Self-assessment Cases

Chapter 30 Palliative approaches to chronic obstructive pulmonary disease

A 60-year-old retired man with very severe chronic obstructive pulmonary disease (COPD) is admitted to the ward with an acute exacerbation of his COPD caused by a severe lower respiratory tract infection. He was diagnosed with COPD 6 years ago and has had three admissions to hospital over the past year due to repeat respiratory infections. The gentleman has attended the ward with his 62-year-old wife who is also retired and is his main caregiver. When they are at home, they live alone in a detached bungalow that has been adapted to meet the gentleman’s growing care needs. He receives long-term oxygen therapy at home due to increased breathlessness, and the healthcare professionals who have been involved in the care of this gentleman have acknowledged that he is in the palliative phase of his illness.

• 1. What is the relevance of knowing the gentleman’s social background?

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  Correct answer:
  In order to provide holistic, patient-centred palliative care, it is important that you get to know your patient and finding out about things such as the patient’s living situation that is important for discharge planning. An example of this would be finding out if the patient lives in a bungalow or a house with stairs, as they may require equipment to help them manage getting up the stairs due to increased breathlessness. It is also important as patients may require financial advice or support if their illness is affecting their finances.

• 2. What is the relevance of knowing his wife is his main caregiver?

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  Correct answer:
  An important part of palliative care is providing support to the patients’ family and informal caregivers alongside the patients. Therefore, it is important to recognise who the patients’ main caregiver is in order to assess their needs. This will also help in gaining a greater picture of how the patient is coping at home and what requirements they will have on discharge.

• 3. Should the pharmacological interventions used to treat this gentleman’s condition be reviewed?

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  Correct answer:
  Medications such as inhalers and nebulisers must be reviewed as this gentleman’s condition progresses. As this gentleman is in the palliative phase of his illness and is having repeat exacerbations, the treatment of his breathlessness and other symptoms should be reviewed in order to alleviate symptom burden.

• 4. Should a multi-disciplinary team approach be taken to this gentleman’s care?

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  Correct answer:
  A multi-disciplinary team approach to palliative care is essential in order to help maximise the care delivered to these patients, their family and their informal caregivers. The involvement of specialist palliative care teams should also be considered if this has not already been discussed.

• 5.What happens if the gentleman’s condition deteriorates?

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  Correct answer:
  The end-of-life care needs of this patient, his informal caregivers and his family should be considered.