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Bob is a 45 year old Accountant who has been admitted to the local medical ward with a history of increasing breathlessness and jaundice. He had been diagnosed with end stage liver disease three months previously.
Susan, Bob’s wife is 35 years old and is 7 months pregnant with her first child. This is Bob’s second marriage and his two sons (aged 18 and 10 years) from his first marriage live with their mother.
Due to his history of alcohol abuse in the past Bob has limited contact with his sons. Also his employers in the past years have been unhappy with his work performance which has resulted in several meetings with him. One hour following admission, Bob has a large haematemesis.
The process of undertaking an holistic needs assessment:
Identifies people who need help. Patients who have had liver disease for a long period of time may have already discussed this with their families. End-of-life discussions can be very difficult, particularly depending upon the underlying cause of the liver disease. There may be unresolved anger or fear in the family of a patient who developed cirrhosis because of alcohol ingestion, drug use, or viral hepatitis, for example. In this case Bob has a history of alcohol abuse and due to this Bob has limited contact with his sons from his previous marriage. Bob may feel isolated as he might not want to tell his sons that he has the disease as this may cause more stress and anger within the family and Bob himself.
Provides an opportunity for the person to think through their needs and, together with their healthcare professional, to make a plan about how to best meet these.
End-stage liver disease is irreversible without a liver transplant. If a patient is not a candidate for transplantation, end-of-life issues must be addressed with the patient and family, especially if a life-threatening complication or a sudden decomposition of liver function develops. Bob is due to be a father and if he is not a candidate for a transplant then end of life issues should be addressed. Health professionals should reassure Bob and provide additional support from the appropriate team for example mental health professionals to assess Bob’s mental state.
Helps people to self manage their condition. Educating Bob regarding recent diagnose of end stage liver disease to reassure and make him aware of care/treatment/interventions that will be carried out. Good communication skills are vital in this situation so that Bob fully understands the diagnosis.
Helps teams to target support and care efforts and work more efficiently by making appropriate and informed decisions. Health care professionals have the responsibility to ensure that Bob has the correct information and knowledge to enable him to make the most appropriate decisions regarding his day to day life in regards to his work life. Promoting rest is essential so that Bob maintains
As well as considering all the above it is important to assess the patients activities of daily living as Bob may find these difficult to achieve alone.
Liver disease is the only major cause of death still increasing year-on-year 1
Bob like many others have a history of alcohol abuse. In 2010 the average number of daily units drunk by a male Bobs age was between 4-8 daily which estimates if drinking the 8units daily to 56 over the scale of a week compared to the recommended intake of 21units per week for a male.
16,087 people in the UK died from liver disease in 2008 2 , a 4.5% increase since 2007, this includes 1,903 in Scotland .
Liver disease kills more people than diabetes and road deaths combined
In Scotland, in 2007/8 there was a 400% increase in patients discharged from hospital with alcoholic liver disease (6,817) compared to 1996. 7 In 2006-7, 1,094 children aged under 18 were admitted to hospital with an alcohol-related diagnosis. Treatment for alcohol related problems in Scotland costs over £1m a day.