PALLIATIVE CARE HOME VISIT

Location: Jalan Wong King Huo

Group 2C
Dheepa Nanthini SCM 017263
Garry Siow SCM 015274
Mohd Hanafi bin Osman SCM 026730
Rodney Arnold Thomas SCM016100
Tan Jia Ming SCM 016037
Tan Li Faung SCM 015419
Zafarudin Ismail bin Zulkifli SCM 026366
Lecturer/Assessors: Assoc. Prof. Dr. Mohd. Raili Suhaili
Matron Ling, Sister Florence
 Patient Info
• Ling Kui Chuo, aged 69 years old, Female,
Single, Chinese, Buddisht address: 4A, 21 Jalan
Wong King Huo 96000 Sibu, Sarawak.
• Contact: 0138003332
• Alternate contact: nephew/ caretaker, Mr. Ling
Kia Teck 0165757773
• Diagnosis: Gastric cancer since February 2014,
grade 3 Infiltrating Adenocarcinoma.
• Attempts to meet patient were made with
liaising with patients nephew.
• Total number of visit: 3 first visit at her home
was on the 23rd of May 2015, followed by the
second visit on the 28th of May when she was
warded and the last visit was made after she
passed on the 6th of June 2015.
PHYSICAL DOMAIN
• Diagnosed with gastric carcinoma in February
2014 with signs of obstruction and anaemia

• OGDS : large ulcer in antrum

• CT abdomen :
a) gastric carcinoma involving the pylorus with
involvement of perigastric lymph nodes &
omental disease
b) Splenic lesion is suspicious of metastasis
• Grade 3 with ulcerative, infiltrating adenocarcinoma of
stomach

• Refused any chemotherapy and surgery & since under

palliative care

• Since then, patient was having the following symptoms

:
i. Nausea
ii. Black discolouration of stool
iii. Bloated after eating & loss of appetite
iv. Weight loss
v. Insomnia
 Clinical Assessment
• Blood pressure : 101/63mmHg
• Pulse : 110/min
• Respiratory rate : 21/min
• Temperature : 36.6‫ﹾ‬C

• Physical state : Pallor, no jaundice, no

clubbing, no cyanosis, no dyspnoea
• Skin : Good hygiene, no pedal oedema
• Mental state : Alert and oriented
• Emotional state : Calm
• Aware of diagnosis : Yes
• Aware of prognosis : Yes
• Pain assessment : No pain
• Mobility status : Ambulatory
• Activities of daily living : Independent
 General Examination
Abdominal Examination
• Not distended and move with respiration, no
dilated veins, mass was palpable at epigastric
region, non-tender, normal bowel sound

Respiratory
• No scars or chest deformities, trachea
centrally located, symmetrical chest
expansion, normal vesicular breath sound
Cardiovascular system
• Apex beat felt at 5th intercostal space in
midclavicular line, no heaves or thrill, S1S2
heard with no murmur

CNS
• Normal muscle tone, reflex and power.
PSYCHOSOCIAL DOMAIN
Patient was able to accept the fact that she had
terminal illness in February 2014 as she believes
it was decided by God. Even though during that
time she still live on her own, she did not reject
the diagnosis and deny feeling despair and
hopelessness. Believing in karma, she believes
that everything happen for a reason and
because of that, she did not want to undergo
any treatment intervention and surgery and did
not wish to prolong her life. Nevertheless,
patient is compliance to her medication
Since patient is unmarried, she had been living
alone for many years. She able to live
independently for 9 months in a rental house
after diagnosed with gastric carcinoma before
moving into her nephew house on November
2014. Patient was able to do daily chores like
cleaning and cooking on her own. Her neighbor
is there to help her buy groceries and provide
transportation in case of emergency or any
occasions.
Patient moved to her nephew house because
her nephew worried of her health and insist to
take care of her. Patient gets along well with her
nephew’s family. All her needs like food and
medication are taken care for by her nephew
and his wife. Soft food like soup and porridge
specially coked for her since she had problem in
digestion. Most of the time, she rest at the bed
or living room. When she is feeling well, she
helps with doing chores in the house.
On 28th May 2015, she admitted to the ward
because of pain over her stomach. The
approaches by doctor mainly to relieve pain by
administer analgesic and keep her comfortable.
SPIRITUAL DOMAIN
• Strong religious believe can makes the patient to
be more able to accept her current conditions as
well as help her to go through the remaining days
of her life.
• However, our patient was guided with heresy
through out her life. She was taught the wrong
way of Buddhism since she was young. Patient
claimed that she was disturbed by “spirits” every
night during her sleep. She was full of anger and
hatred towards the “spirits” that she even said
“there will be the time that I'm dead and there
will be the time you are alive. By the time comes,
I will haunt you like what you did to me”. All
religious never teach anyone to be vengeful or
anger towards self or others.
• Patient also believed that her current
condition was due to karma from her previous
life. She believed that it's God’s will that she
will live and die this way so patient did not
wanted any form of surgery. When patient
was first diagnosed with the disease, she
accepted it and did not seek any method to
find the cure or any ways to prolong her life.
Patient claimed that she accepted her fate
and just waiting for her time to come.
What can we do for her?
• Talk to the patient about her religious beliefs and
practices.
• Identify the heresy teaching in patient’s religious belief.
• Talk to the family members regarding their religious
belief. If they are practicing the wrong way of their
religion, advice them to seek help from Buddhist
Accociation.
• Encourage family members to let patient participate in
more proper religious activities
• Contact community workers from Buddhist Accociation
to give spiritual counseling and support.
• Encourage family members to participate in religious
activity with patient.
SOCIAL DOMAIN
 Potential Roles for the Family
Caregiver

 Decision Maker
 Advocate
 Communicator
 Hands-on Care Provider
 Social Support
Patient was single and unmarried therefore she
has always lived on her own until she was
diagnosed in February 2014.
Patient comes from a family of 14, consisting of
8 brothers and 6 sisters, she was the youngest
among the sisters.
Patient was not an alcoholic neither does she
smoke.
Her life before and after her diagnosis hasn’t
changed much as she still was socially active as
she still met her friends but instead they come
to the nephew’s house to visit her instead.
Patient’s relationship with her family was
strained as she has never been in good terms
with them due to some misunderstanding in the
past.
Patient was residing in her nephew’s house
which was her eldest brother’s son.
Patient was living with her nephew and his
family. She was well taken care of for all her
needs. Patient was previously before her
diagnosis living on her own at Rajang Park
renting a room. After her diagnosis her nephew
persuaded her to move in with her as he felt its
best she lived with him.
Patient was no longer working when she was
diagnosed but she had enough savings to fend
for herself.
Ever since she lived with her nephew, her
nephew, Mr. Ling Kia Teck and his wife Bibina
took care of all her needs from food, shelter and
medical bills.
ENVIRONMENTAL DOMAIN
 Environmental Domain
• Double storey house.
• At 4A, Jalan Wong King Huo, 96000 Sibu,
Sarawak.
• Located next to a main road.
• Lives with her nephew and is taken care by the
nephew’s family.
• Living condition of the house is good.
• House is tidy and clean.
• 3 rooms and 2 washrooms in the house.
• Sleeps alone in the room downstairs.
• A medium size room.
• Well equipped with all her necessities.
• Room wasn’t too compact or congested.
• Good ventilation in the room.
• A single bed , a table fan , an air conditioner , a
resting chair , a cupboard and a television in the
patient’s room.
• Sleeps on a hard mattress (comfortable) & uses
the fan to sleep most of the time
• Patient’s room is always kept clean by the
caregiver.
• Medication and simple food are kept on the shelf
in patient’s room.
• Uses the washroom near the kitchen.
• Washroom floor is made up of tiles.
• Washroom – clean & not slippery.
• Overall, the house is kept very clean.
• Pets (4dogs) kept outside the house.
• Never isolated , she is always around her family.
• Watches television together with them in the living
room.
• Besides that, patient’s friends also pay her a visit off
and on.
• Neighbours are not in good terms – do not visit her.
• Meet the neighbours - ask them a few questions but
they were not receptive to the idea and rejected us.
LEGAL DOMAIN
• Patient had a piece of land near Tanjung
Manis.
• Before she passed away, she planned to sell it
off and take part of the proceeds from the sale
and donate it to a Buddhist Temple.
• As of now, the land has been passed to her
nephew, Mr Ling Kia Teck, who took care of
her.
• She had around RM 24000 in her bank
account which she has divided among her
nephew’s siblings.
• A part of the money from her bank account
was also used for her funeral expenses.
FINANCIAL DOMAIN
 FINANCIAL
• Mr. Ling own a business so food and
accommodation is well provided for
• The house they were living in together was
bought by Mr.Ling when he moved back to
Sibu more than 1 year ago
• Only problem is that Madam Ling is taking
magnesium trisilicate to ease the abdominal
pain, the drug is hard to come by according to
Mr.Ling
• It would be very helpful if the hospital can
provide them with thus drug
BEREAVEMENT
 Bereavement
• The patient Ling Kui Chuo unfortunately
passed away on 28th June 2015 evening
around 5 o’clock
• Her remains were cremated and currently she
rest peacefully at Nirvana Sibu
 Coping and Acceptance
• For the past one year, Madam Ling and her
caregiver - Mr.Ling and his wife, have
developed a close relationship
• She told them that she had long since
accepted her own fate and they need not grief
when she passes
• They too have come to terms with Madam
Ling’s condition and were well prepared
mentally for when the day come
• On the day of Madam Ling’s passing, they
missed the last meet with her due to some
family feud
• They were quite hung up about the fact that
someone would bring up some petty family
feud around Madam Ling and cost them their
last moments with her
• However, they have accepted it since then,
they realize its not their fault and Madam Ling
would not want that to bother them
 Patient’s view
• Since her diagnosis, Madam Ling had
preferred not to receive treatment as she feels
that one’s life is predestined and one should
not interfere with what’s come to pass
• She often says “I was born to this world alone
and without anything, and I have lived the
majority of my life alone, when the time
comes, I would not like to trouble others”
• She is very grateful towards Mr.Ling and his
wife for them being there with her for the last
pages of her life
• She understands that she is living on
borrowed time and she has no regrets in her
life
IN REMEMBRANCE OF OUR PATIENT MDM.
LING KUI CHUO
13/10/1946-28/05/2015
Aged:69 Years