fibrosis8
4A 78-year-old woman with severe pain at the end of life11
5A 67-year-old man with terminal cancer and a DNR order who needs a surgical procedure14
6A 55-year-old man with recurrent metastatic esophageal cancer who wants to "just go to sleep" until death occurs18
7A 10-year-old child on mechanical ventilation and pharmacologic paralysis whose parents request discontinuation of ventilator support22
8A 56-year-old ventilator-dependent man with a previously expressed wish to avoid prolonged mechanical ventilation25
9A 77-year-old woman who expresses a need to discuss her end-of-life care during a routine office visit28
10A 74-year-old man with non-small cell carcinoma who requests physician-assisted suicide32
11A 34-year-old woman with end-stage adenocarcinoma of the cervix with intractable neuropathic pain35
12A 62-year-old woman with a second cancer who has abandoned a belief in God38
13An 82-year-old woman is dying in the ICU and the team does not know how to withdraw curative care for her41
14A 75-year-old Aboriginal woman in the ICU with a large, protective family44
15A 60-year-old woman on chronic dialysis who cries out "Lord, please take me"47
16A 44-year-old woman who is coping with the death of her husband from pancreatic cancer51
17A 54-year-old man with amyotrophic lateral sclerosis and progressive shortness of breath54
18A 32-year-old male medical student with a large yolk sac tumor in his chest requests assistance in dying if his suffering becomes unbearable in the future57
19A 28-year-old woman dying with acute respiratory distress syndrome who needs palliative care in the ICU61
20A 65-year-old man with metastatic lung cancer and decreasing oral fluid intake during home hospice care64
21A 73-year-old woman with ovarian cancer who asks "Why me?"67
22A 78-year-old African-American man who is experiencing uncontrolled pain at the end of life70
23A 75-year-old man with a DNR order who requires transport to the radiology department for a procedure73
24A 64-year-old man with COPD and disabling dyspnea enters pulmonary rehabilitation contemplating euthanasia76
25An 89-year-old woman with advanced dementia, recurrent aspiration pneumonia, and weight loss needs a feeding tube?79
26A very elderly woman with acute respiratory failure82
27A 10-year-old boy with unmanageable aqueductal stenosis and unremitting severe pain86
28A 72-year-old man with pleural adenocarcinoma whose family requests that "everything be done"89
29A 49-year-old woman with metastatic breast cancer and acute respiratory distress syndrome who lacks decision-making capacity and a surrogate decision-maker92
30A 72-year-old woman with nonresectable lung cancer who is living alone96
31A 60-year-old seriously ill man with impaired mentation whose family and physician disagree over treatment plans99
32A 59-year-old woman with metastatic breast carcinoma complicated by anorexia/cachexia/fatigue syndrome103
33A 48-year-old woman with colon cancer who develops profound analgesia-induced sedation105
34A 64-year-old rural rancher with end-stage lung cancer and painful metastases107
35A 64-year-old man admitted to a CCU with an acute myocardial infarction and multiple end-stage medical conditions110
36A 65-year-old man with end-stage metastatic cancer who requests discontinuation of life-sustaining medical interventions114
37A 64-year-old man with COPD who accepts intubation and mechanical ventilation, but not indefinitely117
38A 65-year-old man with advanced cancer with nausea, vomiting, dyspnea, and dysphagia who desires home care120
39A 78-year-old woman intubated for COPD and lung cancer whose family states that she never wanted to be on a ventilator124
40A 56-year-old man in need of palliative care in anticipation of end-of-life distress127
41A 73-year-old woman with multiorgan failure and a contentious, divided family130
42A 26-month-old child with severe developmental abnormalities, hydrocephalus, and recurrent ventricular shunt infections133
43A 73-year-old man with a subdural hematoma and poor prognosis based on an ICU scoring system136
44A 68-year-old woman with respiratory failure who requests in writing to "end it now"139
45A 36-year-old African-American mother with terminal AIDS142
46A 46-year-old African-American man with widely metastatic cancer who "will fight for his life till the end"145
47A 33-year-old man with active substance abuse and metastatic colon cancer who requires analgesia for pain control148
48A 500-g preterm infant born to parents who must make decisions about life-supportive care151
49A 54-year-old man with intractable heart failure who transitions to palliative care in the ICU155
50A 78-year-old man who is unconscious and ventilator-dependent after a stroke with a family that requests transfer of care158
51A 52-year-old woman with metastatic cancer who asks, "How does a Jewish person die?"162
52A 74-year-old man with acute respiratory failure who has not had prior discussions with his family about life-supportive care165
53A 4-year-old boy with fulminant hepatitis whose "terminal" course is altered by liver transplantation168
54A 58-year-old woman with ovarian cancer who requests physician-assisted suicide171
55A 38-year-old man with a secondary leukemia who needs setting of goals of care174
56An 83-year-old woman with acute respiratory failure and a do-not-intubate status whose daughter requests noninvasive ventilation177
57A 68-year-old woman with metastatic cancer and severe pain who cannot tolerate oral medications180
58A 72-year-old man with end-stage COPD and retained secretions183
59A 66-year-old Mexican man with severe dyspnea due to pulmonary fibrosis who says, "Doctor, ayudeme, que no puedo respirar"186
60A 78-year-old man with end-stage lung disease who requests aggressive, life-sustaining care189
61A 48-year-old man with metastatic cancer who has not yet recognized the terminal nature of his disease192
62A 52-year-old man whose family and physicians cannot agree on continuing life-supportive care195
63A 73-year-old man who fears suffocating yet requests withdrawal of life-supportive care198
64A 43-year-man with squamous cell carcinoma of the face causing pain that is intermittently responsive to opioids202
65A 68-year-old man with severe COPD who wishes to forego further invasive treatment but whose children wish to continue aggressive care205
66A 54-year-old woman with severe pain from metastatic cancer whose needs exceed a hospital's palliative care resources208
67An 80-year-old man in respiratory failure who repeatedly removes catheters and tubes212
68A 73-year-old man with a history of stroke, COPD, and arterial insufficiency of the leg whose son requests discussion of end-of-life care216
69A 56-year-old woman with metastatic breast cancer and new hypercalcemia admitted to a hospitalist219
70A 60-year-old man admitted to the ICU with metastatic mesothelioma whose son demands continued aggressive life-supportive care222
71A 35-year-old man with end-stage cystic fibrosis who wants to know if completing an advance directive is important225

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