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B. - Constipation, Uhm yes actually, I have some pressure in my stomach…
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Uhm yes actually, I have some pressure in my stomach which has been causing some discomfort. I am not sure what it could be.
There are a lot of possibilities for what this could be. Asking broad questions then narrowing in could be a good strategy.
It is probably nothing. John usually experiences these aches and pains and they have always been nothing.
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You are a Nurse partaking in a regular home visit to a patient, John, suffering from Parkinson's Disease (PD). They are living with their daughter and part-time caretaker Sandra. You have met with them multiple times prior.
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Hello Sandra, may I come in?
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Hello John, How are you doing today?
Hi, I am doing alright. Just been cooped up watching television as usual.
Were you wanting to go outside for a bit today? I know it can be hard for you but we can take our time if that is something you want John.
Oh no, I am just joking around. I like my shows.
Alright well, do you mind if I ask you some questions? Just to get up to date on how you are doing?
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Ah, just some aches and pains. The usual.
Ah yes, I remember the usual aches and pains. Are there any new aches and pains?
Ok John. Are you experiencing any bloating, stomach pain or cramps, diarrhea or constipation?
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Yes, I have. I had one this morning.
Ok, so it's probably not constipation. You just have stomach aches.
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Alright, how about any diarrhea or constipation?
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No diarrhea, but I might have constipation.
It is perfectly normal to feel uncomfortable. If you are able to feel comfortable enough to tell me I can give you something to help with whatever is bothering you, John.
That is completely normal John. Don't stress about it. I have an assessment form for you if you don't mind filling that out for me. It will just tell me what problems you are having and lets me know what I can do to help you. Is it ok if I give this to you to fill out?
Yes, that's fine. Thank you.
You are very welcome John, that's what I am here for.
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You go over the GIDS-PD questions with John providing simple instructions according to the GIDS-PD questionnaire. You ask John to select the statement that best describes his symptoms.
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You were right in your assumption that it was constipation. Good job. But now you made John feel as if you do not really care and in the future he is going to be more apprehensive to telling you about problems he is having.
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I will look over your scores in a minute. First can we do a Bristol Stool Form Scale (BSFS)? It is used to have you identify what your average stool looks like to the best of your ability.
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Only if you are comfortable doing that. They are just examples to help me know what kinds of bowel movements (BM) you have been having.
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John and you look at the BSFS together. He circles Type 2 and Type 1. This indicates that mild and severe constipation occur frequently.
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You missed an opportunity to investigate a problem that made John uncomfortable. John may not have wanted to talk about this issue which is why he lied to you about having defecated.
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John, would it be ok if I did a physical assessment for you?
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No John, that wouldn't be necessary.
Well, uh, I don't want to do anymore.
Alright, that is ok. What I would have done is take my stethoscope and auscultate your bowels. Essentially just listening for normal bowel sounds. It is not as scary as it sounds. If you could think about letting me do that for you on our next visit I would appreciate it.
Ok ok, Ill think about it. Thank you for coming,
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You talk to his daughter/caretaker about asking him prior to your next visit if he will let you do an assessment of his bowels. You also ask her to contact you regarding medication that can be prescribed for his constipation. Then you leave.
Great job! When a patient gets uncomfortable they often won't want you to continue, like in this case. Although it could be beneficial for you to do an assessment their consent also matters. You had John do a GIDS-PD and a BSFS which allowed for you to determine that he has constipation.