Date (mm-dd-yyyy): 10/13/19

Section of Supportive Hospice and Palliative Medicine

Department of Family and Community Medicine
University of the Philippines – Philippine General Hospital

Name: JOSE MAYO V. VIRAY Contact Number: 0916 407 6687 Email Address: jvviray@up.edu.ph Period/Month of SHPM Rotation: 09/30/19 – 10/13/19
Institution/Hospital: PGH Department: DFCM Fellow F / Resident R / Student S: S Year in Training: LEARNING UNIT VI

SHPM Consultants:
AA – Ang, ABC – Bausa-Claudio, KEG – Estepa-Garcia, MM – Medina, RR – Rosario, MU – Umali
Intent of Management and Care:
CPC – Curative plus Palliative Care, HC – Hospice Care, TC – Terminal Care
Reason/s for Referral:
SC – Symptom Control, PE – Psycho-emotional support, FS – Family and Social support, S – Spiritual support, D – Disclosure, AP – Advance Care Planning, HP – Home Care Preparation, HV – Home Visit, TB – Terminal and Bereavement Care

PATIENTS WITH FINAL DISPOSITION (As of October 13, 2019)

Intent of
SHPM Date Date Family Reason/s for Date Date
Location First Middle Age Sex Diagnosis upon Referral Management SHPM Assessment and Management
Consultant Admitted Referred Name Referral Discharged Expired
and Care
RR 07/30/19 08/02/19 W1 B18 Roxas Cesar Martin 71 M Acute respiratory failure from CPC SC A> Maintained 10/10/19
septic shock secondary to CAP- PE
HR, resolving, and infected P> - Continue best hospice and palliative
sacral decubitus ulcer care
Multiple chronic CVD infarcts - Ensure adequate symptom control
With right-sided residuals - built rapport with the family
Anemia - introduced myself as part of the team
Presumptive TB - Rendered psycho-emotional support to
Sacral decubitus ulcer, grade IV, eldest daughter
infected - Rendered anticipatory bereavement care
s/p tracheostomy and counselling

Will follow-up patient

RR 09/21/19 09/23/19 W2 B8 Culla Reynaldo 74 M Complete gut obstruction CPC SC A> Sigmoid adenocarcinoma 10/05/19
Secondary to stromal mass PE s/p laparotomy, double bowel ileostomy
Probably malignant FS (09/21/19)
s/p laparotomy, double barrel sacral decubitus ulcer, Grade 1
ileostomy (09/21/19)
P> SHPM Intervention:
- full disclosure of diagnosis and prognosis
- psycho-emotional support rendered to
patient and caregiver
- advised bed turning every 2 hrs
- suggest to procure egg crate mattress
- t/s Calmoseptine ointment on affected
area TID
- patient was advised wound care of SDU
and care of ileostomy
- patient was advised for homecare
preparation
- advised proper nutrition and physical
activity
- advised about importance of follow-up
consults and maintenance medications
- patient and family was rendered with
psycho-emotional support
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RR 09/12/19 10/04/19 NICU B1 Alinsunurin Pedro Gadaingan 56 M Chronic CVD infarct CPC SC A> maintained 10/07/19
Pontomesencephalic tegmentum, PE
Neuro Left FS P> - Issues and problem identified
Ward B3 Occipital and thalamic - psycho-emotional counselling done with
primary caregiver
- noted plans for tracheostomy
- family was advised to procure the
following prior to discharge:
1. improvised hospital bed
2. egg rate mattress
3. O2 tank with gauge
4. suction machine
- continue present management
- continue best supportive care for now
RR 09/25/19 10/04/19 NICU B4 Ardeno Remedios Escander 79 F Subacute SAH CPC SC A> Maintained 10/08/19
Hospital acquired pneumonia PE
In Acute respiratory failure FS P> Noted and agreeing with current plan
Sepsis from Gram negative and management
1) bacteremia
2) urinary tract infection SHPM Intervention
- established rapport and introduced SHPM
to family
- ensure adequate symptom control
- eldest daughter appraised regarding
prognosis of patient
- discussed with daughter the goals care for
our patient
- rendered PE support to daughter
- advised daughter about proper NGT
feeding and prevention of bed sores
- provide palliative care and help optimize
condition
- reviewed advanced directives
- anticipatory bereavement care and
counselling done
- refer to Chaplain if not yet done
RR 09/21/19 09/23/19 Ward 2 Benaso Roberto 61 M Sepsis from CAUTI, r/o SBP CPC SC A> Maintained 10/09/19
Bed 8 Hypertensive episode, resolved FS
Encephalopathy secondary to P> Established rapport and introduced
1) sepsis 2) hepatic SHPM to patient and family
AKI secondary to 1) renal Discussed with family the goals of care
hypoperfusion 2) sepsis Patient’s family decided not to disclose the
t/c GO from extrinsic diagnosis and prognosis to patient
compression from liver mass Reviewed advance care directives
Decompensated chronic liver Refer to Chaplain if not yet done
disease,
1) Chronic hepatitis 2) Alcoholic Take Home Meds
liver disease TDL 50 mg every 6 hours for pain
Liver mass t/c HCCA HNBB 50 mg every 8 hours for abdominal
pain

Follow-up at RM 304 SHPM OPD Clinic

October 14, 2019 (Monday, 8-5 PM)

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ADMITTED PATIENTS (As of October 13, 2019)

Intent of
SHPM Date Date Reason/s for Date Date
Location Family Name First Middle Age Sex Diagnosis upon Referral Management and SHPM Assessment and Management
Consultant Admitted Referred Referral Discharged Expired
Care
MU 08/14/19 09/06/19 Palliative Pongos Hanna Marie Alcontin 8 F Brainstem glioma with cerebellar extension CPC SC A> maintained Still
Care Unit Obstructive hydrocephalus, resolved PE admitted
S/pp VPS insertion (9/8/19, PGH) FS P> Facilitated admission to palliative care
S/p RT x 6 days (6th day 9/30) unit under the service of Dr. Umali (Service
Acute symptomatic seizure in status epilepticus, resolced consultant)
Central microbial keratitis, OU Secured consent for admission and
Nosocomial pneumonia (9/17/19), resolved management
Monitor VS every 4 hours and rounds
Noted and agreeing with present
management of co-managing service

SHPM Intervention
ensure adequate symptom control
advised mother about proper NGT feeding
and prevention of bed sores
provide palliative care and help optimize
condition
MU 08/19/19 10/10/19 Ward 9 Obibe Rose Ann 10 F Bacteria vs TB HC SC A> Maintained Still
Bed 32 acute symptomatic seizure in status epilepticus, resolved, PE admitted
probably from P> noted and agreeing with current plan
Ward 11 1) t/c viral encephalitis 2) t/c MELAS (Mitochondrial and management
Bed 16 Encephalopathy, Lactic acidosis, and Stroke-like episodes 3)
t/c Neuronal ceroid lipofuscinosis SHPM Intervention
- established rapport and introduced SHPM
to family
- ensure adequate symptom control, while
waiting for results of diagnostics and final
assessment
- rendered PE support to mother
- advised mother about proper NGT
feeding and prevention of bed sores
- provide palliative care and help optimize
condition

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OUT-PATIENT AND HOME VISIT PATIENTS

SHPM Date Date Intent of Management Reason/s for Date Date

Location Family Name First Middle Age Sex Diagnosis upon Referral SHPM Assessment and Management
Consultant Admitted Referred and Care Referral Discharged Expired
MU OPD 10/02/19 SHPM OPD Santos Regene 24 F Known case of papillary renal cell HC SC A> Maintained
Clinic carcinoma PE
s/p tumor excision (2018) FS P> SHPM Intervention
Lost to follow up for - ensure adequate symptom control
chemotherapy - rendered PE support to caregivers
- advised caregivers about adequate and appropriate feeding
- provide palliative care and help optimize condition

Medications
Fentanyl patch
- 25 mg patch, 50 mg patch
Oxycodone 10 mg/tab
- 1 tab every 8 hours
Fentanyl 100 mcg/tab
- 1 tab every 2 hours SL
Pregabalin 75 mg/tab
- 1 tab every 8 hours
Paracetamol 500 mg/tab
- 1 tab every 8 hours
KEG Home 10/04/19 Baclaran, Nolasco Leticia 80 F Hypertension CPC SC A> Maintained
Visit Paranaque Diabetes mellitus T2 PE
S/p CVD infarct c Right sided FS P> SHPM Intervention
weakness - ensure adequate symptom control
Dyslipidemia - rendered PE support to caregivers
SDU Grade 2 (healing) - advised caregivers about adequate and appropriate feeding
and prevention of bed sores
- provide palliative care and help optimize condition

Diet as tolerated
Continue Glucerna 5 scoops in 200 mL TID
Medications:
Continue maintenance
Sitagliptin + metformin 50/500 mg OD
TMZ 35 mg OD
Atorvastatin 40 mg OD
Lactulose 30u OD
Bisacodyl syrup if no bowel movement for at least 5 days
Vit D + Calcium OD
multivitamins OD
Labs:
CBC; Na, K, Cl
Lipid profile, Serum albumin; BUN/Crea, SGPT

BP monitoring
Continue Rehab Therapy
Daily wound care with SSD cream TID
Bed turning q2h

Schedule of home visit: Once with results OR affer 2 weeks to 1

month

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