Introducing
Your new presentation assistant.
Refine, enhance, and tailor your content, source relevant images, and edit visuals quicker than ever before.
Trending searches
Case Report #1
3
October 23, 2018
CASE REPORT
Tiffany Gonzales, MD
At the hospice house...
55 year old female
T.M.
- Endometrial adenocarcinoma with metastases to the vaginal wall, ovaries, liver, peritoneum
PMHx: Bipolar disorder x 30 years (Valproate and Risperdal)
- Intractable pain
- Vesico-vaginal fistula
History
2012
cc: abdominal pain + distention x year
Stage I endometrial adenocarcinoma + L ovarian adenocarcinoma (synchronous vs ovarian mets from uterine primary)
Tx: TAHBSO + 6 cycles chemo (8/2012)
2015
cc: postmenopausal vaginal bleeding
Recurrence at the vaginal cuff
Tx: radiation, brachytherapy
2018
cc: epigastric pain then RUQ pain, + anorexia
3cm liver mass consistent with metastatic spread
3/2018
debulking attempted
periteoneal carcinomatosis
4/2018
Tx: chemo (carbo/doxil/avastin) until 8/2018
7-8/2018
cc: vaginal pain, dysuria, urinary incontinence, nausea
Abx for UTI
Pain meds
Chemo
Abx for UTI
Pain meds
8/23/2018
St. Lukes Anderson ER
cc: intractable vaginal pain + discharge
PAH ER
8/24/2018
Pelvic exam under general anesthesia
extensive radiation necrosis of entire vaginal canal; anterior vaginal wall disintegrated that symphysis pubis can be palpated; urethra can't be cannulized by FC; urine seen draining from defect within wall
vaginal mesh removed
urethral-vaginal fistula vs vesicovaginal fistula
8/27/2018
Hospice
R PCN for comfort
8/28/2018
Restarted meds for bipolar
Hospice House
Hospice
At the hospice house...
Day 1-2
cc: pelvic pain
Tx: dilaudid, ativan
pleasant, cooperative
Tx: ketamine/lidocaine enema
Tx: gabapentin, risperdal, depakote
Day 3
cc: pain, hallucinations
Tx: d/c ketamine enema
confused
Tx: increased dilaudid
Day 4-6
cc: pain, refusing meds, cigarettes
Tx: dilaudid, ativan
confused
Tx: ketamine/lidocaine enema
Tx: gabapentin, risperdal, depakote
Jeff
Dan/John
T.M.
3 children
Estranged
Married
Divorced
From CA
Bill
Victoria
letigious
Suicidal attempt
Mental health issues
lives with TM
Karen
From SC
Marilyn
Developmentally delayed
Day 7
cc: full-blown psychosis
Tx: dilaudid CADD pump, ativan
confused, agitated
Tx: Olanzapine IM x 1, and scheduled
Tx: gabapentin, risperdal, depakote
Day 8
cc: pain, refusing meds, cigarettes
Tx: dilaudid CADD pump, ativan
Tx: gabapentin, risperdal, depakote
confused, wants us to talk to OP psych doc
Tx: Olanzapine IM x 1, and scheduled
Day 9
cc: pain, pleasant, cigarettes
Day 10
cc: pain, refusing meds
brother may be suicidal
Tx: dilaudid CADD pump, ativan
confused, agitated
Tx: Olanzapine prn
Tx: gabapentin, risperdal, depakote
Day 11
cc: full blown pyschosis
Tx: dilaudid CADD pump, ativan
confused, agitated
Tx: Olanzapine scheduled
Tx: phenobarbital scheduled
Day 12
cc: calm, comfortable
Tx: dilaudid CADD pump, ativan
unresponsive
Tx: Olanzapine scheduled
Tx: phenobarbital scheduled
Day 13
Died
Bill
Dan/John
Karen
Victoria