Mikhail's Nausea (Palliative)

Name	Mikhail Collins
DOB	26/03/1954 (62 years)
Occupation	Chemist
History	I have inoperable bowel cancer and have less than 3 months left. I do not thing I deserve this and feel quite horrible about it. I do not engage with student. The bowel cancer has been managed conservatively and apart from some rectal bleeding and severe less of weight (10kg in 3 months), I have had no symptoms until now. I have now been feeling incredibly nauseated for 3 weeks and have vomited my food on several occasions, with no blood present. I am also hardly eating as I have severe loss of appetite: single fruit for breakfast, half a jacket potato for lunch, usually skip dinner. I have had no other symptoms. If directly asked, spicy foods tend to make it worse. I have tried eating less spicy food. I want to know what's causing it and how I can sort it out as I don't want to die feeling this unwell. I also want my appetite to return and wish for suggestions on what I can do to eat properly and prevent further weight loss.
Past Medical History	Nil
Drug History	Paracetamol
Family History	Father and brother with bowel cancel.
Social History	I drink 5-6 pints of alcohol daily. I know this is above the limit but don't see the point of cutting down. I do not realise that nausea and vomiting may be due to excessive alcohol. I receive support from my neighbour with shopping and am able to cope with my daily activities with the help of carers that come three times per day. I am not spiritual.

Introduces yourself	0	1
Confirms name & age of patient	0	1
Explains reason for consultation & builds rapport	0	1
Gains consent	0	1
Briefly clarifies long term diagnosis, management and prognosis	0	1
Asks open question	0	1
Onset and time course of anorexia	0	1
Duration and changes to anorexia	0	1
Exacerbating/alleviating factors of anorexia	0	1
Clarifies what patient eats	0	1
Asks about weight loss	0	1
Assesses volume	0	1
Checks if there is any blood	0	1
Establishes onset and number of events	0	1
Asks if there were any triggering events	0	1
Specifically screens for NSAID overuse (peptic ulcer)	0	1
Screens red flags of dysphagia, melaena, loss of appetite and weight loss	0	1
Screens for pain	0	1
Screens for breathlessness	0	1
Screens for constipation	0	1
Screens for anorexia	0	1
Elicits past medical history	0	1
Elicits drug history	0	1
Checks for allergies	0	1
Establishes what patient has tried so far for symptoms	0	1
Discusses anorexia management (frequent small meals, supplements/dexamethasone)	0	1
Discusses nausea & vomiting management (small meals/avoiding trigger foods, antiemetics)	0	1
Suggests to patient that they may need further tests to identify cause (giving examples)	0	1
Asks about spiritual or religious beliefs and whether support is wanted	0	1
Asks about social support and mentions services available (e.g. McMillan)	0	1
Explores and responds to ideas	0	1
Explores and responds to concerns	0	1
Explores and responds to expectations	0	1
Shows empathy	0	1
Avoids jargon	0	1
Summarises back to patient	0	1
Thanks patient	0	1
Patient global score	0	1	2

Emma's Constipation (Palliative)

Name	Emma Durand
DOB	26/03/1953 (63 years)
Occupation	Author
History	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.
Past Medical History	Appendix removed as child.
Drug History	Paracetamol, Oramorph and cyclizine. No allergies.
Family History	Nil
Social History	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.

Introduces yourself	0	1
Confirms name & age of patient	0	1
Explains reason for consultation & builds rapport	0	1
Gains consent	0	1
Briefly clarifies long term diagnosis, management and prognosis	0	1
Asks open question	0	1
Onset and time course of constipation	0	1
Duration and changes to constipation	0	1
Exacerbating/alleviating factors of constipation	0	1
Checks for red flags: inability to pass wind, rectal bleeding, back pain, neurological symptoms in legs, urinary changes	0	1
Screens for pain	0	1
Screens for breathlessness	0	1
Screens for anorexia	0	1
Screens for nausea & vomiting	0	1
Elicits past medical history	0	1
Elicits drug history	0	1
Checks for allergies	0	1
Establishes what patient has tried so far for symptoms	0	1
Discusses constipation management (fluid intake/diet/mobilisation, adjustment of opiates/laxatives)	0	1
Suggests to patient that they may need further tests to identify cause (giving examples)	0	1
Asks about spiritual or religious beliefs and whether support is wanted	0	1
Asks about social support and mentions services available (e.g. McMillan)	0	1
Explores and responds to ideas	0	1
Explores and responds to concerns	0	1
Explores and responds to expectations	0	1
Shows empathy	0	1
Avoids jargon	0	1
Summarises back to patient	0	1
Thanks patient	0	1
Patient global score	0	1	2