2. SUMMARY OF ILLNESS
57/ male Chandra Bdr. Gurung k/c/o
HTN since 9 years not under
medication.
h/o cardiac attack 7 years ago and
brought to Lamjung Hospital
Lamjung. Then he was refered with
all signs and symptoms to teaching
hospital for further management.
3. SUMMARY OF ILLNESS
From last 4 month he was
completely bedridden . Again
brought to LHL and managed
symptomatically then
discharged.
Last 2 month he started
developing bed sore in multiple
area( sacral area b/l feet)
Again brought to LHL
4. WHAT DOES PATIENT UNDERSTANDS
ABOUT HIS ILLNESS?
PATIENT KNOWS HE IS A COMPLETE QUADRIPLEGIC and
experiences pain over sacral region.
He thinks his illness wont be cured and he will die of this
disease one day.
6. Emotional/spiritual issues
He was emotionally in sadness and helplessness.
He also stated the grief of loss of his previous level of
function and independence.
He has started feeling of burden to his family members.
7. Social Issues
His mobility and freedom is totally limited due to quadriplegic
He is dependent on his family members for activity of living
which has impacted his overall quality of life
His potential isolation & restriction from social interaction at
home has greatly affected his mental health.
There is significant stress to caregiver due to need of constant
assistance leading to care giver burnout.
Their financial status has greatly impacted during his
treatment course.
10. Neurological symptoms:
Complete quadriplegic
Pressure sores
Grade III infected , foul smelling pressure sores.
Mental Burden
He feels due to his condn of requiring constant
assistance, his family members feel burnout to him.
12. Medical indication
We tried collaboration with palliative care
specialist at GP hospital for management of case but
the patient party declined.
So we admitted the patient , started on antibiotics
and did daily dressing with metronidazole crust and
hydrogen peroxide.
Took him to OT and did debridement under IVA.
13. Quality of life
Provided counselling to the patient
Educated caregiver about proper management of
bedsore at home
Initiated open and ongoing communication with
family members about prognosis , treatment and
end of life preference.
14. Patient choice
We acknowledged and respected patient current
desire and addressed to his family members
We respected the choice of patient not to go to GP
hospital for further treatment
15. Context
His treatment cost during the hospital was covered by
insurance
We discharged him with all the materials necessary for
pressure sore care for 1 month.
We also had a talk with Dr. Dan if it is possible from SUNITA
PROJECT to provide him with foam mattress
We respected patient condition and gave assurances to the
family that we are always there for you when you need us.
