Tutorial 8: Case 1

Question 1

Camille, 28 years old asks ‘I haven’t been feeling very well. Can you give me something for the burning feeling I have around my chest and stomach area, please?

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 (female asking…)

Answer 1

A) Myself

B) Discomfort and burning feeling in my stomach area and behind my ribs

C) Most of yesterday evening and today. I think it was after I ate a curry dish for dinner yesterday

D) I have been sipping on peppermint, however it isn’t helping

E) Just a pregnancy multivitamin

F) No

G) Yes, I am 30 weeks pregnant

Question 2

Appropriate extended questions

1. Are there any other symptoms?
2. Have you had this before?
3. Do you have pain elsewhere including radiating pain or severe pain?
4. Any vomiting or bowel movement changes?
5. Do you experience these symptoms when you are not pregnant
6. Has anything changed recently? Any activities? Does anything appear to make it worse?

Answer 2

1. Im feeling like I have to burp a lot. Sometimes there is a funny sour taste in my mouth after I burp.
2. I recall having this in a previous pregnancy in the last trimester.
3. No, it’s definitely the area from my stomach and a bit behind my chest.
4. No, only a little trouble here and there with passing a bowel motion like usual in pregnancy, nothing I have needed to do anything about as yet.
5. No, never, thankfully
6. The curry I ate was probably not a good choice as spicy foods seem to make it worse. Also if I eat then lay down quite soon after it does get worse especially with the sour traste, which I have been doing lately.

Question 3

What is the diagnosis? Explain reasoning to patient.

Answer 3

Based on the signs and symptoms, I believe you have GORD (gastro-oesophageal reflux disease) which is more commonly known as acid reflux. The burning feeling in the stomach area and behind your ribs, the sour taste in your mouth, the fact that it gets worse when you lie down has confirmed my diagnosis. It is most likely triggered by the spicy food you ate for dinner yesterday but your pregnancy may be a contributing factor.

Question 4

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

Answer 4

Antacid (mylanta, gaviscon)

• Indication: It will neutralize the acid in your stomach, reduce your symptoms such as the burning feeling in your stomach and the sour taste in your mouth. Safe to use in pregnancy.
• Dose and directions: Take 20mL up to four times a day after meals/before bed. Space 2 hours apart from any other medications.
• Adverse effects: Generally well tolerated
• Duration of treatment, time to recovery, when to refer: Stop within 14 days or if symptoms get better. I will refer you if pain radiates to your arm or jaw, if you need often, start vomiting. (using long term NSAIDs .. for out of roleplay)
• Lifestyle/self-care: Avoid spicy food, fatty food, coffee. Eat smaller meals and eat slowly. Don’t go to bed after 2 hours of eating. Use a wedge pillow.

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