Actor Script — Bed Space 1

History of presenting complaint: 38 weeks pregnant. Has had a headache since yesterday. Band around the front of her head. Not improved with paracetamol. 5/10 pain scale. Throbbing. Associated with a bit of blurred vision and occasionally flashing lights (“it looks like the opening credits to Star Wars”). No other associated symptoms with the headache.

Also noticed mild swelling of her ankles yesterday. Think has improved overnight – not as bad this morning. Still feeling baby move. No abdominal pain. No vaginal bleeding.

First pregnancy. No problems during pregnancy. Has attend all antenatal appointments.

Past medical history: No past medical history

Drug history: Allergy to penicillin – causes a rash.

Family history: Your mother had breast cancer 2 years ago (60yrs old) however she has responded well to treatment. You do not know you father.

Social history: You live with your partner. You work as a primary school teacher. You were due to finish work next week and start your maternity leave. You used to smoke 10 cigarettes a day but stopped when you found out you were pregnant. You partner still smokes at home which you do not like but has promised to stop when the baby arrives. You had a sip of Champagne at the weekend at your best friend’s wedding, and you are worried this may have hurt the baby. You do not take any recreational drugs.

Systems review: No other concerns

You will be the same character all morning. The simulation is split into two halves. 2 students will be looking after you for each part of the simulation. These will be observed by student observers. The observers are there to provide feedback for the student and should not be involved in the simulation itself. Following each half of the simulation you will be asked to provide feedback from the patients perspective.

Students will need to take a history from you. There will be a pregnant abdomen model for them to examine. They may wish to take your vital signs however a set of these will already be available. Students may explain to you that you have preeclampsia and then explain they will refer you to the obstetric team.

You have given birth via an induced vaginal delivery to a baby boy. You are feeling much better. You are unsure what the term pre-eclampsia means and therefore would like the students to explain this to you if they have not done so already. You were given labetalol whilst pregnant by the obs team but now they have said you need a different drug (either enalapril or nifedipine). You want to know what side effects these may have and if they are safe for your baby.

The students will need to take your blood pressure and a new set of observations. As your blood pressure will not be elevated you are keen to go home as soon. You want to know if that is possible and if so when might you be followed up.

The students will then need to perform a newborn examination on your baby. This is a screening check to make sure everything is ok. Ask them to explain to you why they are doing this. You baby has peed and passed urine. You have started breast feeding and think it is going ok at present. The students may give you a red book. This is the handheld notes for your baby, and you will need to take them to medical appointments. You are keen to know what other screening test your baby may need. Ask the students to talk you through these. These will include the newborn heel prick test at around day 5 which tests for certain genetic conditions, a hearing screening which involves a fine probe being placed in your baby's ear and then a 6-week check which will be at your GP.

NICE information: https://cks.nice.org.uk/topics/hypertension-in-pregnancy/management/postpartum-follow-up/