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Interviewing Cancer Patients Group 34 - Coggle Diagram
Interviewing Cancer Patients
Group 34
Pt. #1: B.B
45 year old african american woman who reports painful bloody bowel movements.
Pt has a history of emphysema but was adopted so does not know any family history.
Pt uses and inhaler and takes aspirin.
Pt denies drinking or illicit drug use. Pt has smoked a half a a pack of cigarettes daily for 30 years.
What is assumed?
Pt smokes and has emphysema, the first thing to assume would be lung issues.
Bloody bowel movements correlate with colorectal cancer
what is known?
Usage of Inhaler and Aspirin
Pt smokes half a pack a day for 30 years.
Pt has emphysema.
tobacco use is a risk factor for colorectal cancer
what stands out?
Bloody and painful bowel movements.
Mnemonic questions...
S: On a scale from 1-10, how painful is it when you make a bowel movement? Or before/after it?
C- What does the pain feel like? Is it a shooting pain, stabbing pain, ache?
O - When did this begin? Is there only pain during a bowel movement?
L- Where is the pain located? The rectum, abdomen, etc?
D - How long does the pain last? Does it last the duration of a bowel movement? Longer or shorter? Is there only bleeding during a bowel movement?
T- How long does the pain last? How frequent is it?
OLDCARTS
A – does anything trigger the pain other than bowel movements? Is it worse at certain times? Is it worse after eating? Is there anything that alleviates the pain?
Have you been experiencing lethargy and fatigue?
what other info would be helpful?
What other symptoms are you experiencing?
A CT scan to look for tumors
Stool sample for testing
Genetic testing would be helpful because she is adopted and does not know about her family history.
a chest x-ray to see lungs
Have you been experiencing any more frequent spurts of shortness of breath?
Have you experienced any unusual bleeding other than the bloody bowel movements?
Have you experienced hematuria (blood in urine) too?
Have you been experiencing any back pain?
Have you been experiencing unexplained weightloss?
Have you been experiencing a feeling of being unable to empty your bowels completely?
Have you been screened for inflammatory bowel disorders such as ulcerative colitis or crohn's disease?
How would you explain your diet?
What type of lifestyle do you lead? Is it sedentary, active, lightly active?
Have you been experiencing an unexplained cough?
Have you noticed any change in your voice?
Have you noticed any pain in your bones or joints?
Pt #2: C.C
21 year old female presents with a persistently sore throat. Has been swabbed for strep and flu and has come up negative.
Pt is HPV +
Pt had a Colposcopy at 18.
Parents have no known illnesses- they are healthy.
Pt takes a daily vitamin and oral contraceptive.
Pt uses the tanning salon daily, denies smoking cigarettes, drinks socially, recreationally uses marijuana, denies illicit drug use.
SOCRATES
C- describe the soreness in your throat, any unique symptoms?
E: Does consumption of food, drink, alcohol, etc. trigger pain?
S- how severe is the pain on a scale from 1-10?
T- Time and Duration: She goes daily. How long are you laying in the tanning bed for each time?
O- when did you start to notice pain in your throat?
what is known ?
HPV Positive
Denies smoking & other illicit drug use.
Pt uses the tanning salon daily.
persistent sore throat, tested negative for both strep and influenza.
HPV can be correlated to oropharyngeal cancer
what is assumed
frequent use of a tanning bed can lead to many diseases and types of cancers
HPV + means you are at risk for cervical and laryngeal cancer
what stands out
persistently sore throat
uses tanning salon daily
what is needed to narrow down diagnosis?
is there plaque in her throat?
a skin biopsy to test for melanoma
women's health check - Pap smear, etc to because she is HPV +
Do you wear sunscreen daily?
Have you noticed any change in your voice?
Have you noticed any lumps or swelling in your throat or lymph nodes?
What were the results of the colopscopy?
What type of HPV were you infected with?
Have you experienced a difficulty swallowing?
Have you experienced unexplained weight loss?
Is there a white patch on your tongue or lining of your mouth that does not go away?
Do you live near any power plants?
Where was your HPV located?
Do you get frequent pap smears?
Have you been experiencing unexplained fever and chills?
Do you bruise or bleed easily?
Have you noticed any rash or experienced itchiness most common on the lower extremities but could be anywhere?
Have you been experiencing any abdominal pain or unexplained bloating? If so, how frequently?
Have you been experiencing chest pain?
Have you ever received a CBC? If so, what were your WBC count, hemoglobin levels, and albumin levels?
What is your natural hair color?
Do you have alot of moles?
Have you noticed any change in shape or color in your moles or freckles?
Have you noticed any discoloring in your nails?
Pt. #3: D.D
36 year old latin woman experiencing difficulty focusing and remembering things.
Pt has a history of arthritis.
Pt's mother died from complications of DM at 40/ Pt's brother has a history of HL. Pt's sister has a history of Ovarian Cancer. Pt drinks socially but denies smoking cigarettes or illicit drug use.
Pt takes NSAIDS, Methotrexate, and oral contraceptive.
PQRST
S:What is the characterization of when the memory loss or focus is the worst?
R- Region and Radiation. If she has breast cancer is it benign or malignant. Is it contained or will it metastisize
Q - how much does it affect your daily life? can you still teach a days worth of school? Is it safe for you to drive? Is it more long term or short term memory? is it memory lapses - like forgetting for a second and then remembering or completely forgetting?
T- how long have the memory issues gone on? any new onset of strange symptoms recently?
what stands out?
concerning family medical hx - ovarian cancer, hodgkin's lymphoma, DM
memory loss
what is assumed?
Higher risk of developing ovarian cancer due to family history of it
if cancer has spread to her spinal cord that will be cause of memory issues
what is known?
family hx of: DM, ovarian cancer, hodgkin's lymphoma
trouble focusing and remembering information
Hispanic/latina ethnicity
Oral contraception and medications used for arthritis,
We know that it is commonly found that breast cancer can metastasize through the lymph to the spinal cord
what is needed to narrow down diagnosis?
a mammogram to rule out breast cancer and metastsizing
transvaginal ultrasound to rule out tumors on the ovaries.
Have you had any genetic testing done?
Have you been experiencing dizziness?
Do you take your medications as intended?
Have you noticed any lumps in your breasts or lymph nodes?
How often do you get a mammogram?
Have you noticed abnormal nipple discharge or pain?
Have you experienced shortness of breath?
Have you had your serum calcium levels checked?
How long have you been on contraceptives?
Have you experienced abdominal bloating or swelling?
Have you experienced changes in your bowel movements?
Do you menstruate regularly or irregularly?
Do you have any children? If so, how many?
Have you noticed personality changes other than memory loss or the inability to focus?
Have you noticed any difficulty balancing?
Have you had exposure to radiation? If so, how often have you been exposed?
memory test