Interlocutor: SETTING: Community Health Centre

PATIENT: You are 70 years old and are concerned because your fingernails have become yellow and break easily. You want some advice. The nurse has just examined your nails. TASK: When asked, say the problem started a couple of months ago; your fingernails became yellow and now break easily. You haven’t had this before. You haven’t injured your nails and they aren’t painful. You’ve only tried over-the-counter nail cream but it’s not helping. Say you’re generally well and very active. You aren’t on any long-term medication. You don’t have any other symptoms. Say you don’t drink very much water and you don’t eat that well; you don’t really like fruit and vegetables. You sometimes take vitamin supplements, but that’s it; It could be aging but you know that you don’t have a thyroid problem. Say you’ll try to make some changes to your diet; you’ll try to eat more fruit and vegetables. Say you’ll continue using the nail cream and you’ll make a doctor appointment.

SETTING: Community Health Centre

NURSE: You see a 70-year-old patient whose fingernails have become yellow and brittle. You suggest a possible cause and give advice on self-care. You have just examined his/her nails. TASK: Find out relevant details (onset, previous occurrences, any injury to nails, any pain, treatments tried, etc.). Find out further information about patient (general health, new/long-term medication, any other symptoms, etc.). Give possible causes of yellow/brittle nails (aging, poor diet/fluid intake, vitamin deficiency, underlying thyroid problem, etc.). Explore relevance of these to patient. Explain that diet/fluid intake is likely cause of nail problem. Stress needs to make dietary changes (e.g., increase in fluid intake, balanced diet, etc.). Make suggestions for improving condition of nails (e.g., regular use of nail cream, keeping nails short, etc.). Recommend making doctor appointment (e.g., health check, rule out any underlying problem/cause, etc.).

Sample role play transcript by Lifestyle Training Centre

Nurse: Hi, Soffiya. I have just completed checking your fingernails, and I understand that your fingernails appear yellow and brittle. Is that right?

Patient: Yes.

Okay, before we proceed any further, I would like to collect some information for documentation purposes. Can you please tell me your age?

Patient: Sure, I’m 70 years old.

Nurse: Do you smoke or drink?

Patient: I do not smoke.

Nurse: And when did this issue actually start? Have you experienced this anytime before? Have you ever injured your nails, especially recently?

Patient: I haven’t experienced this before, and I haven’t injured my nails recently.

Nurse: Do you experience any pain on your nails? Have you tried any treatments?

Patient: No pain, and I haven’t tried any treatments.

Nurse: Okay, I understand. I would like to collect some more information. Please tell me about your general health. Are you okay health-wise?

Patient: Yeah, I’m well.

Nurse: And are you on any long-term or new medication?

Patient: I am not taking any long-term medication.

Nurse: Do you experience any symptoms connected to this issue?

Patient: No, I don’t have any other symptoms.

Nurse: Okay, thanks for providing all this information. Now, let me also talk about the possible causes of this condition. Can you think of anything that may be causing this condition?

Patient: Not really, I’m not sure. I don’t drink much water. Is that a problem?

Nurse: Okay, we’ll come to that. First of all, age has some role in this. Maybe as we grow old, our fingernails become softer and not so strong. Maybe it has a part to play. And you say that you do not drink much water. It’s actually very important to stay hydrated. Please make sure that you drink regularly enough water. Do you understand?

Patient: Yes, I understand.

Nurse: Vitamin deficiency can contribute to this problem. So please make sure that you consume proper nutritious food and supplements. For example, do you take enough vegetables?

Patient: No, but I’ll try to pay more attention to my diet.

Nurse: Sometimes underlying thyroid problems can contribute to these kinds of issues. Do you have any thyroid issues?

Patient: No, I don’t have any thyroid issues.

Nurse: Okay, that’s good news. Please make sure that you make these changes, and increase your fluid intake and maintain a balanced diet. I also recommend that you schedule a doctor’s appointment, just to check your overall health. Could you do that?

Patient: Sure, I’ll make an appointment.

Nurse: Okay, that’s wonderful. Please apply nail creams regularly as well and see how it works. Cold you do that?

Patient: Yes, I’ll give it a try.

Nurse: In order to avoid any injuries, please make sure that you cut your nails short. That should also help. Okay?

Patient: Got it.

Nurse: Alright. Do you have any more concerns or questions?

Patient: No, thank you, I appreciate your help.

Nurse: You’re welcome. Take care, Soffiya.

Mock test on 18/03/2024

Nurse: Hi, John. I have just completed the assessment of your nails, and I understand that you are suffering from this condition where your nails are yellow and brittle. Is that right?

Patient: Yeah, that’s correct.

Nurse: Okay, I’m sorry, but I’ll be glad to assist you today. But before we proceed any further, I’d like to collect some information for documentation purposes, is that all right?

Patient: Yes, of course.

Nurse: Great. Let’s start with your age. How old are you, John?

Patient: I’m 70 years old.

Nurse: Do you smoke or drink?

Patient: No, I don’t.

Nurse: Do you have any ongoing health concerns apart from this issue with your nails?

Patient: No, I don’t have any other health concerns.

Nurse: Are you allergic to any food or medicines?

Patient: No, I’m not allergic to anything.

Nurse: Okay, when did this issue with your nails start exactly?

Patient: It’s been a couple of months now.

Nurse: And is this the first time you’re experiencing this issue, or have you had it before?

Patient: No, it’s the first time I’ve experienced this.

Nurse: Do you experience any pain or discomfort related to your nails?

Patient: No, not at the moment.

Nurse: Have you tried any treatments for your nails?

Patient: Yes, I’ve tried over-the-counter treatments, but they haven’t helped much.

Nurse: Okay, I understand. Based on your symptoms and history, can you tell me what you think may be causing this issue?

Patient: I’m not sure exactly, but my fingernails have become yellow and brittle.

Nurse: Understood. How would you describe your overall health aside from this nail issue?

Patient: I’m generally in good health, aside from this.

Nurse: Alright. Based on the information you’ve provided and my assessment, I think there could be a number of factors contributing to this problem. First of all, age can naturally affect the health of nails. Additionally, diet and hydration levels play a significant role. Do you drink enough water daily?

Patient: No, I don’t drink much water.

Nurse: Okay, that could be a contributing factor. It’s important to stay hydrated. Additionally, vitamin deficiency could contribute to this condition. Do you intake a vitamin rich diet?

Patient: Yes, I sometimes take vitamin supplements. May be my age is taking a toll on me.

Nurse: Okay John. One more thing; have you ever had any thyroid-related issues?

Patient: No, I haven’t had any thyroid problems.

Nurse: Alright. Please make sure to increase your water intake and improve your diet. Including more vegetables and fruits can help. Can you do that?

Patient: Yes, I’ll try.

Nurse: Great. Additionally, continue using your nail cream regularly and keep your nails short to avoid injuries. Okay?

Patient: Sure.

Nurse: I also recommend you to schedule a medical check-up with your doctor to rule out any underlying issues. How does that sound?

Patient: That sounds like a good plan.

Nurse: Alright. If you have any further questions or concerns, feel free to ask. Take care, John.

Patient: Thank you for your help, Nurse. I appreciate it.

Nurse: You’re welcome, John. Don’t hesitate to reach out if you need anything else. Have a good day.