course guide Flashcards
why is it important to read the pt *
if the pt changes body lang or only gives minimal answers it helps you structyure the qns to get the most out of them //
you need to read them to see their level of health literacy - some people might have very good knowledge of their condition
what are cardioresp symptoms
- exertional dyspnoea (quantify exercise tolerance: how many stairs)
- paroxysmal nocturnal dyspnoea
- orthopnoea (i.e. Breathless on lying flat – a symptom of left ventricular failure)
- oedema
- palpitations (awareness of heart beats)
- cough
- sputum
- haemoptysis (coughing up blood)
- wheeze
what do you ask for HPC *
When did it start? What was the first thing you noticed? Progression since then. Ever had it before?
Assess the patient’s knowledge of investigations (have they had previous investigations? Do they have an expectation regarding investigations?)
Assess the patient’s knowledge of treatment (have they received treatment? Do they have an expectation regarding treatment?)
Try to characterise pain and symptoms roughly as:
• Site; radiation; intensity; duration; onset (gradual or sudden)
• Character (sharp, dull, knife-like, colicky)
• Associated features (nausea, vomiting etc)
• Exacerbating and alleviating factors (What, if anything, makes it worse? What, if anything, takes it away or makes it better?)
Direct questioning
Specific questions about the diagnosis you have in mind (and risk factors e.g. travel) and a review of the relevant system
what do you investigate about PMH*
Serious illnesses beginning in childhood • Hospitalisations • Surgical Procedures • Accidents or Injuries • Current Medications • Immunisations • Screening Procedures
what do you ask about medications *
Any tablets, injections?
• Any ‘off the shelf’ drugs?
• Herbal remedies?
• Ask the features of allergies; it may not have been one.
what do you ask about sh/fh *
Probe without prying.
• “Who else is at home with you?”
• Job
• Marital status
• Spouse/partner’s job and health
• Housing
• Who visits? – relatives, neighbours, GP, nurse
• Who does the cooking and shopping?
• What can the patient not do because of the illness?
• Age, health, and cause of death, if known, of parents, siblings, children; ask about TB, diabetes mellitus, and other relevant disease.
• Areas of the family history may need detailed questioning e.g. to determine if there is a significant family history of heart disease you need to ask about grandfathers’ and male siblings’ health, smoking, and tendency to hypertension,
30
hyperlipaedemia, and claudication before they were 60 years old, as well as ascertaining the cause of death.
what do you ask about spiritual or world views *
Does the patient belong to a religious denomination?
• Do they have any particular religious needs
• How is the patient coping with illness
• How does this fit with their beliefs/world views
what is included in lifestyle *
Diet (what types of food do they typically eat?) • Exercise • Sexual history • Recent travel • Any significant life events Alcohol, ‘recreational’ drugs, tobacco
what system review questions to you ask when you suspect cancer/tb*
weight loss • night sweats • any lumps • fatigue • appetite • fevers • itch • recent trauma
what are gut symptoms *
abdominal pain (constant or colicky, sharp or dull; site; radiation; duration; onset; severity; relationship to eating and bowel action; alleviating/exacerbating or associated features)
• indigestion; nausea/vomiting
• stool – colour, consistency, blood, colour of blood, slime, difficulty flushing away
• tenesmus (feeling that there is something in the rectum that cannot be passed e.g. due to a tumour)
• maleana is altered (black) blood passed PR
• haematemesis (vomiting blood)
what are genitourinary tract symptoms *
incontinence (stress or urge) • dysuria (painful micturition) • haematuria (blood in urine) • nocturia (needing to pass urine at night) • frequency • polyuria • hesitancy • terminal dribbling • vaginal discharge • menses: frequency, regularity, heavy or light, duration, painful, first day of last menstrual period (LMP) • number of pregnancies • menarche • menopause • chance of current pregnancy?
what are neuro symprtoms *
Sight • Hearing • Smell / taste • Seizures, faints, funny turns • Headache • Pins and needles (paraesthesiae) • Weakness “Do your arms and legs work?” poor balance • Speech problems • Sphincter disturbance • Higher mental function and psychiatric symptoms • Differences between right and left The important thing is to assess function: what the patient can and cannot do at home, work etc.
what are muscoskeletal symptoms *
- Pain, stiffness, swelling of joints
- Diurnal variation in symptoms (i.e. With time of day)
- Functional deficit
- Muscle wasting
- Trauma
what are thyroid symptom *
- Hyperthyropidism: Prefers cold weather, sweaty, diarrhoea, oligomenorrhoea, weight loss, tremor, visual problems
- Hypothyroidism: depressed, slow, tired, thin hair, croaky voice, heavy periods, constipation, and dry skin
hwo do you calculate units *
find out what the drink’s ABV is
• then multiply that by how many milli-litres of liquid are in the drink
• then divide that by 1,000
