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Final case study

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Hi, is this Mrs. Sullivan? Oh, no. It’s Miss Sullivan. Hi, Miss Sullivan. My name is Amira I’m the prescribing pharmacist covering the emergency line today at the surgery. I’ve been told that you are having trouble breathing today. Can you can I just start by confirming your name and date of birth, please? Yeah, it’s Natalie Sullivan, and my date of birth is the 17th of January, 1984. OK, great. And are you happy for me to ask further questions so that I can find out how I can help you today? Yes. Yes, that’s fine. So could you just tell me in your own words why you called us today?
I’ve had this cough for about a week now, and it keeps waking me up at nights. And sometimes I’m kind of feeling like I can’t catch my breath.
OK, so could you tell me a little bit more about that shortness of breath that you’re getting? Yeah, well initially it wasn’t that bad, but now I feel like it’s getting really hard to take a full breath, especially in the last few days, and I’m coughing up lots of stuff as well. And when I’m breathing, I feel like I can hear a whistling sound when I’m breathing, and I’m starting to get really worried about it because I’ve got this– I’m starting to get this pain in my upper back as well.
If I just recap with you. So you’ve mentioned that you’ve had your symptoms for roughly about a week? Yeah. It’s affecting your sleep, you’ve started noticing a bit of shortness of breath and some whistling wheezing sound when you’re breathing. And you’ve also mentioned the upper back pain. Is that right? Yeah. That’s right. And the stuff that you said that you’re coughing up, what colour is that? Well, I think it started being white colour and now it’s gone quite dark green now. OK. And just to confirm do you use inhalers at all? Yeah, well, I used to have childhood asthma. Sorry. I have these inhalers, but I don’t really use them all the time cause my symptoms aren’t that bad.
But, actually thinking about it now, when I was a child I did used to end up in hospital a lot because of my breathing. But I don’t use them now really, all the time. OK. And to confirm the inhalers that we’re talking about, is the blue Salbutomol 100 microgram and the brown Clenil 100 microgram inhalers. Is that right? I don’t know. I don’t know. I don’t know, to be honest. I don’t even know where my inhalers are to check because I haven’t really used them in months OK, and do you know exactly the last time, you might have used them? I had a chest infection months ago, and I used them then. OK. Fine.
And was there anything else you wanted to mention today? Yeah, well I’m also a bit worried because I’ve lost some weight. I’ve noticed I’ve lost weight and I’ve not been trying to at all. And it’s just that food doesn’t taste very nice at the moment. OK. And do you know how much weight you’ve lost and over what period of time?
Probably about half a stone just in the last couple of weeks, I think. But to be fair, there’s not much food in the house. I’ve really been struggling to stock up, and my little boy is living off the sweets that we’ve got in the cupboard because I just don’t have the appetite, and I can’t get out. OK, do you have any allergies at all? No. OK. And what about your parents or your immediate family’s health histories, or any kind of long-term history, long-term conditions that anybody has? Mum, dad, siblings?
Well, my Mum died when I was quite young. And my dad has COPD. I’m not really in touch with my siblings. OK. And what about your situation at home? Is it just you and your son? Yeah, it’s just me and Nathan. But like I said, I have really been struggling to leave the house in the last week, and he’s been living on sweets and crisps and just what we’ve had in the cupboard. Yeah, looks like he’s going to need a trip to the dentist once you feel better. I guess. OK, and do you smoke at all? Yeah, I do. I do. About 10 a day for quite a long time. All right. And do you smoke at home?
No, no, no, no. OK. Any illicit substance use? No, not anymore, no. OK. You mentioned having a fever, as well. Did you have any headaches or is there any sensitivity to light or vomiting at all? No. No. And did you actually check your temperature today? No. No, I haven’t checked it today. I just feel like I’ve got one. OK. Have you had any issues passing urine or opening your bowels at all? Nope. Everything’s normal. Well, I think from my side, that finishes all the questions that I had. Was there anything that you wanted to add or ask me?
No, I guess I’ve told you everything. I’m just, I’m worried about not being able to look after my son. But the way I’m feeling, and with the back pain and the breathlessness. Right. I mean, with the back pain, do you remember exactly when the pain started? Were you doing something? Did you lift anything in particular? Not that I remember. It started around the same time as the cough started. All right. OK. So, I mean, based on the symptoms that you’re showing and the chat that we’ve had today so far, we could say that it’s, what we call an exacerbation of your asthma. It’s possibly being caused by an infection in your lungs.
So we would– the way we would approach it is we would restart your inhalers to start managing the asthma, and then treat the infection with the antibiotics. And the back pain can be explained by the constant coughing that you’re having, so it puts that strain on the muscles in the back. Another thing that we need to look into a bit more would be the weight loss that you mentioned. But how does the plan sound so far, in terms of treating the infection and restarting your inhalers to stop managing your asthma so that this thing doesn’t happen again? Yeah. Yeah. Anything to help me breathe better and just not feel this rough. Yeah. OK.
So what I’ll do is I’ll get in touch with the pharmacy. We’ll send the prescription over for the antibiotics and the inhalers, and we’ll see if they can drop off the medication for you. Yeah, that would be great cause yeah, I really can’t get out of the house at the moment, the way I’m feeling. OK. I’ll also arrange for the community nurses to have your bloods done at home. And then once you start to feel a bit better, we can order a chest X-ray and then we can– so that we can start looking into your weight loss in more detail. OK. OK, thank you.
OK, and before I let you go, I just– a couple of things to take home with you. So just make sure that you complete the course with the antibiotics, even if you start to feel better. That will just get rid of the infection completely. If you find that your breathing gets worse or your wheezing gets noisier as such, or will you start to feel worse in any way, then make sure you give us a call back. Or if we’re shut, then there’s always the NHS 111 line that you can contact. OK? OK. I will do. OK, thank you very much for your help. Thank you. All right. Take care.

Welcome to the final case study!

Watch the video above and listen to the excerpt of a consultation between Miss Sullivan and the pharmacist.

Whilst watching we would like you to critique the consultation, what goes well and what does not go so well. You may wish to use the following questions a prompt for your answer:

  1. Does the clinician use an identifiable model for the consultation?
  2. Was it appropriate to hold this consultation remotely? Explain your answer.
  3. Did the clinician take basic observations during the consultation? Were there any in particular that might have been useful?
  4. Could the clinician have made use of any risk stratification tools whilst in the consultation? If so, which ones?
  5. Did you pick up on any safeguarding issues during the consultation? What were they?
  6. Did you pick up on any red flags during the consultation? What were they?
  7. Did the clinician close the consultation appropriately? Explain your answer.
  8. Did the clinician safety net the patient appropriately?

Share your thoughts in the comments section below and take some time to read and respond to other learners’ comments.

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Conducting Remote Consultations and Triage

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