A 39-year-old male with traumatic quadriparesis and stage IV pressure sores presents with pain, constipation, and urinary leakage, living with his elderly mother and facing financial hardships. His treatment history includes hospitalization after a fall, and he experiences significant emotional distress due to his condition and financial burden. Palliative care is deemed necessary, focusing on pain management, support for family dynamics, rehabilitation, and community involvement.

1. Name of Case Presenter : Dr Arjun D
Designation : Palliative Care Physician
Organizational Affiliation : Pallium India Trust
CASE PRESENTATION

2. PATIENT DETAILS
AGE: 39 GENDER: Male
DIAGNOSIS: Traumatic Quadriparesis with Stage IV pressure sore on sacral region and left
gluteal region

3. PRESENTING COMPLAINTS
 Constipation(2 day)
 Bed sore over sacral region and gluteal region
 Moderate pain over the hip region
 Urinary leakage.

4. HISTORY OF ILLNESS
 He had history of fall while carrying weight followed by neck pain and weakness of both
limbs and was diagnosed with Traumatic Quadriparesis in August 2015.
 Admitted and got treatment from one of the government hospital and discharged after
one month.
 After 6 month he developed a bed sore over the sacral and gluteal region (stage IV).
 History of pain over the hip and wound site for more than 2 weeks. Pain over the hip
region (5/10- intermittent burning type pain) B/L and wound site(4/10-continuous
throbbing type of pain) Due to this sometimes they keep the wound open.
 Disturbed sleeping pattern.
 Decreased oral intake.

5. EXAMINATION
• Conscious and oriented
• Temp: 98̊ F
• Pulse: 82 b/min
• Respiration: 20 breath/min
• BP: 120/70 mmHg
• Systems- WNL

6. Pressure Sores
● Warmth and tenderness
● Exudates present
● Tunneling present
● Irregular in shape
● Foul smelling

7. TREATMENT AND SIGNIFICANT INVESTIGATION
Routine Investigation done:
Routine investigations done
Hb-10 g, TC-34,000, P- 80%, L-18%, E-2% Platelet- 1.6 lakhs/microL,
Serum Creatinine-0.9 mg/dl, Serum Sodium -132 mg/dl, Potassium- 4 mg/dl

8. PSYCHOSOCIAL ASPECTS
• 39 year old unmarried man living with his 65 year old mother in a rented house.
• He has one siblings and he is married and living separately and not caring and
helping them
• He was a manual laborer and was the breadwinner his family.
• Now his mother is a manual laborer and she is taking care of him.
• Now the main source of income is from mother’s daily wages, her pension and some
of his friends.
• Have taken Rs.1.5 Lakhs from private finance bank for the treatment purpose.
• Devout Christian, now unable to go to Church , this makes him very sad.
• He communicates through cell phone.
• He says to his mother like, "I don’t think I can walk so please don’t spend money
over my treatment“.

9. MAIN CONCERN
 Pressure sore
 Pain
 Financial problems

10. SUMMARY
• 39 year old man with traumatic Quadripresis with bed sore present over
sacral and left gluteal region (stage IV) with pain over the hip region.

11. DISCUSSION POINTS (Points to be discussed in class based on the patient’s story)
 Do we need to provide palliative care for this patient?
 What are the problems faced by this patient?
 What all can be done for this patient and his mother?

12. ● Yes this patient needs Palliative care. We
can see the various aspects of his
suffering, not just physical, but emotional,
social and spiritual.
● The care should be delivered at his home.
● His mother needs support to take care of
him
● He needs rehabilitation support – both
physical and vocational
● His bed sore would ideally need a surgical
management which may not be possible
many a times. Then giving the best
possible care at home through the family
and community would be best
● Being a burden to mother, financial needs
to be taken care of – we can help him to
find meaning of being there even if he is
not as functional as before
● A good communication, follow up, support
from community are to be developed.
● Management of bed sores, communication
to patient and family, decision making
about treatment, community support
development will be dealt in upcoming
sessions

13. Dr Arjun D
Palliative Care Physician
Pallium India
THANK YOU