The care goals concerning clinically assisted nutrition and hydration are less prominently presented, the care goal concerning the maintenance of the patient's skin integrity was deleted and the form of documentation of the care goals was changed to 'yes' or 'no' instead of 'achieved' or 'not achieved'.
After more than three months of fluconazole maintenance therapy, the patient was re-admitted because signs and symptoms of relapse.
Seven months after discontinuation of the maintenance therapy the patient presented with mild dyspnea and worsening kidney function as well as proteinuria and microhematuria with dysmorphic erythrocytes.
Many guidelines with algorithms were developed and proposed to solve DAM, but maintenance of the patient's oxygenation is the cornerstone of all of these recommendations [ 5- 9].
An individualized pain management plan is developed, including preoperative oral medications and the assured perioperative maintenance of the patient's chronic opioids.
During his first week of maintenance therapy, the patient experienced a respiratory infection with temperatures of ≈38°C, mild dyspnea, and a cough.
The interpretation is that forgoing active treatments for end-of-life patients based on improvement or maintenance of the patient's QOL is more beneficial than continuation of treatments that may potentially harm the patient.
The pre-publication history for this paper can be accessed here: http://www.biomedcentral.com/1471-2407/14/456/prepub The authors thank Ms. Loralee Lobato for her help with clinical coordination and maintenance of the patient database.
This result may be explained, in part, by the patients presenting "chronic" dyspnea before the last week of life, potentially leading to admission to the PCH or hindering the maintenance of the patient at home or their return home, due to the risk of asphyxial respiratory distress.
During the maintenance phase, the patients were assessed at 6, 12, 18 and 24 months.
