Communication Stations Flashcards
What is the general framework for communication stations?
Introduce yourself
Establish a plan
Establish patient’s initial understanding (open Qs)
Ask if patient has questions or concerns
Explain procedure/test/procedure (avoid jargon, use diagrams, check understanding)
Conclude with a brief summary, give leaflet and offer to meet again/give contact info
What is the target INR for people with AF, PE, DVT, Mechanical valver?
2-3
How would you start a warfarin counselling consultation?
‘We recommend that you start taking a new medication called warfarin because of your —-. Have you heard of warfarin?
I’d like to explain how warfarin works and why it has been recommended that you take this medication’
How would you describe warfarin to a patient?
A medication that thins you blood, reducing the risk of blood clots forming in your heart, lungs and legs. This is why it is important to take it regularly’
What important bits of information do you need to include in a warfarin consultation?
Impact on life (diet, alcohol, activities)
Blood test monitoring and yellow book
Doses and timings, what to do if you miss a dose
What to watch out for/emergency bleeding
What should you warn the patient to look out for and contact GP or NHS-24 immediately?
Bleeding or severe bruising Prolonged nose bleeds Coughing/vomiting blood Black tar like bowel motions Haematuria
What are some common patient concerns about taking opiates
Will I become addicted
Will morphine make me die sooner
If I take morphine now, will it mean it won’t work later on when I really need it?
How would you address the concerns that opiates won’t work later on if you start them now
Tolerance does occur but it doesn’t mean that the drug won’t work, you may just need higher doses
When pain worsens it is usually due to disease progression but the dose can be increased.
Emphasise the use of regular medication and extra to control breakthrough pain
List the common side effects of opiates and what can be done to combat them
Constipation (use prophylactic Senna or lactulose)
Nausea (common but clears after 1 week, cover with anti-emetic)
Drowsiness (usually acute, alternative fentanyl considered)
Myoclonus (esp renal impairment, reduce dose/change opioid)
Hallucination (reduce dose)
Tolerance (increase dose for genuine pain control)
What is usually given for breakthrough pain?
Oramorph
What opiate is more appropriate in patients with renal dysfunction?
Alfentanil
What other things do you offer a patient in chronic pain?
Referral to chronic pain clinic Spiritual/emotion support Relaxation techniques and mindfulness Acupuncture/aromatherapy TENS (transcutaneous electrical nerve stimulation)
Name 8 modifiable risk factors for cardiovascular disease
Smoking Dyslipidaemia Hypertension Obesity Excess alcohol Excess salt Lack of exercise Environmental stress
Lifestyle advice
WAFFLES Weight (BMI 20-25) Alcohol Fruit and veg (5-8 portions a day) Fat (reduce total) Low salt Exercise (30 mins per day, ideally every day) Smoking cessation
What is the technique for breaking bad news?
SPIKES Setting Perception Invitation Knowledge Empathy Strategy/summary
