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Breathlessess - the patient management journey

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Breathlessess - the patient management journey

  1. 1. DISCLAIMER: The views and opinions expressed in this presentation are those of the authors and do not necessarily represent the views and policy of PLAN(Pan London Airways Network).
  2. 2. PATIENT BACKGROUND  74-year-old gentleman with end stage COPD  Persistent and progressive breathlessness  Lives in a 2 story house  Wife passed away 2 years ago in hospital  Christian man with strong family support but don’t live with him  He has 2 grandchildren whom he adores  Being able to play football with his grandchildren is a priority  Most important time of the year for him is Christmas
  3. 3. MEDICAL HISTORY  x 3 acute admissions in 6 months  Pulmonary hypertension  On optimal medical treatment  Fluid retention-bilateral leg oedema  On 1L oxygen at rest, 2L ambulatory oxygen  Coughing fits  Anxiety  No end of life discussion whilst in hospital
  4. 4. MEDICAL INTERVENTIONS  Oramorph  Lorazepam  Oxygen  Diuretics  Maintenance prednisolone 10mg  Exacerbation management  Dietary management  Advance care planning
  5. 5. NON-MEDICAL INTERVENTION  Breathing technique focusing on expiration  Fan therapy  Positioning  Pacing  Home Pulmonary Rehab  Palliative Rehab Group e.g St. Luke’s ,St. John’s, St. (Moving Forwards Rehab Group STJH )  ICon STJH or equivalent  Micro environment options – with caution
  6. 6. NON-MEDICAL INTERVENTIONS CONTINUED….  Psychological support  Help to fulfill role as a grand-father  Care support/friends  Christian family involvement-mass  Giving him choice and help to fulfill goals where possible: Christmas  Befriending referral  Community palliative care team support if approaching the end of life
  7. 7. ADVANCE CARE PLANNING  “A voluntary process of discussion and review to help and individual who has capacity to anticipate how their condition may affect them in the future and, if the wish, set on record choices relating to their care or treatment so that these can then be referred to by their carers (whether professional or family carers) in the event that they lose capacity to decide once their illness progresses” • DoH (2011) Capacity, Care planning and Advance Care Planning in life limiting illness – a guide for health and social care staff  Issues commonly included  Preferred place of care  Ceilings of treatment  Admission to hospital/hospice  Preferred place of death  DNACPR  Symptom control
  8. 8. You can’t change the pathology You CAN change quality You CAN help people to live alongside breathlessness

Editor's Notes

  • Micro environment for me would be last resort. More about setting yourself up for resting and pacing. I would be concerned about reducing potential for functional tasks thus reducing mobility, tolerance stamina and then respiratory function by default

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