Acute cough Flashcards
Introduction
- *W**ash hands
- *I**ntroduce yourself
- *P**atient’s consent
- *E**xplain procedure/purpose for Hx
PC
“What brought you in today?”
HPC
Explores history of cough:
Onset - “when did it start?”, “did it start suddenly or gradually?”
Duration - “how long has it been going on for?”
Enquires about sputum and blood - “do you bring up sputum when you cough?”, “what colour is it?”, “do you cough up any blood?”
Fever - “have you had a fever?”, “did you measure it?”, “how high was it?”
SOB - “do you get short of breath?”, “is this constant or only when you’re moving around?”, “how far are you able to walk before you feel short of breath?”
Pain - “do you have any chest pain?”, “are you able to point out with 1 finger where the pain is?”
Generalised symptoms of fatigue / unwell - “how do you generally feel in yourself?”, “do you feel unwell?”, “do you feel tired sometimes?”
Enquires about foreign travel and contact with animals (G for both) - “have you been abroad recently?”, “where did you stay?”, “have you had any recent contact with animals or do you have pets at home?”
Ascertains that problem is generally improving - “has there been any improvement since when you first noticed your cough?”
ICE
Ideas - “what do you think could have caused your cough?”
Concerns - “is there anything that your worried about regarding your cough?”
Expectations - “what were you hoping we would do for you today?”
PMH
“Do you have any medical conditions like COPD, asthma or any heart conditions congestive heart failure or a previous heart attack?”
DH
- “What have you already tried for the cough? Did it help?”*
- “Are you on any medications that have been prescribed by your doctor?”, “do you take any over the counter medications?”*
- “Do you have any allergies to any medications? What happens when you take the medication?”*
SH
Alcohol, smoking, recreational drugs (including IVDU) - “do you smoke?”, “how much do you smoke each day?”, “how long have you smoked for?”, “have you ever smoked? How much did you smoke and for how long?”(if the patient said they don’t smoke),”do you drink?”, “how much/what do you drink each day?”, “do you use recreational drugs?”, “have you ever injected drugs or shared needles with other people?”
Occupation - “do you work?”, “what do you do for work?”
Home situation - “what’s your home situation like?”, “do you need help with things like cooking, washing/cleaning yourself?”
Examination
Asks to examine patient (G if gives two examples: e.g. mouth/lungs)
“I’d like to examine you now by having a look inside your mouth and listening to your lungs. Is this ok with you?”
Counselling
Student provides explanation – likely to be a virus causing the cough - “it is likely that your cough is being caused by a virus instead of a bacteria”
Suggests self-care (e.g. steam from shower) G for both - “there are self-care methods you can do such as steaming from the shower, or using some vapo-rub which could help with the cough that you’re getting”
Suggests self-care (e.g. paracetamol and linctus from pharmacy) G for both - “You can also get paracetamol or a cough syrup over the counter from your local pharmacy”
Discusses antibiotic prescribing:
Most coughs will improve within 7-10 days - “most coughs tend to improve within 7-10 days”
Mentions potential side effects of having antibiotics (e.g. diarrhoea, vomiting, rash) and that therefore not worth it if they are unlikely to be effective - “I understand you want antibiotics, but they also come with side effects like diarrhoea, vomiting and sometimes a rash which aren’t worth it if the antibiotic won’t be effective in treating your cough. Antibiotics don’t affect viruses only bacteria.”
Explains green sputum does not automatically mean antibiotics - “Yes I understand you’re having some green sputum, but this does not always guarantee that you have a bacterial infection”
If pushed hard, considers delayed prescribing strategy - “Ok, I will send an e-prescription to your pharmacy for some antibiotics which you can pick up within the next 48 hours if your symptoms don’t improve at all despite trying some of the self-care techniques I’ve shared with you.”
Advises self-certification for up to seven days (G if both) - “You can self-certify yourself for our to 7 days”
Form available from employer or gov.uk website (G if both) - “and you can get the form from this from gov.uk or from your employer”
Safety-netting
Safety netting with 3 examples (coughing up blood, sob, high fevers)
“If you find that you’re coughing up blood, becoming short of breath or are getting high fevers, please come back to the surgery as quick as you can or go to A&E for an urgent review”
Close consultation
“Thank you so much for speaking with me today. Before you go I’d like to give you a patient information leaflet. A great website to go to is arthritis research UK, which I’ll write on a piece of paper for you to take home with you.”
