Clinical Transition Unit Actor Script — Bed Space 5 (2 actors required) |
CTU |
| Patient Name | Cameron Wild (actor 1) |
|---|---|
| Age/DOB | 76 (01/01/50) |
| Presenting Complaint | Delerium |
History of presenting complaint: You have dementia. You also have a urinary tract infection. You are therefore very confused and restless. You are not responding to the students questions and you keep trying to get out of bed and wander around. Initially you get back into bed willingly however keep doing this and trying to get into bed with other patients. If the actor as your partner tried to stop you really shout at them and run them down, saying how useless they are. Then shout for help saying they are trying to hurt you.
You will be with Cameron and students will be expected to speak to you to take a history.
Presenting Complaint: Increased confusion and falls
History of presenting complaint: Has been increasingly confused over the past 24 hr. Has been struggling to orientate themselves around the house and forgetting who you are. You think they may have been hallucinating as they seemed at times to be talking to someone else in the room. They have felt warm today and have been struggling to pass urine. They have seemed less stable walking also today but have not fallen.
They have no other symptoms.
Past medical history: Alzheimer dementia. Progressively getting worse. You are struggling to cope. Currently you are Cameron’s main carer, and you feel like you could do with some help. If students, ask more about this show them bruises on your wrists which are from Cameron grabbing you. You are concerned about your safety and would welcome further help.
Drug history: No medication. No allergic to anything
Family history: No known
Social history: You and Cameron are both retired. You live in a two storey house which has been challenging recently because Cameron has been struggling with the stairs. You are worried that they will fall. Neither of you drink, smoke or use any recreational drugs.
Systems review: No other concerns
ICE: You think Cameron may have a water infection. You are concerned however if not if this is worsening of their dementia. You are also worried about how you will cope if they send you home with antibiotics as you are not sure you can without more help. You are expecting them to do some tests.
This is a two-actor station where students will be expected to take a collateral history. 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 patient’s perspective.
Students will need to take a collateral history from patient’s partner. They will need to try to examine the patient. Cameron will be reluctant to do this initially however if they develop a rapport with students, they will be very accommodating. Cameron will be very aggressive and angry towards their partner, especially if they keep telling them to get back into bed. If students pick up on this, please can Mo explain to them about their concerns about looking after Cameron and that you do not feel safe, showing them your bruises. Mo will be happy for a referral to safeguarding. Cameron’s investigations will show evidence of a urinary tract infection, and appropriate antibiotics will be started
Whilst on the ward, Cameron has a fall and has injured their right hip. They will need to be examined and are reluctant to have this done. They will have limited movement and lots of pain when their hip is touched. An x-ray will show a fracture and then students will need to refer to trauma and orthopaedics. Mo will be very upset about this. They are angry that Cameron has hurt themselves whilst on the ward. They want to know what will be done about this. They will be reassured if student approach this appropriately.