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Name
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Emma Durand
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DOB
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26/03/1953 (63 years)
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Occupation
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Author
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History
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I have breast cancer and have less than 6 months left. It was
managed with radiotherapy and chemotherapy, until I developed metastases to
the back and shoulders.
I have been completely constipated over the last 4 days but am
still passing wind. Usually I go every day. It has gradually worsened over
the last 2 weeks (if directly asked, since I started higher doses of morphine
which is completely controlling my pain). I have had no other symptoms.
Nothing helps or makes it worse. I have tried eating more healthily but don't
know what to do. Please explain to me
why I am getting this constipation and what can be done about it.
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Past Medical History
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Appendix removed as child.
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Drug History
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Paracetamol, Oramorph and cyclizine. No allergies.
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Family History
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Nil
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Social History
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I am supported by my daughter who has moved in to live with my
partner and myself. She is very helpful as I am not able to do many things
for myself like cooking and shopping. I am quite a spirtual person but do not
believe in any one religion.
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Introduces yourself
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0
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1
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Confirms name & age
of patient
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0
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1
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Explains reason for
consultation & builds rapport
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0
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1
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Gains consent
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0
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1
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Briefly clarifies long
term diagnosis, management and prognosis
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0
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1
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Asks open question
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0
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1
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Onset and time course
of constipation
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0
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1
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Duration and changes to
constipation
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0
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1
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Exacerbating/alleviating
factors of constipation
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0
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1
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Checks for red flags:
inability to pass wind, rectal bleeding, back pain, neurological symptoms in
legs, urinary changes
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0
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1
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Screens for pain
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0
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1
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Screens for
breathlessness
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0
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1
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Screens for anorexia
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0
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1
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Screens for nausea
& vomiting
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0
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1
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Elicits past medical
history
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0
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1
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Elicits drug history
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0
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1
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Checks for allergies
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0
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1
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Establishes what
patient has tried so far for symptoms
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0
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1
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Discusses constipation
management (fluid intake/diet/mobilisation, adjustment of opiates/laxatives)
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0
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1
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Suggests to patient
that they may need further tests to identify cause (giving examples)
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0
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1
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Asks about spiritual or
religious beliefs and whether support is wanted
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0
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1
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Asks about social
support and mentions services available (e.g. McMillan)
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0
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1
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Explores and responds
to ideas
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0
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1
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Explores and responds
to concerns
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0
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1
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Explores and responds
to expectations
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0
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1
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Shows empathy
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0
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1
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Avoids jargon
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0
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1
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Summarises back to
patient
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0
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1
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Thanks patient
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0
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1
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Patient global score
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0
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1
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2
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