Breathlessness Flashcards

1
Q

Name

A

Jamie Stevens

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2
Q

Age

A

45

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3
Q

DOB

A

04/12/79

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4
Q

Opening Statement

A

“I’m feeling a bit breathless and wonder whether it’s just my smoking that’s causing it or something else”.

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5
Q

Symptoms, last couple of years (3)

A
  • Mild breathlessness
  • Cough
  • Gradually getting worse, but not drastically so
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6
Q

Symtoms - immediate (4)

A
  • Mild breathlessness and wheeziness when walking the dog
  • Slowing down, a big cough, and a couple of deep breaths normally helps
  • Don’t need to stop
  • Otherwise don’t really notice it
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7
Q

Not-symptoms (3)

A
  • No pain in chest
  • Not sweaty
  • Not nauseous
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8
Q

When out of breath and wheezy (4)

A
  • Cough a bit
  • deep breaths
  • Relieves symptoms
  • Clear phlegm
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9
Q

My thoughts (2)

A
  • Smokers cough
  • Normally happens first thing in morning and when out with the dog
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10
Q

Any recent change in breathlessness?

A
  • Not really
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11
Q

Any other symptoms at the moment? (3)

A
  • Don’t feel ill
  • Don’t have temperature
  • Phlegm no different to normal
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12
Q

Make sure you mention (3)

A
  • Chest infections in the past
  • One every winter for last three years
  • Always ill before Christmas!
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13
Q

Annual chest infections (6)

A
  • Feel ill
  • Cough more
  • Bring up green mucus
  • Feel more breathless and wheezy
  • Antibiotics sort it out
  • Steroids last time were even better! Sorted the wheeze a beauty
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14
Q

Ever brought up blood?

A

No

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15
Q

Chest pain?

A

No

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16
Q

Hurt to take a deep breath in?

A

No

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17
Q

Calf pain or swelling?

A

No

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18
Q

Been immobile recently/

A

No

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19
Q

Weight

A

Steady

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20
Q

Feeling tired

A

No more than normal

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21
Q

Swollen ankles?

A

No

22
Q

Need to sleep propped at night?

A

No

23
Q

Wake gasping for breath?

A

No

24
Q

Past medical background (2)

A
  • Appendix taken out as child
  • Bad Covid bout during Pandemic
25
Q

Medication?

A

None

26
Q

Allergies?

A

None

27
Q

Family history? (2)

A
  • Dad died of lung cancer in his 70s (heavy smoker)
  • No other family history I’m aware of
28
Q

Home life (4)

A
  • Live with partner and little dog
  • Two teenage boys
  • All fine
  • She’s been nagging me to see a doctor
29
Q

Work (4)

A
  • Taxi Driver
  • have done this all my life
  • Enjoy it
  • Never worked a job that would expose me to hazardous chemicals
  • Work late hours
30
Q

Been abroad?

A

Never

31
Q

Smoking (3)

A
  • Started age 15
  • Smoked until two years ago
  • Quit when dad got lung cancer
32
Q

Drink (2)

A
  • social accessions
  • once a month
33
Q

Drugs?

A

Never

34
Q

Diet

A
  • Generally quite healthy
35
Q

Exercise

A
  • but don’t get a lot of exercise
  • slow dog walks
36
Q

Patient ideas

A
  • think it’s a smoker’s cough which will settle in time now I’ve stopped smoking
37
Q

Patient Concerns (2)

A
  • Not overly worried
  • Partner worried it could be lung cancer
38
Q

Patient Expectations (2)

A
  • To be told it’s a smoker’s cough that will get better with time
  • Maybe an X-ray to make sure
39
Q

Patient Impact

A
  • Coughing in the taxi is a bit off-putting for clients!
40
Q

Patient emotions

A
  • A positive person so not really letting it get to me
  • just a bit wary of lung cancer
  • annoyed with the cough
41
Q

Sc. 2: Background

A
  • Come in for follow up.
  • Spirometry tests and a chest X-ray
  • No sign of lung cancer
42
Q

Sc.2: Question

A

Is there anything to worry about on the chest x-ray? What are the results of the spirometry? The nurse said you’d need to discuss it with the GP – so you got the impression it might be something else?

43
Q

Sc.2 Potential Questions

A
  • What difference will stopping smoking have made?
  • What treatments are there?
  • Will I end up needing oxygen?
44
Q

Sc.2 Perspective

A
  • Realise this is serious
  • Happy I stopped smoking
  • Happy to take further advice
45
Q

Sc.3 Background

A
  • Not cross with the student, but with the treatment so far
46
Q

Sc.3 Questions (4)

A
  • Why has no-one ever mentioned COPD before?
  • I’ve had ‘chest infections’ the last three years, have I been misdiagnosed?
  • I was told before it was just infections, and now I’m being told it’s something else.
  • Has this delay in diagnosis caused long term harm?
47
Q

Sc.3 Reaction to student trying to ‘explain it away’

A

Get a bit surly and withdrawn. Not prepared to listen.

48
Q

Sc.3 If student colludes with you or offers to help you make a formal complaint in writing.

A

“Oh, it doesn’t matter”.

49
Q

Sc.3 Ideal student response (4)

A
  • Listen to you and make you feel like you’ve been taken seriously.
  • Feel reassured that I will have my concerns addressed
  • Say they will discuss it with their clinical supervisor and ask them to discuss this with you.
  • Allow you to have a proper conversation about this.
50
Q
A