Patient Instructions
Name of Patient:
Margaret Holdsworth, aged 81
Description of the patient & instructions to simulator:
Few months history of feeling more breathless, especially on exertion.
Also noticed ankles are a bit more swollen than normal, especially at the end of the day.
Mild cough
No chest pain or palpitations
Feels fatigued.
Sleeping with two pillows recently to stop feeling short of breath, as she gets 'puffy' if she lies flat. No gasping for breath in the early hours
Had blood tests and CXR checked last week after seeing GP and come back for results today.
Anxious that there is something wrong as she needs to be well to look after Derek when he needs her.
Lives with husband, Derek and 2 cats. Enjoys gardening, but finding this a bit of a struggle at the moment as not been as well in recent months.
Normally independent, no extra help at home currently.
Derik has his own health problems – diagnosed with rectal cancer last year, inoperable, for palliative care. Currently doing really well and managing to be independent but huge concern for Margaret that she can’t afford to be unwell too.
Possible diagnosis of heart failure was not explained at previous appointment.
PMH = Hypertension and osteoporosis
ICE
Ideas – Thinks it’s something to do with her lungs – it is a chest infection.
Concerns – Needs to feel better, asap, to be able to care for her husband.
Expectations – Probably will just need some antibiotics.
Doctor’s (GP ST) Instructions
Name & age of patient
Margaret Holdsworth, 81
Summary Card
PMH: Hypertension, Osteoporosis
DH: Bendroflumethiazide 2.5mg OD. Adcal D3, Alendronic Acid
Allergies: Amoxicillin
BP/BMI/ ?smoking and alcohol hx:
Never smoked.
Minimal alcohol intake.
Case Notes - Last few entries in records:
Last week – 2/12 hx feeling more sob on exertion. Mild cough. No temps. No weight loss. Non smoker.
Plan – check ECG, CXR and bloods inc BNP. Review with results.
Results –
BNP 400
CXR – mild cardiomegaly
Hb – 135
U+Es – normal
ECG – sinus rhythm, Regular
CSA EXAMINATION CARD
Patient Name: Margaret Holdsworth
Examination findings:
BP 125/80
P80 reg
BMI 27
Chest – mild wheeze, fine bibasal creps.
Comfortable at rest, breathless on exertion.
Mild pitting oedema to ankles.
Sats 98%
Heart sounds normal.
CSA Case Marking Sheet
Context of case
n Heart Failure
Assessment Domain:
1. Data-gathering, technical and assessment skills
Positive descriptors:
n Reviews symptoms from prev consultation and asks specifically about HF symptoms
n Asks about impact on life – impact on ADLs and ability to cope at home
n Asks about general health
n Enquires about husbands health and home situation and impact of illness on these
n Explores her ICE. / Negative descriptors:
n Does not review symptoms
n Does not ask about how it’s affecting ADLs
n Does not enquire about general health
n Does not enquire about husbands health and home situation
n Does not explore her ICE
Assessment Domain:
2. Clinical Management Skills
Positive descriptors:
n Interprets results correctly – suggest heart failure
n Provides an comprehensible explanation of HF which makes sense of symptoms and Rx
n Offers to refer to specialist services for Echo and assessment/confirmation of diagnosis
n Offers to swap bendro to loop diuretic to provide the rapid relief of symptoms she wants
n Explores options to help her support Derek
n Provides follow up appt.
n Offers written information
n Safety nets re worsening symptoms / Negative descriptors:
n Does not recognise results suggest heart failure
n Fails to response to her ICE
n Does not offer Rx
n Fails to recognise requires specialist referral
n Poor/absent explanation of heart failure
n Fails to offer follow up
n Fails to offer social services assessment
n Does not safety net
Assessment Domain:
3. Interpersonal skills
Positive descriptors:
n Breaks bad news sensitively
n Offers emotional support for patient
n Attentive to concerns and fears
n Offers to speak with Derek together if patient wishes / Negative descriptors:
n Doctor centred – does not recognise concerns about husband
n Uncaring, unsympathetic
2