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
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1

Confirms name & age of patient
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1

Explains reason for consultation & builds rapport
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1

Gains consent
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1

Briefly clarifies long term diagnosis, management and prognosis
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1

Asks open question
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1

Onset and time course of constipation
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1

Duration and changes to constipation
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1

Exacerbating/alleviating factors of constipation
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1

Checks for red flags: inability to pass wind, rectal bleeding, back pain, neurological symptoms in legs, urinary changes
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1

Screens for pain
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1

Screens for breathlessness
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1

Screens for anorexia
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1

Screens for nausea & vomiting
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1

Elicits past medical history
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1

Elicits drug history
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1

Checks for allergies
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1

Establishes what patient has tried so far for symptoms
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1

Discusses constipation management (fluid intake/diet/mobilisation, adjustment of opiates/laxatives)
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1

Suggests to patient that they may need further tests to identify cause (giving examples)
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1

Asks about spiritual or religious beliefs and whether support is wanted
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1

Asks about social support and mentions services available (e.g. McMillan)
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1

Explores and responds to ideas
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1

Explores and responds to concerns
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1

Explores and responds to expectations
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1

Shows empathy
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1

Avoids jargon
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1

Summarises back to patient
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1

Thanks patient
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1

Patient global score
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1
2