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Palliative and End-of-Life Pearls

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Overview

This addition to the popular Pearls SeriesĀ® 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.

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Product Details

  • ISBN-13: 9781560535003
  • Publisher: Elsevier Health Sciences
  • Publication date: 4/15/2002
  • Series: Pearls Series
  • Pages: 232
  • Product dimensions: 7.06 (w) x 10.00 (h) x 0.47 (d)

Meet the Author

Professor and Associate Dean, Department of Medicine, Medical University of South Carolina, Charleston, SC

Research Professor of Philosophy, The Practical Ethics Center, University of Montana, Missoula, MT

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Table of Contents

1 A 78-year-old man with a ruptured aortic aneurysm and unfinished business 1
2 A 62-year-old man with lymphoma who develops respiratory failure, renal failure, and hypotension after bone marrow transplantation 4
3 A 14-year-old boy with cystic fibrosis 8
4 A 78-year-old woman with severe pain at the end of life 11
5 A 67-year-old man with terminal cancer and a DNR order who needs a surgical procedure 14
6 A 55-year-old man with recurrent metastatic esophageal cancer who wants to "just go to sleep" until death occurs 18
7 A 10-year-old child on mechanical ventilation and pharmacologic paralysis whose parents request discontinuation of ventilator support 22
8 A 56-year-old ventilator-dependent man with a previously expressed wish to avoid prolonged mechanical ventilation 25
9 A 77-year-old woman who expresses a need to discuss her end-of-life care during a routine office visit 28
10 A 74-year-old man with non-small cell carcinoma who requests physician-assisted suicide 32
11 A 34-year-old woman with end-stage adenocarcinoma of the cervix with intractable neuropathic pain 35
12 A 62-year-old woman with a second cancer who has abandoned a belief in God 38
13 An 82-year-old woman is dying in the ICU and the team does not know how to withdraw curative care for her 41
14 A 75-year-old Aboriginal woman in the ICU with a large, protective family 44
15 A 60-year-old woman on chronic dialysis who cries out "Lord, please take me" 47
16 A 44-year-old woman who is coping with the death of her husband from pancreatic cancer 51
17 A 54-year-old man with amyotrophic lateral sclerosis and progressive shortness of breath 54
18 A 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 future 57
19 A 28-year-old woman dying with acute respiratory distress syndrome who needs palliative care in the ICU 61
20 A 65-year-old man with metastatic lung cancer and decreasing oral fluid intake during home hospice care 64
21 A 73-year-old woman with ovarian cancer who asks "Why me?" 67
22 A 78-year-old African-American man who is experiencing uncontrolled pain at the end of life 70
23 A 75-year-old man with a DNR order who requires transport to the radiology department for a procedure 73
24 A 64-year-old man with COPD and disabling dyspnea enters pulmonary rehabilitation contemplating euthanasia 76
25 An 89-year-old woman with advanced dementia, recurrent aspiration pneumonia, and weight loss needs a feeding tube? 79
26 A very elderly woman with acute respiratory failure 82
27 A 10-year-old boy with unmanageable aqueductal stenosis and unremitting severe pain 86
28 A 72-year-old man with pleural adenocarcinoma whose family requests that "everything be done" 89
29 A 49-year-old woman with metastatic breast cancer and acute respiratory distress syndrome who lacks decision-making capacity and a surrogate decision-maker 92
30 A 72-year-old woman with nonresectable lung cancer who is living alone 96
31 A 60-year-old seriously ill man with impaired mentation whose family and physician disagree over treatment plans 99
32 A 59-year-old woman with metastatic breast carcinoma complicated by anorexia/cachexia/fatigue syndrome 103
33 A 48-year-old woman with colon cancer who develops profound analgesia-induced sedation 105
34 A 64-year-old rural rancher with end-stage lung cancer and painful metastases 107
35 A 64-year-old man admitted to a CCU with an acute myocardial infarction and multiple end-stage medical conditions 110
36 A 65-year-old man with end-stage metastatic cancer who requests discontinuation of life-sustaining medical interventions 114
37 A 64-year-old man with COPD who accepts intubation and mechanical ventilation, but not indefinitely 117
38 A 65-year-old man with advanced cancer with nausea, vomiting, dyspnea, and dysphagia who desires home care 120
39 A 78-year-old woman intubated for COPD and lung cancer whose family states that she never wanted to be on a ventilator 124
40 A 56-year-old man in need of palliative care in anticipation of end-of-life distress 127
41 A 73-year-old woman with multiorgan failure and a contentious, divided family 130
42 A 26-month-old child with severe developmental abnormalities, hydrocephalus, and recurrent ventricular shunt infections 133
43 A 73-year-old man with a subdural hematoma and poor prognosis based on an ICU scoring system 136
44 A 68-year-old woman with respiratory failure who requests in writing to "end it now" 139
45 A 36-year-old African-American mother with terminal AIDS 142
46 A 46-year-old African-American man with widely metastatic cancer who "will fight for his life till the end" 145
47 A 33-year-old man with active substance abuse and metastatic colon cancer who requires analgesia for pain control 148
48 A 500-g preterm infant born to parents who must make decisions about life-supportive care 151
49 A 54-year-old man with intractable heart failure who transitions to palliative care in the ICU 155
50 A 78-year-old man who is unconscious and ventilator-dependent after a stroke with a family that requests transfer of care 158
51 A 52-year-old woman with metastatic cancer who asks, "How does a Jewish person die?" 162
52 A 74-year-old man with acute respiratory failure who has not had prior discussions with his family about life-supportive care 165
53 A 4-year-old boy with fulminant hepatitis whose "terminal" course is altered by liver transplantation 168
54 A 58-year-old woman with ovarian cancer who requests physician-assisted suicide 171
55 A 38-year-old man with a secondary leukemia who needs setting of goals of care 174
56 An 83-year-old woman with acute respiratory failure and a do-not-intubate status whose daughter requests noninvasive ventilation 177
57 A 68-year-old woman with metastatic cancer and severe pain who cannot tolerate oral medications 180
58 A 72-year-old man with end-stage COPD and retained secretions 183
59 A 66-year-old Mexican man with severe dyspnea due to pulmonary fibrosis who says, "Doctor, ayudeme, que no puedo respirar" 186
60 A 78-year-old man with end-stage lung disease who requests aggressive, life-sustaining care 189
61 A 48-year-old man with metastatic cancer who has not yet recognized the terminal nature of his disease 192
62 A 52-year-old man whose family and physicians cannot agree on continuing life-supportive care 195
63 A 73-year-old man who fears suffocating yet requests withdrawal of life-supportive care 198
64 A 43-year-man with squamous cell carcinoma of the face causing pain that is intermittently responsive to opioids 202
65 A 68-year-old man with severe COPD who wishes to forego further invasive treatment but whose children wish to continue aggressive care 205
66 A 54-year-old woman with severe pain from metastatic cancer whose needs exceed a hospital's palliative care resources 208
67 An 80-year-old man in respiratory failure who repeatedly removes catheters and tubes 212
68 A 73-year-old man with a history of stroke, COPD, and arterial insufficiency of the leg whose son requests discussion of end-of-life care 216
69 A 56-year-old woman with metastatic breast cancer and new hypercalcemia admitted to a hospitalist 219
70 A 60-year-old man admitted to the ICU with metastatic mesothelioma whose son demands continued aggressive life-supportive care 222
71 A 35-year-old man with end-stage cystic fibrosis who wants to know if completing an advance directive is important 225
Index 229
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