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INSTRUCTIONS FOR THE DOCTOR

This is a short case.

Please take a history as if you were in clinical practice and then outline your plans to Mrs Worthington.

Scenario

Mrs Nell Worthington is an 80-year-old retired legal secretary. She has hypertension. She has just moved to your area to be nearer to her daughter. She has brought her summary sheet from her previous practice.

The following information is on her summary sheet from her previous practice:

  • Past medical history

  • Hypertension diagnosed 2013

  • Osteoarthritis of neck and hips

  • Vaginal hysterectomy for prolapse 1995

  • Four children

  • Medication

  • Spironolactone 25 mg od

  • Ramipril 10 mg od

  • Potassium chloride 600 mg slow release 1 tab od

  • Allergies

  • Nil known

  • Immunisations

  • Up-to-date

  • Social history

  • Widowed 2008.

INSTRUCTIONS FOR THE PATIENT, NELL WORTHINGTON

You are an 80-year-old retired legal secretary. You have just moved to be nearer your daughter. Life has been hard since Vince, your husband, died in 2008. You are feeling lost as you try to establish your new life in this town. You had attended the same doctor back home for years and are nervous about coming here today.

You have been feeling lethargic recently but have put this down to the move. Your opening line will be, ‘Doctor I’m feeling tired, but maybe this is because I have just moved here.’

The following information is on your summary sheet:

  • Past medical history

  • Hypertension diagnosed 2013

  • Osteoarthritis of neck and hips

  • Vaginal hysterectomy for prolapse 1995

  • Four children

  • Medication

  • Spironolactone 25 mg od

  • Ramipril 10 mg od

  • Potassium chloride 600 mg slow release 1 tab od

  • Allergies

  • Nil known

  • Immunisations

  • Up-to-date

  • Social history

  • Widowed 2008.

SUGGESTED APPROACH TO THE CASE

Establish rapport

Welcome Mrs Worthington to the practice

  • — Ask about the move, is she settling in?

Explore patient’s ideas, concerns and expectations regarding this consultation.

Specific questions

Enquire about current symptoms

Brief systems review—any problems with your breathing, your appetite, your bowels, your ‘waterworks’, sleep, energy level, weight changes?

Sensitively explore any mood symptoms

Review information on summary sheet with Mrs Worthington

Confirm current medication

Explore other cardiac risk factors

  • — Exercise

  • — Smoking

Other preventive health measures

  • — Immunisation status

  • — Alcohol consumption

Full physical examination—needed, but not part of this consultation.

Investigations

Explain need for investigations

Surgery tests: BSL or urine dipstick, ECG

Lab tests

  • — Arrange urgent UEC—drug regimen risks hyperkalaemia, can cause tiredness

  • — Non-urgent BSL, FBC, ...

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