EXPLAINING A DIAGNOSIS Flashcards
STRUCTURE
what is the structure for explaining a diagnosis?
BUCES
- B = brief history
- U = Understanding
- C = Concerns
- E = explanation
- S = summarise
STRUCTURE
what should you include in the brief history?
- what has brought them to see the doctor?
- any symptoms
- any risk factors (lifestyle, family history)
STRUCTURE
what should you include in understanding?
- Do you understand why I wanted to discuss ____ with you?
- Have you heard of ______ before?
- What do you know about _______?
STRUCTURE
what should you include in concerns?
ICE
- Ideas = what is your understanding?
- concerns = what are your concerns?
- expectations = what are you hoping to gain from the appointment?
STRUCTURE
what should you include in explanation?
Sign post
Im now going to explain how the ________ works, then move on to discuss what _______ is, why it is important to address and how we can manage it together
“Normally We Can Probably Manage”
- N = normal anatomy/physiology
- W = what is it? explain the disease
- C = causes, risk factors
- P = problems/complications
- M = management
STRUCTURE
what is the structure for the explanation component?
“normally we can probably manage”
- N = normal anatomy/physiology
- W = what is the disease?
- C = causes
- P = problems/complications
- M = management
STRUCTURE
what should you include in the summarise part?
- summarise key points
- ask the patient if they have any questions
- offer leaflets and direct to NHS website
HTN
how would you explain normal anatomy/physiology for HTN?
“The circulation system within your body is made up of your heart, a muscular pump, and blood vessels.”
“The pressure within the vessels is a combination of how hard the heart pumps and how stretchy the vessels are. This is measured both when the heart pumps – systole, the top number – and when the heart relaxes – diastole, the bottom number.”
HTN
how would you explain what HTN is?
“High blood pressure occurs when the vessels become less elastic and more narrow. This means that to pump blood around the body, the heart has to work harder, which increases the pressure in the vessels.”
“It is normal for your blood pressure to go up and down during the day, especially when you are active; however, it should not be consistently greater than 140 over 90.”
“Although your blood pressure is high today, this doesn’t necessarily mean you have hypertension. To formally diagnose, I would like for you to be fitted with a machine that takes readings over 24 hours and provides an average.”
HTN
how would you explain the causes of HTN?
“The most common cause of high blood pressure is getting older. However, many factors in your lifestyle can have a significant impact; these include smoking, not getting enough exercise, being overweight, drinking alcohol in excess and a diet high in salt, sugar and fats.”
HTN
how would you explain the problems/complications of HTN?
- IHD
“Fatty deposits can build up so much that the artery which supplies the heart muscle becomes partially or completely blocked; this is called angina or a heart attack. Both of which can lead to permanent damage to the heart and even death.” - stroke, TIA and vascular dementia
“Fatty deposits can also build up in vessels that supply your brain. If these become blocked, it can cut off the oxygen supply to parts of your brain, leading to a stroke or a type of memory impairment called vascular dementia.” - CKD
“If there is too much pressure in the kidneys, this leads to damage that reduces kidney blood flow. This damage means that the kidneys cannot filter the blood as effectively.” - PVD
“The narrowing of vessels due to high blood pressure can reduce the circulation to your hands and feet. If this progresses, you can get pain in your limbs when moving and, in the worst-case scenario, can lead to amputation.”
HTN
how would you explain the management?
- target is to reduce BP to below target
- unlikely to get symptoms of HTN so BP must be regularly monitored to ensure we maintain this target
- lifestyle changes = smoking cessation, weight loss, 150 minutes of moderate activity per week, limit salt, caffeine + alcohol. Encourage fruit, veg, grains, nut and oily fish
- antihypertensives if unable to lower BP with lifestyle changes alone. Will require frequent monitoring to ensure you dont get low blood pressure, which can cause dizziness.
- can calculate risk of having a heart attack or stroke in the next 10 years. If this is above 10% we can offer you a statin to reduce risk.
ANGINA
how would you explain the normal anatomy/physiology of angina?
“The heart is a muscular organ in the centre of your chest that acts as a pump, circulating blood throughout your body to deliver oxygen and nutrients to your organs and tissues.”
“The heart requires its own blood supply. The arteries which supply the heart are called the coronary arteries.”
ANGINA
how would you describe what angina is?
“Angina is chest pain or discomfort that happens when your heart isn’t getting enough blood, often because of narrowed arteries. It can be triggered by physical activity, stress, or cold weather.”
“There are two types: stable and unstable. Stable angina typically occurs during exercise and goes away with rest or medication. Unstable angina is more serious and poses a greater risk. It can happen at rest, be more intense and may not improve with medication.”
ANGINA
how would you explain the causes?
“The most common cause of angina is coronary artery disease, where the arteries that supply blood to your heart become narrowed due to a build-up of fatty deposits. This can happen due to factors like an unhealthy diet, lack of exercise, smoking, ageing, or a family history of heart disease.”
ANGINA
how would you explain the problems/complications?
MI
- fatty deposits can build up in arteries supplying the heart muscle.
- when they are completely blocked it is a heart attack
- this can cause permanent damage to the heart and its function
Stroke
- fatty deposits can also build up in the blood vessels supplying the brain
- if these become blocked it can cause a stroke
Unstable angina
- if angina is lasting longer than usual, occurring at rest or more severe, it is a medical emergency and you should attend hospital immediately
sudden cardiac death
- in rare cases it can lead to sudden death
reduced quality of life
- can limit ability to engage in usual activities
can be challenging and we recognise that is can be stressful
- please know we are always there to support you
further support
- many websites offer support and information
- example = british heart foundation
ANGINA
how would you explain the management?
- goal = reduce how often you have symptoms, make them less painful and relieve discomfort quickly. also want to prevent worsening + lower risk of heart attack or stroke
- recommend combination of healthy lifestyle + long term medications
- lifestyle = smoking cessation, weight loss, physical exercise (150 mins per week), reduce alcohol, encourage fruit, vveg, whole grains, nuts and oily fish. Limit salt
- GTN spray = if experience chest pain, use GTN spray. If the pain has not gone after 5 mins, take a second dose. If pain still has not gone or got worse call 999
- long term meds = to reduce how often you have angina + can improve overall function of heart. If you experience episodes still use GTN
- surgery = if meds don’t work or are unsuitable
COPD
how would you explain the normal anatomy/physiology for COPD?
- lungs are responsible for breathing, supplying oxygen and removing CO2
- breathe in = air enters nose/mouth and goes down your windpipe. Trachea divides into bronchi and then into bronchioles
- alveoli are at end of bronchioles. They are stretchy air sacs
- blood enters blood through walls of alveoli + waste CO2 is removed
COPD
how would you explain what COPD is?
- COPD = common condition affecting lungs, making it harder to breathe
- includes emphysema and chronic bronchitis
- inflammation in lungs which narrows tubes in your lungs, making if harder to breathe
- lungs produce mucus which is coughed up as phlegm
- air sacs called alveoli are destroyed. This makes it harder to absorb oxygen
COPD
how would you explain the causes of COPD?
- caused by long term exposure to harmful irritants that damage the lungs
- most common = smoking. the risk increases the more you smoke and the longer you have been smoking for
- other things = breathing in chemical fumes, air pollution and rarely an inherited genetic condition
COPD
how would you explain the problems/complications?
- symptoms develop slowly over many years
- unfortunately symptoms like breathlessness and cough worsen over time, making daily activities more challenging
- treatment can slow progression but there is no cure
- narrowing of airways = feeling breathless
- damage, irritation and inflammation = mucus + cough
- more prone to chest infections, particularly in winter as it is harder for lungs to clear mucus + bacteria
- may get flare-up (exacerbation) = breathlessness, coughing, wheezing + more mucus. Can be triggered by infection, irritants or changes in weather
COPD
how would you explain the management?
STOP SMOKING
- most important = stop smoking. Most effective way to prevent it getting worse as it prevents further damage + improves breathing
VACCINATION
- entitled to free vaccinations = one-off pneumococcal vaccine + annual flu jab
PULMONARY REHAB
- pulmonary rehab = programme of exercise classes, info on looking after lungs, eating well + managing COPD. Helps understand COPD + reduce breathlessness
INHALERS
- SABA = delivers small amount of medicine directly to lungs. Relaxes muscles in airways + opens them up. Eases breathlessness
- LABA = provide sustained relief of breathlessness throughout the day. typically used twice daily
- ICS = reduces swelling + inflammation in airways. Should be used consistently even when feeling well to maintain airways + prevent flare ups
TREATMENT OF FLARES
- oral steroids = short course of steroid tablets, typically for 5 days
- antibiotics = if worsening breathlessness, cough or phlegm turning brown, green or yellow
OXYGEN
- if blood oxygen levels are low + meet specific criteria = qualify for long term oxygen therapy. Involves having oxygen delivered through tubes in nose or mask for at least 15hrs per day
ACNE
how would you describe the normal physiology?
- normal function = act as a barrier
- imagine skin as bricks stacked on top of each other
- there are glands which produce oily substance called sebum = helps maintain and protect skin
- acne = too much sebum produced
ACNE
how would you explain the condition?
- over production of sebum
very common in teenagers - commonly affects face, chest and back
- mild acne = comedones (whitehead = open comedone, blackhead = closed comedone)
- severe = papules and pustules
ACNE
how would you explain the cause of acne?
- problem with hair follicles and associated glands in skin
- a few different things cause increased sebum
- increased sex hormones during puberty
- menstruation causes varying symptoms
- bacteria on skin
- medications like steroids or glands being blocked by things like makeup
ACNE
how would you explain the problems/complications?
- once healed can be left with scarring or changes in skin colour. This is why it is important to treat acne well
- often makes people self-conscious or worried about appearance. Important to talk to someone about it.
ACNE
how would you explain management?
- acne can be unpleasant to live with so we try to get it under control
TOPICAL CREAMS
- first try OTC creams = salicylic acid (unblocks glands), benzoyl peroxide (helps with any bacteria on skin)
- cleanse and wash skin everyday with these
TOPICAL RETINOID
- if moderate = topical retinoid (reduces amount of sebum produced but can be drying)
- use every other day and see how you get on with it
OTHER TREATMENTS
- if those don’t work, come back and there are some tablets that we can try that often help or if we are really struggling I can refer you to dermatologist
PSORIASIS
how would you explain normal physiology/anatomy?
normal function = act as barrier
- imagine skin as layers of bricks stacked on top of each other
- normal skin = mortar between bricks, preventing irritants getting in and prevents water getting out (stops skin drying)
PSORIASIS
how would you explain what psoriasis is?
- chronic inflammatory skin condition
- most frequently affecting scalp, elbows and knees
- develop itchy red scales
PSORIASIS
how would you explain the cause of the disease?
- development is very complicated + lots of different factors contribute
- thought to be a problem with parts of immune fish becoming overactive, leading to inflammation of the skin
- don’t know the exact cause but thought to be combination of genetic, immune + environmental factors
- genetic component = often runs in families
- often no clear trigger
- some things precipitate it = infection, hormone changes + medications e.g. lithium
- some things make it worse = skin trauma, smoking, alcohol + stress
PSORIASIS
how would you explain the problems/complications?
rare complication = severe flare known as pustular or erythrodermic psoriasis. It is serious + requires emergency medical treatment
if you notice pus filled blisters on body or develop painful itchy rashes al over = seek urgent medical advice
OTHER PROBLEMS
- persistent disease
- anxiety + depression from psychosocial burden
- reduced QoL
- development of psoriatic arthritis
PSORIASIS
how would you explain the management?
- important to get under control
- topical cream = mainstay of treatment
EMOLLIENTS
- emollient = fills cracks between dry bricks to stop irritants getting in + prevents water escaping.
- Also reduces flares.
- lots of different types of emollient e.g. cream, gel, ointment. Can work together to find one that works.
- ask a specialist nurse to speak to you about them today if you like?
TOPICAL STEROID
- used alongside emollient to help manage symptoms
- can change to alternative if first one does not work
- should not be used on face as it can cause skin thinning and other serious side effects
- always wash hands after applying steroid cream
OTHER TREATMENT
- in most people, treatments discussed help
- do have other treatments if these are not successful and we can discuss those if it becomes appropriate
ASTHMA
how do you explain the normal physiology/anatomy?
- breathe in = air enters mouth down windpipe. Air then goes into bronchi, bronchioles and into air sacs called alveoli. Here oxygen is absorbed into the blood
ASTHMA
how would you explain what asthma is?
- one of the most common lung conditions
- have inflamed and sensitive airways than can become narrower than normal
- common symptoms = cough, wheeze, chest tightness + SOB
- symptoms come and go, often in response to specific things
- important to take medication everyday even if feeling well as it reduces the chance of you being unwell
ASTHMA
how would you explain the causes?
- don’t know the exact cause
- some people are more likely to get asthma such as having allergies + family history
- common triggers = allergies, infections, stress, smoking + sudden temperature changes
ASTHMA
how would you explain the problems/complications?
ACUTE ASTHMA
- worsening symptoms not relieved by inhalers = asthma attack (exacerbation)
- important to manage as it can be life-threatening
- signs = wheezing a lot, tight chest, coughing, difficulty talking due to breathlessness, breathing quickly
- if experience this = call 999
PERSISTENT SYMPTOMS
- important to take medication everyday as it builds up protection in airways to prevent attacks
- if experience symptoms frequently = review with GP who may alter medications
- seek review if affecting activities, waking up at night or peak flow readings are lower than normal
ASTHMA
how would you explain management?
- aim = to minimise impact on day to day life
- if managed effectively would expect no symptoms during day or night + no limitation on exercise
INHALERS
- will be given a inhaler with the type dependent on severity of asthma
- used to relieve asthma symptoms + help reduce long term inflammation in airways
- should use inhaler twice per day
- important to not miss doses
- take extra doses if you feel short of breath, up to maximum
OTHER TREATMENT
- may require stronger medication + referral to specialist
PEAK FLOW
- will give peak flow meter
- tube that you blow into + emasures how fast you can blow air out of lungs
- important to do twice daily when starting medication + if symptoms get worse
PERSONALISED ASTHMA MANAGEMENT PLAN
GLAUCOMA
how would you explain the normal anatomy/physiology?
- eyes produce watery fluid called aqueous humour
- required to provide nutrients and oxygen to tissues in the eye
- maintains eyes normal pressure and shape
- fluid is produced at the back of the eye, travels to the front and leaves via a sieve-like drainage system
GLAUCOMA
how would you describe what glaucoma is?
- an eye condition where the optic nerve which connects the eye to the brain becomes damaged
- caused by build up of fluid in the front of the eye which increases pressure
- if not diagnosed and treated it can lead to blindness
- there are multiple types, most common = primary open-angle glaucoma. It develops slowly over many years + is caused by drainage channels gradually being clogged up
- like a kitchen sink, if you leave a tap on for a long time, the sink will block
- in the eye there is nowhere for the extra fluid to go so pressure increases and damages the nerves
GLAUCOMA
how would you explain the risk factors and symptoms?
- often picked up at regular eye appointments
- usually no early warning symptoms and they develop over a long time so often go un-noticed
- unclear why drainage system clogs but there are multiple risk factors
- increasing age
- short sighted (myopia)
- afro-caribbean ethnicity
- smokinf
- family history of glaucoma
GLAUCOMA
how would you explain the management?
- involves eye drops
- important you are comfortable with when and how to put these in effectively
- important you are aware of side effects
- if drops don’t work, surgery can be offered
REGULAR CHECK-UP
- will be invited for regular check-ups with an optometrist
- they will measure pressure in the eye + have a look at the back of the eye
- they will do regular visual field tests as well
GLAUCOMA
how would you explain the problems/complications?
ACUTE ANGLE CLOSURE GLAUCOMA
- sudden pain, red eye or reduced vision = seek medical attention immediately
- often accompanied with N+V and seeing haloes around lights
PROGRESSION OF GLAUCOMA
- risk of worsening sight
- can become severe enough to effect QoL
- important to use eye drops as instructed to reduce risk of damage
DRIVING
- important to make sure you meet DVLA sight requirements
- as eyesight gets worse the brain tries to adapt + fill in blanks so it is hard to tell blind areas
EPILEPSY
how do you explain the normal anatomy/physiology?
- brain controls how we move, say and do, memories and emotions and how we interpret the world around us via different senses
- different areas with different roles talk to each other
- signals go in both directions, both recognising thing sin world around us and making us move
EPILEPSY
how would you explain epilepsy?
- a condition that affects the brain
- causes a person to have an increased tendency to have seizures
- different types
EPILEPSY
how would you explain a seizure?
- an event where there is a chaotic burst of signalling that interferes with the brains normal function
- most last 30 seconds to 1 minute
- some people have warning signs= aura
- can stay awake or lose consciousness
- may feel very tired, confused and need sleep to recover
EPILEPSY
how would you explain the cause?
- does not have one specific cause
- some people are born with it and some develop it later in life
- can be caused by events before you were born or during birth
- can develop later in life from head injury, stroke or brain tumour
- in many cases it remains unknown
- some circumstances can trigger a seizure such as flashing lights, fevers, drugs + missing epilepsy medications
EPILEPSY
how would you explain the complications?
IMPACT ON LIFE
- avoid taking baths or swimming alone
- avoid climbing or skiing
- avoid driving until no seizures for one year
- if having frequent seizures, may be encouraged to wear a helmet
STATUS EPILEPTICUS
- prolonged seizure activity without recovery
- is a medical emergency that can result in brain damage if not recognised + treated promptly
- inform family + friends if you carry rescue meds so they can help in an emergency
SUDDEN UNEXPLAINED DEATH IN EPILEPSY
- rare, often during sleep
- may occur during or just after seizure
- happens in 1 in 1000 people with epilepsy each year
- can decrease risk by taking medications
SIDE EFFECTS
- may experience side effects
- will vary based on medication taken
- can affect development of babies if you were to become pregnant
- important to be on effective contraception
- should speak to doctor if you want to start a family so medications can be reviewed whilst still controlling seizures
