Answer 2

  • Gain informed consent
    • 1. Explain the nature of the treatment, benefits, risks, side effects, alternative courses of action, any possible consequences of not having the treatment
    • 2. Answer questions asked from patient
    • 3. Get consent verbally, in writing, or implied through behaviour 
    • 4. Patients can refuse consent or withdraw consent at any moment 
    • 5. If the patient is unable to consent, refer to the substitute decision maker.
    • As there is no mention of cognition issues, explain that you would still monitor their cognition by monitoring how they answer questions and follow conversation.
  • Continue with subjective assessment
    • Presenting complaint of pain and drop foot
      • Onset
      • Location
      • Duration
      • Character of pain (dull, tingliness) 
      • Aggravating factors
      • Relieving factors
      • Past pain (Has he felt this before?)
      • Progression of pain
    • Review medical history
      • Mention how he had not remembered a trauma but would still ask about trauma just in case
      • Has he had any investigations?
      • Other than the family doctor, has he seen anyone else?
      • Does he have any other diagnoses/comorbidities?
    • How is his general health?
      • Smoker?
      • Alcohol intake?
      • How is his physical activity level?
    • What is his social history?
      • Living situation
      • Does he have stairs in his house?
      • Is his bathroom on the main floor?
      • Is his bedroom on the main floor?
      • Does he already have supports in place?
      • How is he managing at home?
      • Does he have transportation into the clinic?
      • Family support?
      • If he has family support, how is their health?
      • Any hobbies?
      • Do these symptoms stop him from doing his job/hobbies?
    • Goals
      • What does he want to achieve?
      • Collaborate with Paul to ensure short and long term goals are SMART.