FoPC Formative Year 2 Flashcards
Jim is a 58 year old retired policeman. He is a widower who formed a relationship with Jill 3 years ago. He is proud of his health, having kept fit through his years of service and is also proud of the fact that he never needs to attend the doctor.
Jim considers himself to be healthy and is proud of that, what is the WHO definition of health?
Health is a state of physical, metal and social well-being and not merely the absence of disease.
Jim is out walking to the newsagents when he becomes clammy, out of breath and nauseated.
He starts to sweat and has a heavy feeling on his chest. He becomes faint, collapses and an ambulance is called. What is the likely diagnosis?
The most likely diagnosis is a heart attack (myocardial infarction)
Jim is admitted and treated in the cardiology unit (CCU). He is discharges after 48 hours later on medication.
What groups of medication might he now be on e.g. anti-platelets?
Anti-Anginals
Anti-hypertensives
Statins (cholesterol lowering drugs)
Emily is also seven and is doing well at school.
Her mum is 33 year old Alison, who is a lecturer at the local University. Alison is married to Tim, who works in the oil industry as a contractor, though now mostly is a stay at home dad since world oil prices took a downturn and contract work has dried up. This suits them both as Alison is well paid and enjoys her career.
She notices some pins and needles over her trunk and has noticed she has to ask her husband to open bottle tops. she stumbles on stairs and drops things. She sees her neurologist colleague who writes to you suggesting an MRI.
MRI shows significant demyelination, what is the likely diagnosis?
Multiple Sclerosis
Jim’s discharge letter arrives with you 8 days after his discharge and you note that he was asked to make an appointment with you. You check and he has not done so. You ask reception to phone him and ask him to come in.
Jim attends and tells you he decided not to start the medication. You try to persuade him to start. What consultation model would be the preferred option when discussing Jim’s new treatment with him?
Mutual Participation - Jim is intelligent is is likely to respond to information about the risks and benefits of the proposed treatment.
It is important to allow him to ask questions and understand his treatment.
This would result in improved compliance.
After a longer consultation than usual, Jim comes to terms with the fact that he now has long-term medication.
What factors might put someone at risk of developing a LTC ?
Genetic Factors
Environmental factors
Alison now has a LTC. LTC may have far reaching impacts.
Give examples of 3 potential “impacts” of a LTC?
On the individual: Can be negative or positive. Can include denial, self-pity and apathy.
On family: Can be financial, emotional. The health of other family members may be affected.
Community/society: Isolation of an individual may result.
Physical adaptations and changes in attitude may be required
The WHO attempts to classify disability, including that resulting from long-term conditions in to 3 categories. What categories does it use to classify disability?
Body and structure impairment: Abnormalities of structure, organ or system function (organ level)
Activity limitation: Changed functional performance and activity by the individual (personal level)
Participation restrictions: Disadvantage experienced by the individual as a result of impairments and disabilities (interaction at a social and environmental level)
Alison’s condition deteriorates rapidly and she needs increasing levels of support at home.
What members of the health and social care team become involved in her care and what might be their roles? list 5
GP: Coordinating care and reviewing treatment and medication.
District nurse: Coordinating care at home (wound care, dressings, bloods, catheter care etc.)
Occupational therapist (OT): Assessing environment around patient at home and at work and providing aids to promote independence
Physiotherapist: Looking to maximize patient’s physical function e.g. mobility, chest care.
Care manager: Coordinating social care package
There are 2 different models of disability.
Can you recall them and give 2 examples of each?
Medical:
1: Individual/personal i.e. accident while drunk
2: Underlying pathology i.e. morbid obesity
3: Individual level intervention i.e. health professionals advise individually
4: Individual change/adjustment e.g. change in behavior
Social:
1: Societal cause i.e. low wages
2: Conditions relating to housing
3: Social/political action needed i.e. facilities for disabled
4: Societal attitude change i.e. use of politically correct language
Alison could react to her diagnosis in a number of ways. What factors may influence the way in which she reacts? List 8
The nature of the disability The information base of the individual. The personality of thee individual. The coping strategies of the individual. The role of the individual i.e. loss of role or change of role. The mood and emotional reaction of the individual. The reaction of others around them. The support network of the individual.
As previously stated Alison is the main income earner in her family.
Suggest 3 areas of her life which may be affected by her recent diagnosis?
Personal
Economic
Social
Are there any differences in the way that Alison and Jim presented with their illnesses?
What do you feel are important pre-morbid/pre-illness factors comparing these 2 cases and the way the illnesses presented?
How might this affect their psychological adaptation to their illnesses?
Both considered themselves healthy and did not expect to become unwell.
Jim’s illness was sudden and did not leave time for him to process how it would make him feel psychologically.
Alison was very young to develop a life changing illness.
She will have little experience with her condition. However, her symptoms developed gradually so she may have had somewhat more time to adjust to her condition than Jim did to his.
Brenda attends her GP noticing that she has been coughing much more than usual and is noticeably SOB than a year ago. She has no chest pain, but cannot manage to walk far and takes the lift in work rather than the stairs.
She wants to understand what is happening because she is worried about how quickly this has all changed . Her mum also smoked and had the same symptoms at a similar age.
1: What is her most likely diagnosis?
2: What would be the most important bit of advice or treatment option for Brenda?
3: What barriers might there be to that ?
1: COPD
2: To stop smoking or at least cut down
3: Thinking back to year 1 smoking is being used as a coping strategy to manage a lot of her other life stresses. Until she finds other ways of coping, it is likely she will return to smoking.
Lisa attends her GP to discuss contraception. She wishes to use the combined pill, but heard that there was a study done which showed there were dangers associated with the pill.
You wish to discuss the risks with her.
What 2 different types of risk would be appropriate to discuss, which is the most relevant for Lisa to take into account here and how might you communicate risk to her?
Actual risk and relative risk (Actual risk is the most important)
Verbally, using fractions, or perhaps using illustrations.
