GrandMantisPerson533
History Geoff Holder, a 52 year-old owner/operator of a pest…
History
Geoff Holder, a 52 year-old owner/operator of a pest control franchise, has been admitted to the
medical ward. He was admitted from home via the emergency department and arrived on the ward at
0200hrs this morning.
Geoff has a history of Diabetes Mellitus Type II which has been previously well controlled by diet and
exercise. He was diagnosed with pancreatic cancer six months ago and underwent a Whipple’s
procedure with initially good outcomes. Geoff lives at home with his wife and eight year old son: his
daughter from a previous marriage lives with Geoff’s ex-wife and attends university, studying
education. Geoff has increased contact with his daughter since his diagnosis and she has dinner /
visits with his family at least once a week.
Geoff’s father died aged fifty in hospital from liver cancer, after a history of heavy alcohol and
cigarette use. Geoff was twenty years old and recalls him experiencing significant pain before he
died. Geoff’s mother has dementia and has lived in a residential dementia unit for two years. Geoff
has limited contact with his only sibling, a brother who lives in Perth.
Since his diagnosis of pancreatic cancer six months ago and after his Whipples procedure which
initially was successful Geoff was able to continue working from home, but now is extremely fatigued,
cannot undertake activities of daily living and has increased pain, his diabetes is also now not well
controlled.
He presented to the emergency department at 1800hrs for pain control and reluctantly consented to
admission for review by the palliative care team today. He has not accepted community services,
including community palliative care services, to date.
His medications from home (Ordine) have been brought in and are locked in the controlled drugs
cupboard. He has an Acute Resuscitation Plan and is not for active resuscitation. His care has been
managed by the GP since his discharge after the Whipple’s procedure.
Since being on the ward he has had two episodes of break through pain (9/10) that he was given oral
analgesia for, the first at 0230hrs of 5 mg of Ordine and another 5mg of Ordine at 0500hrs. This
reduced his pain to a score of 4/10, but the pain continues to worsen. He says his pain score goal is
to remain below 3/10. He has been too fatigued to mobilise to the toilet. His blood sugar level was
8.2mmol/L at 0600 hrs, and this is being checked three times daily.
He is for review by the palliative care team later in the day.
Vital signs: T 37.2, BP 108/70, P 110/regular, R 16, SpO2 98% on room air
Position supine, bed head at 45° and pillow propped behind right shoulder to lift him slightly
ID Band (UR: 106425, Geoffrey Ray HOLDER, 10 Luca Street, Brighton. DOB: 07.02.1960, Male)
Medications as per the medication chart are
Ordine (Morphine Sulphate) 1mg/1ml – order for 2.5-5mg PRN by Dr Mitchell
MS Contin SR 5mg tablets
Q1. Identify and document the ethical concerns that may arise from Geoff’s case study.
Q2. Document 3 points that you would reflect on during a debriefing session regarding the care of this patient.
