Kofi Mensah is a 70-year-old gentleman you visit at his home with your practice assessor. He is married to Agnes and they have a 40-year-old daughter and 4 grandchildren.
He has recently been discharged from hospital after falling down the stairs at home. He is complaining of pain in his chest. This is not cardiac related; his discharge letter confirms that he has a fractured rib as a result of his fall. Kofi has been seen this morning by his GP and has been prescribed analgesia. He is reluctant to take these regularly for fear that he will become addicted. He is speaking very slowly due to the pain and is finding it difficult to share information with you.
He worked as a pub landlord but retired a few years ago due to poor health. He used to have a very active social life but has not been able to go out for some time because of limited mobility. He has become withdrawn but enjoys seeing his grandchildren and close family members.
Observations
Signs and Symptoms
Past Medical History
Current Medication
Family History
Social History
Discuss one assessment strategy for this symptom/sign and explain the underlying pathophysiology.
NOTE
PLEASE USE ABCDE APPROACH TO ASSESS THE PATIENT
Case Study 2: The Patient with Shortness of Breath
Hayley Smith is a 32-year-old female patient, who works in retail as an Assistant Manager in a high street shop. She attended A&E this afternoon complaining of shortness of breath and wheezing which started early this morning but has progressively worsened. She has used her blue inhaler, but this did not relieve her symptoms. She ran out of her ‘preventer’ inhaler 5 days ago. Hayley says she has had attacks like this before, so knew to come into hospital as when she feels like this, she knows she needs help. She has a new-born baby at home.
A&E is very busy, and Haley is anxious to get home to her son.
Observations
Social History
Signs and Symptoms
Past Medical History
Current Medication
Family History
Mother has type 2 diabetes.
Social History
Discuss one assessment strategy for this symptom/sign and explain the underlying pathophysiology
NOTE
PLEASE USE ABCDE APPROACH TO ASSESS THE PATIENT
Case Study 3: The Patient with Tachycardia
Arjun Bakta is a 58-year-old gentleman of Hindu heritage. He came to England from Punjab with his parents when he was a child. He is married to Nisha and they have 4 adult children. Two of their children live at home, along with Arjun’s mother who is 82. They live in a 4-bedroom terraced house.
Arjun has a PhD and works as a laboratory technician for a pharmaceutical company. He finds his work incredibly stressful due to staff shortages and is expected to work long hours. This has resulted in him having episodes of anxiety and depression which he does not like to discuss. Gradually, he is beginning to lose interest in his job and phones in sick regularly.
He has come into A&E via his GP with tachycardia, palpitations and shortness of breath.
Observations
Signs and Symptoms
Past Medical History
Current Medication
Family History
Social History
Discuss one assessment strategy for this symptom/sign and explain the underlying pathophysiology.
NOTE
PLEASE USE ABCDE APPROACH TO ASSESS THE PATIENT
Case Study 4: The Patient with Altered Conscious State
John Kelly is 82 years old and was admitted to the ward this morning via A&E having fallen at home. John is a widower and has been living on his own for the last 6 years since his wife died. He has 4 grown up children (3 sons and a daughter), 7 grandchildren and 12 great grandchildren.
John’s eldest son and daughter-in-law live nearest to John, so came to the hospital with him and are now on the ward. Physically John appears to be well and, although bruised, x-rays show that he has no fractures. However, John seems to be confused and when you ask his son about this, he insists that his father is ‘just being awkward as usual’. However, John’s daughter-in-law appears concerned and reports that she thinks John has become increasingly confused over the last 2 weeks.
Observations
Signs and Symptoms
Past Medical History
Current Medication
Family History
Social History
Discuss one assessment strategy for this symptom/sign and explain the underlying pathophysiology
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