BACKGROUND: What are they experiencing (insert symptoms)Relevant information (include observations from PPS)

Eileen s a 98-year-old woman living in her home. She has chronic obstructive pulmonary disease. She receives oxygen through a nasal canula and receives opioids daily to manage her breathlessness. You visit to provide personal care and help her with breakfast. This morning when you arrived to help her get out of bed, she was frowning and moaning, and she shook her head and said, "No, not today. I'm staying in bed!" You responded, "You are not your usual self. What is happening?" She replied, "My tummy is hurting. I don't want to get up." She suddenly pressed her hands to her midsection, called out in pain, groaned loudly, and rolled onto her side. You asked if a pillow behind her back and between her legs would help make her a bit more comfortable, and when she agreed, you positioned the pillows. Eileen gave you permission to ask her some more questions and talk with the nurse. She said that the pain in her tummy started this morning. You asked her to point to where it hurts, and she rubbed her hand up and down and back and forth over her abdomen. You asked her to de- scribe the pain, and she replied, "The spasms come and go."You asked her to rate her pain on a scale of 0 to 10, with 10 being the most severe pain that she can imagine and 0 being no pain. She said that when it is bad it is an 8 out of 10, and when it is not bad her abdomen is just tender. She was not able to say how often the pain comes and goes. She thought it may be caused by eating too much dinner. She also did not remember when she had her last bowel movement. She was short of breath as she responded to the questions. You asked how you can best help, and she said she doesn't know, but that she needs something done because the pain is awful. You told her that you will get her some water and will phone the nurse to let her know about the pain, and to ask if she can see Eileen today