This document discusses the medical history and care plan for a 74-year-old man with end-stage COPD. He has been hospitalized three times in the past six months and is on maximum medical treatment. His priorities are spending time with his grandchildren and celebrating Christmas. The care plan involves medical interventions like medications and oxygen as well as non-medical support through pulmonary rehab, psychological support, and helping him fulfill his goals. The document also discusses the importance of advance care planning to ensure his preferences are followed as his illness progresses.

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. 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. 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. MEDICAL INTERVENTIONS
 Oramorph
 Lorazepam
 Oxygen
 Diuretics
 Maintenance prednisolone 10mg
 Exacerbation management
 Dietary management
 Advance care planning

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. 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. 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. You can’t change the pathology
You CAN change quality
You CAN help people to live alongside breathlessness