Tutorial 6: Case 1

Question 1

Silvana has around her umbilical area, she says “I need something for my period pain to get me through the next few hours of work”.

A) Who is it for?

B) What are the symptoms?

C) How long have you had these symptoms?

D) Action taken

E) Medications being taken?

F) Medical conditions

G) Allergies

H) P/BF?

Answer 1

A) Myself

B) I have this pain in my tummy, im pretty sure it has something to do with my period

C) Since yesterday

D) I had some panadol at home so I took a couple of tablets –> it hasn’t helped much

E) Oral contraceptive pill

F) None

G) None

H) No

Question 2

Appropriate extended questions

1. When is your period due (or are you having your period now)?
2. Any other symptoms such as fever or abdominal vaginal discharge?
3. Is this period like your normal periods (length/duration, amount of bleeding)?
4. Can you describe the pain (is it cramping)?
5. Location of pain?
6. The severity of pain (scale of 1-10)
7. Have you had this pain before
8. How long does the pain usually last
9. What have you tried in the past

Answer 2

1. Yes, my period came a couple of hourrs ago
2. I dont feel hot or anything, no abnormal vaginal discharge, but I do feel a little sick
3. It appears to be like my normal periods, normally bleed for about five days and I get my period every month
4. Definitely cramping pain
5. Around the lower abdomen
6. Would say about 4 out of 10, pain is bearable now, i would like a tablet to give me some relief
7. Yes normally with each period, less with the contraceptive pill.
8. Starts a few hours to a day before my period arrives normally, then starts to ease off after the first or second day
9. I have taken some period painkillers in the past, but can’t remember the exact name, so whichever you recommend would be fine

Question 3

What is the diagnosis? Explain reasoning to patient

Answer 3

Primary dysmenorrhoea

Based on the signs and symptoms you have told me, I believe you have primary dysmenorrhoea, more commonly referred to as period pain. Symptoms you have including the cramping pain in the lower abdomen, and you having your period coming a couple of hours ago has confirmed my diagnosis.

This occurs due to chemicals released with hormone changes in your monthly cycle.

Question 4

What product would you recommend for this patient? Provide IDARL.

Answer 4

Ibuprofen –> NSAID (Nurofen)

• Indication: Anti-inflammatory medication which will reduce the inflammation and pain associated with your period pain as it reduces the chemicals responsible for the cramping pain you are experiencing
• Dosage and directions: Take 1-2 tablets (200-400mg) every 8 hours, max 6 tablets a day, can start prophylactically for the next few cycles if required
• Adverse effects: Generally well tolerated, it may cause nausea and indigestion. Serious side effects are associated with long term use.
• Duration of treatment, time to recovery, when to refer: Use for the days you have pain, typically starting the day before menstruation and 1-3 days later. Refer if pain relief is not sufficient, pain during sexual intercourse, fever with pain.
• Lifestyle/self-care: heat packs may help with pain, try acupuncture, rest, use a period diary, avoid caffeine

I will give you a self-care card for primary dysmenorrhoea and a consumer medication information leaflet. Do you have any questions for me?