Simulated Patient Instructions



Patient Instructions

Name of Patient: Jane Smith age 76

Description of the patient & instructions to simulator:

Jane lives by herself, John, her husband, died 10 years ago.

Normally quite active, goes to the local church and walks her dog ‘Tess’ daily

Non smoker.

Little alcohol, low salt diet as suggested by the PN years ago.

Lives in a terrace house

In the last two months when she gets out of bed or out of a chair she feels unsteady/dizzy for a few moments, almost like she is going to faint. A few days ago, she got up quickly to answer the door bell and fell with fleeting loss of consciousness. No injury. Unwitnessed. Not a driver

Information divulged freely:

Opening line ‘I’ve been having whoozy spells and I would like my ears checking out’

If GPSTs asks ’tell me more’. You reply about what doctor?’

If they ask re ear infection or whoozy spells

You can freely divulge 8 wks of feeling whoozy, feel like you are going to fall.

‘My friend Mavis had similar symptoms when she had an ear infection.’ (Only to be divulged if specifically asked - Mavis had felt the world to be spinning, struggled to cope at home, had nausea and vomiting settled over two weeks after given tablets by the doctor – Mavis at the time was told it was due to an ear infection)

Divulged when asked:

No ear pain, no discharge, no loss of hearing and no tinnitus

No headache

No chest pain or palpitations or shortness of breath.

No true rotational vertigo

No dizziness when turning in bed.

No dizziness when turning her head or looking up.

No slurred speech or weakness in face, arm or leg.

When she gets out of bed or out of a chair she feels unsteady.

She does not have true rotational vertigo.

No headache. No muscle weakness.

Compliant with meds as prescribed.

No falls… yet – fears falling

PMH: HT 2005, MI 2010, 2012 CKD3a - You have no symptoms of classical angina

Idea- Thinks a problem with her ears is the cause

Concerns: Fears falling especially when walking the dog or getting up at night to go to toilet

Expectations: Antibiotic tablets for a possible ear infection

Doctor’s (GP ST) Instructions

Name & age of patient Jane Smith aged 76

Summary Card

PMH: HT 2005, MI 2010, 2012 CKD3a

DH: Aspirin 75mg a day, Atorvastatin 20mg a day, Ramipril 10mg a day, Amlodipine 5mg a day, calcichew D3 1 bd,

Allergies:

Non smoker

Case Notes - Last few entries in records:

October: Influenza vaccination given

September: CKD/IHD/HT review – ACR normal, no angina, aware 999 rules, BP at target 130/70

CSA EXAMINATION CARD

Patient Name: Jane Smith

Examination findings: GPST must examine

Reveal finding only if examined

BP 122/90 sitting, standing 98/82

ENT no abnormalities.

HS normal. Pulse regular 85.

CSA Case Marking Sheet

|Case Name: |Case Title: |

|Context of case | |

|Postural hypotension due to HT meds | |

|Assessment Domain: | |

|1. Data-gathering, technical and assessment skills | |

|Positive descriptors |Negative descriptors: |

|Elicits ICE |Fails to explore psycho social impact of symptoms |

|Psycho social- lives alone and fear of falling. | |

|Appropriate focussed questions to differentiate between common causes. |ICE note explored |

|Elicits symptoms are postural | |

|Focused exam- ENT (ears examined). HR, BP include lying and standing. |Doesn’t ask about symptoms on changing posture |

| | |

| |Limited OR unfocussed questioning regards likely diagnosis |

| | |

| |Inept or missing examination |

| | |

| | |

| | |

|Assessment Domain: | |

|2. Clinical Management Skills | |

|Positive descriptors: |Negative descriptors: |

|Explains postural hypotension |Does not make correct diagnosis |

| |Gives Abx for ear infection/ offers Epley manoeuvre etc. |

|Reduces antihypertensive Rx e.g. Ramipril to 5mg a day. Or if choses to|Doesn’t reduce dose of antihypertensive |

|stop Amlodipine must counsel regards possible emergence of classical |No simple advice re postural hypotension |

|angina symptoms. |No warning re possible emergence of classical angina symptoms with |

| |Amoldipine cessation if that is the Rx plan suggested |

|Offers simple advice re postural hypotension and reducing risk of falls|No f/u or safety netting. |

| | |

|Appropriate follow up BP check | |

| | |

|Appropriate follow up for review of symptoms AND safety netting re | |

|angina/chest pain if stopping Amlodipine | |

|Assessment Domain: | |

|3. Interpersonal skills | |

|Positive descriptors: |Negative descriptors: |

|Established and maintains good rapport |Lack or rapport |

|Shows empathy for psycho-social impact |No empathy |

|Engenders hope re resolution | |

| | |



How can I prevent symptoms occurring?

Take particular care in the morning. Blood pressure tends to be lowest in the morning and therefore symptoms are likely to be worst.

Get out of bed in stages. Cross and uncross your legs firmly before sitting up and again before standing.

Sit down again promptly if you have symptoms at any time.

Increase your fluid intake. You need to drink 3-4 pints (1.5 - 2 litres) of fluids per day, aiming to keep your urine clear all day.

Support stockings or tights

................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download