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M
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CASE
HISTORY
ACUTE
PAIN IN PALLIATIVE CARE
Jean is a 72 year-old woman with recurrent bowel cancer following a hemi-colectomy two years ago. She is known to have both local recurrence and liver metastases and her pain has been under control on MST 90 mg bd. She has a small sacral pressure sore which is dressed regularly by her district nurse. She lives with her 78 year-old husband who has angina.
Question 1.
You are the district nurse visiting to change her sacral dressing one Sunday morning. Jean's husband is relieved to see you as she has had quite severe pain in the right upper abdomen for the past hour despite having taken her normal dose of MST. He is not sure what to do. What would you do in this situation?
Question 2.
You are the duty doctor at BORDOC and receive the message to phone back the district nurse. Before speaking to her you consider the possible reasons for Jean's sudden onset abdominal pain. What might they be?
Question 3.
You are the doctor doing home visits that morning. What features would you look for to try and establish the cause of her acute abdominal pain?
Question 4.
What action would you take?
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