Case 1: John Silver (a 67 year old man with dyspnea)
Mr. John Silver has been a patient on your inpatient service for the
past two days -- admitted with metastatic lung cancer. He was diagnosed
several months ago and has received chemotherapy. The most recent round
of chemotherapy was stopped, as he was unable to tolerate it ( due to
increased nausea, and fatigue). He had expressed a wish for comfort care
only and has elected to become a “no code” (do not resuscitate)
patient.
Over the past two weeks he has experienced increasing dyspnea with three
emergency room visits finally prompting this admission. An evaluation
for reversible causes of dyspnea was not successful and the pulmonary
consultant believes the dyspnea is irreversible, caused by the underlying
lung disease.
Past Medical History
Mild hypertension.
Bronchial asthma.
Medications
Hydrochlorothiazide 12.5mg every day
Albuterol and ipratropium inhalers prn.
Examination
On admission his respiratory rate was 22-26 per minute, pulse was 100 beats
per minute and pulse oximetry was 100% on room air. He complains of breathlessness.
Exam reveals only scattered wheeze bilaterally.
What are some interventions that should be considered at this point?
