Amir's Breathlessness (Palliative)

June 08, 2016 Print Friendly Version of this page Print Get a PDF version of this webpage PDF
Name
Amir Chakma
DOB
27/05/1945 (71 years)
Occupation
Retired Receptionist
History
I have COPD and have less than a year left. It is managed with many inhalers which I take regularly. I have been admitted to ITU several times with pneumonia, however they said they will not admit me to ITU if this happens again preferring to support me at home to die.

I have been feeling really breathless over the last week, more than usual. I also have had a sharp chest pain over the same amount of time. I have no other symptoms to report except my usual symptoms of COPD including cough with some white sputum. I am not able to walk whereas previously I could walk to the bathroom 20 steps away. I have not lost any weight. I am very keen on oxygen to treat this and I demand it frequently. I have not tried anything for it as I am sure nothing apart from oxygen will work.
Past Medical History
Hypothyroidism
Drug History
Levothyroxine, Salbutamol, Tiotropium, Ipratropium and various other inhalers I don't remember. Allergy to Penicillin causing anaphylaxis.
Family History
Nil
Social History
I am a current smoker of 5 per day. I am supported by my wife who does the daily activities. I am able to usually eat, get dressed and get to the toilet but have been having difficulties doing this. I usually spend most my time in the chair. I am keen on speaking to people from the Christian faith to see if they can help support me spiritually. 

Introduces yourself
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1

Confirms name & age of patient
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1

Explains reason for consultation & builds rapport
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1

Gains consent
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1

Briefly clarifies long term diagnosis, management and prognosis
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1

Asks open question
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1

Onset and time course of breathlessness
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1

Duration and changes to breathlessness
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1

Exacerbating/alleviating factors of breathlessness
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1

Asks about exercise tolerance
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1

Asks about cough/sputum, orthopneoa/paroxysmal nocturnal dyspnoea, chest pain
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1

Checks for red flags: haemoptysis, weight loss, night sweats
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1

Screens for pain
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1

Screens for constipation
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1

Screens for anorexia
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1

Screens for nausea & vomiting
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1

Elicits past medical history
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1

Elicits drug history
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1

Checks for allergies
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1

Establishes what patient has tried so far for symptoms
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1

Discusses breathlessness management (fan/opening windows/positioning/physiotherapy, oxygen/benzodiazepines/opiates)
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1

Suggests to patient that they may need further tests to identify cause (giving examples)
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1

Asks about spiritual or religious beliefs and whether support is wanted
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1

Asks about social support and mentions services available (e.g. McMillan)
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1

Explores and responds to ideas
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1

Explores and responds to concerns
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1

Explores and responds to expectations
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1

Shows empathy
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1

Avoids jargon
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1

Summarises back to patient
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1

Thanks patient
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1

Patient global score
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1
2