Information giving Flashcards
What should the stages of explaining how to use an inhaler be?
- Introduction, consent, open question
- Ask the patient what they understand about asthma and inhalers; ask about their allergies
- Ask patient about any previous experience with them, possible reasons for poor technique
- explain how an inhaler works
- explain how to use an inhaler
- Ask patient to perform the procedure
- SAFETY NET - MAKE PT AWARE OF IN CASES OF OVERDOSE AND SEVERE ASTHMA
- Ask patient what they understand about spacer devices
- explain what a spacer device is and why its required
- Ask patient to perform the procedure
- Explain cleaning/storage of the device and importance of replacing every 6-12 months
- SAFETY NET - MAKE PT AWARE OF IN CASES OF OVERDOSE AND SEVERE ASTHMA
- Organise an asthma review appointment
- Closure
How is a blue inhaler used?
Reliever inhaler (BLUE):
Contains SABA
Given to every asthma patient
Taken to relieve symptoms of asthma, but doesn’t treat the underlying cause of the disease (inflammation)
Work by relaxing muscles surrounding the airways, allowing them to open up and making it easier to breathe again
Safe medicines with few side effects unless overused
They should rarely be necessary if asthma is well controlled, and a patient needing to use them 3+ times per week should have their treatment reviewed
How is a brown/orange inhaler used?
Preventer inhaler (BROWN/ORANGE):
Contains ICS
Taken to help control symptoms and prevent disease progression
Work over time to reduce the amount of inflammation in the airways, prevent asthma attacks occurring and reducing the likelihood of long term changes to lung structure
Need to be used for some time before you gain full benefit, and may still occasionally need to use the reliever inhaler
Recommended if you have asthma symptoms 2+ times per week, wake up due to asthma symptoms or have to use reliever inhaler 2+ times per week
how do you use an inhaler?
- Remove mouthpiece cover,*
- shake the canister for 5 seconds,*
- hold inhaler vertically with thumb with mouthpiece near mouth and index finger on top of inhaler,*
- breathe all the way out,*
- put mouthpiece in mouth with lips forming a tight seal,*
- take deep breath in and press firmly with index finger as you take a breath,*
- breathe in for as long and hard as possible, hold*
- breath for 10-15secs then breathe out normally,*
- repeat*
What is a spacer device and how is it used?
- A spacer is a device to enable better control of asthma by allowing inhaler medication to reach deep into the lungs, whilst removing complexity of needing to have good coordination of depressing inhaler and inspiring at the same time.*
- It also reduces the risk of oral candidiasis.*
- It follows the same steps as previously mentioned- only put the mouthpiece of the inhaler into the spacer, put the spacer mouthpiece into your mouth, then push down once on the inhaler and breathe in slowly*
What are the notifiable diseases [under the health protection regulations 2010]?
The diseases notifiable to local authority under the Health Protection(Notification) Regulations 2010 are:
- Acute encephalitis
- Acute infectious hepatitis
- Acute poliomyelitis
- Anthrax
- Botulism
- Brucellosis
- Cholera
- Diphtheria
- Enteric fever
- Food poisoning
- Hemolytic uremic syndrome
- Infectious bloody diarrhoea
- Invasive group A streptococcal disease
- Legionnaire’s disease
- Leprosy
- Malaria
- Measles
- Meningococcal septicemia
- Mumps
- Plague
- Rabies
- Rubella
- Severe Acute Respiratory Syndrome (SARS)
- Scarlet fever
- Smallpox
- Tetanus
- Tuberculosis
- Typhus
- Viral haemorrhagic fever (VHF)
- Whooping cough
- Yellow fever
What is the format for a notifiable disease station such as a pt Dx with TB?
https: //www.cdc.gov/tb/topic/basics/tbprevention.htm
https: //www.cdc.gov/tb/topic/basics/tbinfectiondisease.htm
Notifiable disease
1) Intro
- Confidentiality line – (if you know it’s a notifiable).
- Everything we speak about is completely confidential between you and the medical team, except if you or someone else it at risk.
2) PC
- symptoms
- how is it being managed
- social history – is anyone at home with you. sexual history (if STI) sexual history – are they having symptoms. have you told them
3) Mini History
4) Partner or Family at risk
- Do you mind if I ask why you haven’t told them (they’re scared)
- What makes you say that
- [Gague this before you say it:] ?You wouldn’t want your wife/children to go through the same thing you have
5) Why do they not want to disclose
6) Explain when confidentiality has to be breached
- TB is completely treatable, we can prevent them from getting it If they know now
- But only if we catch it in time e.g. latent period is much easier to treat even if they dont have symptoms
- you know we spoke earlier about confidentiality, this is one of those situations where others at risk. therefore, we will have to break confidentiality.
(if migrant – You and your health our our concern and not the immigration status. However, the people we tell are very well trained in this area and professionally trained in this situation. They will educate them in a way they know don’t be fired for this)
7) Negotiate and offer solutions
- How about we make an appointment and we can bring your family/partner in and tell them together
- How about you come in a few days time and we can go in from there
(often they will ask – are you going to tell the home office)
- we do have to tell the health authorities. However, you are kept completely anomanous.
- thye will sent an anomalous letter to your family notifying them they are at risk if you have not told them by then.
- that’s why we encourage you to try and tell them
This will be kept as anomanous as possible. It is completely curable.
If they say NO
- Empathy etc
Who are the relevant authorities for communicable disease control and surveillance?
CCDC - Consultant in Communicable Disease Control. Within 3 days.
Pt Can be anonymised.
Explain the diagnosis of COPD to a patient
- Chronic obstructive pulmonary disease (COPD) is the name for a group of lung conditions that cause breathing difficulties, and this includes
- Emphysema- damage to the air sacs in the lungs
- Chronic bronchitis- long-term inflammation of the airways
- Cause –>
- COPD is a common condition that mainly affects middle-aged or older adults who smoke. Many people don’t realise they have it
- The main cause is smoking, and the likelihood of developing COPD increases the more you smoke and the longer you’ve smoked
- However, the condition can sometimes affect people who have never smoked- some cases of COPD are caused by long-term exposure to harmful fumes or dust, or occur as a result of a rare genetic problem that means the lungs are more vulnerable to damage
- Symptoms –>
- The breathing problems tend to get gradually worse over time and can limit your normal activities, although treatment can help keep the condition under control
- The main symptoms of COPD are:
- Increasing breathlessness, particularly when you’re active
- Persistent chesty cough with phlegm (some people may dismiss this as just a “smoker’s cough”)
- Frequent chest infections
- Persistent wheezing
- Without treatment, the symptoms usually get slowly worse. There may also be periods when they get suddenly worse, known as a flare-up or exacerbation
discuss treatment options for COPD with a patient including cessation of smoking
- Treatment –>
- The damage to the lungs caused by COPD is permanent, but treatment can help slow down the progression of the condition
- Stopping smoking - the most important thing you can do
- Inhalers and medications - help make breathing easier
- Pulmonary rehabilitation - a specialised programme of exercise and education
- Surgery or a lung transplant - this is only an option for a very small number of people
- The outlook for COPD varies from person to person. The condition can’t be cured or reversed, but for many people treatment can help keep it under control so it doesn’t severely limit their daily activities
Explain directions for taking warfarin
Directions for taking warfarin
It is important to take warfarin exactly as directed and not to change the dose unless advised to (the aim of therapy is to decrease the blood’s tendency to clot, but not stop it clotting completely so the dose may be changed)
It is taken once a day, usually in the evening (and it’s important to take your dose at the same time each day, before, during or after a meal)
How long you take warfarin for depends on your condition
explain missed doses of warfarin
Missed doses
If you normally take warfarin in the morning but forget to, take it as soon as you remember (however if it’s time to take your next dose don’t take a double dose to catch up)
If you normally take warfarin in the evening but forget to, take it if you remember before midnight (if not, leave it)
Explain monitoring warfarin
Monitoring warfarin
You’ll have regular blood tests at your GP surgery or local anticoagulant clinic to make sure your dose is correct
The international normalised ratio (INR) is a measure of how long it takes your blood to clot. The longer it takes your blood to clot, the higher your INR. Your INR will be used to determine the dose of warfarin you need to take. INR needs to be 2-3
When you start taking warfarin, you may be given a yellow booklet about anticoagulants, which explains your treatment
explain side effects of warfarin
Side effects
- Contraindicated in: pregnancy, severe hypertension, high risk of internal bleeding (e.g. stomach ulcer), bleeding disorders
- Bleeding (blood in urine/faeces, severe bruising, long nosebleeds, bleeding gums, cough up blood, unusual headaches, increased bleeding during period)- take care with shaving, brushing teeth, gardening, sewing, contact sports
- Skin rashes
- Hair loss
- Interactions
- Medications- alert HCPs before taking other medicines (avoid herbal medicines, supplements, aspirin/ibuprofen (paracetamol is ok))
- Diet- decrease foods with vitamin K (green leafy vegetables (spinach/broccoli), vegetable oils, cereal grains)
- Alcohol- do not drink more than 14 units per week
- Always inform dentists/surgeons
- Sports- avoid contact sports, martial arts and kick boxing
- Body piercings- not recommended
Explain to a patient how to take sublingual GTN in the event of chest pain
- Spray- when pain develops, spray 1-2 times under the tongue, close mouth immediately and pain should ease within 1 minute
- Tablets- when pain develops, place 1 tablet under the tongue, allow to dissolve and pain should ease within 1 minute
- If 1st dose doesn’t work, take a 2nd dose after 5 minutes
- If pain continues for 15 minutes, call an ambulance
- Administration PRIOR to exercise will provide better relief than administration AFTER onset of pain
- Spray/tablets should be carried at all times
- Spray is preferred to tablets due to a longer shelf life
- Side effects include headache and flushing (due to vasodilation)
