2023 April Coffee Chat-Case Study

Case Study

Pdf Summary

This case study discusses a 66-year-old retired male who has been diagnosed with chronic respiratory failure, Parkinson's disease, dysphagia, interstitial lung disease, recurrent aspiration pneumonia, and CLL. The patient also experiences chronic pain, describing it as never-ending headaches and joint pain throughout his body, as well as back pain. He has been prescribed high doses of Oxycodone for his pain, but sometimes takes it more often or doubles the dose. The patient expresses concern that hospice will stop his medication. <br /><br />During the RN assessment, the patient reports being out of Oxycodone and Valium and expresses a desire to be pain-free and not suffer anymore. He agrees to have his PCP speak with the hospice medical director about his pain medication. The patient is not eating much, consuming only 0-25% of meals, and has lost 25 pounds over 6 months. He has been sleeping more and exhibits symptoms such as cachexia, dyspnea at rest, pursed lip breathing, diminished lung sounds, tremors, weakness, and unsteadiness. The patient uses oxygen at 6-9 L/NC daily, with saturation levels dropping below 60 when not using it.<br /><br />In the first week of hospice, the patient goes through a 7-day supply of medication in 3 days and depletes the morphine from the comfort pack, claiming it was dropped by the visiting nurse. He then receives a daily delivery of six days worth of medication, but reports that it is less than what was prescribed. The patient complains about the lack of pain control and requests a dose escalation. He refuses a trial with buprenorphine and there is consideration of switching him to methadone.

Keywords

chronic respiratory failure

Parkinson's disease

dysphagia

interstitial lung disease

recurrent aspiration pneumonia

CLL

chronic pain

Oxycodone

hospice

medication