Minor Ailments - Travel health Flashcards
1
Q
What to consider about travel health?
A
- Mode of transport= air,car, sea
- Length of journey = how long they need th med to work for
- Destination= Especially for malaria you need to know the risk of malaria
- Length of stay = How much med do you need to give
- Purpose of trip = Vist fmaily , volunteering
- Accommodation = tent , hotel (affects mosquitoe exposure)
- Travel health risk assessment – 6-8 weeks before travel – need for vaccines, malaria prophylaxis
2
Q
what patinet groups are high risk?
A
- Children= most likely to be hospitalised
- Elderly = jetlagged
- Pregnant women = generally recommendation you can travel upo to 36 weeks
In air= increase risk of clots
S/ airlines want preg women to present certificates for when due date is - Immunocompromised= increases risk of infections
- Health conditions e.g. respiratory, renal/hepatic
impairment, diabetics = Need to have enough supply
2
Q
What is Travel sickness?
A
- v/ common
- sickness when travelling due to brains inability to process conflicting sensory information = Regarding movement & position there is conflicting info so patient becomes nauseous
- Can affect anyone on any mode of transport,
more common in young children, women and
migraine sufferers - Symptoms: nausea, vomiting, dizziness, sweating, drowsiness, headache, pallor
2
Q
How to manage travel sickness? (1)
A
- Ideally stop motion causing sickness= not always possible
- Prevent travel sickness by taking medication prior to travel
- Choice based on length of journey/duration of action
- Sedating antihistamines e.g. Cinnarizine 15mg tablets (P),= 2 tablets 2hrs before travel (really long journey = repeat dose after 8hrs)
Promethazine 25mg tablets (P),= 1 the night before or 1-2 hrs before, for longer journeys 4-8 hours - Anticholinergic e.g. Hyoscine hydrobromide 300mcg tablets (P), most effective, short journey up to 4 hours. = Quick acting take 20-30 mins before = most common + effective
- Caution – closed angle glaucoma= rise in eye pressure
- Acupressure bands = limited evidence
- Ginger - tea, biscuits, tablets – more effective than placebo
3
Q
Sun protection
A
- Sun exposure natural way of getting vitamin D and elevates mood
- Sun damages skin by ultraviolet (UV) radiation , UVA rays cause skin tanning and UVB rays cause skin burn
- Skin cells, melanocytes produce melanin on exposure to UV light which causes darkening of skin
- UV radiation main cause of skin cancers, damages DNA within skin cells
- Avoid excessive skin exposure, highest risk of damage when sun strongest, 11am – 3pm
- Wear sunglasses, hat with brim, long sleeved tops
3
Q
What can you do to manage travel sickness?
A
- Distract yourself
- Limit motion – front seat/middle of boat
- Breath fresh air – open car windows
- Look ahead, focus on horizon
- Focus on slow breathing
- Stop for breaks on longer journeys
- Avoid looking at moving cars
- Avoid eating heavy meals or drinking alcohol prior and during travel
- Avoid reading, focusing on electronic devices
- For dry mouth = suck on sweets
4
Q
What is sunburn?
A
- Inflammatory response to excessive UV radiation that damages the skin, usually settles within 7 days
- Duration of exposure, sunscreen usage, severity
- Symptoms: skin becomes red, hot to touch, sore, peels away after few days
- Severe = you get blisters
- Large blisters = refer
- Self care – get out of sun exposure, cool skin by coldshower/bath/compress, drink plenty of cool fluids, apply aftersun cream or aloe vera gel, leave blisters intact ( popping increases risk of infection) , pain relief – paracetamol or ibuprofen
- Sunburn causes premature aging of the skin
5
Q
Sunscreens
A
- Products that protect against skin damage caused by sun’s UV radiation
- ‘SPF’ sun protection factor, shows protection against UVB rays, SPF 50+ provides highest protection
- ‘SPF’ is the amount of time taken to get sunburn versus skin alone
e.g. if you get sunburn in 10 mins of sun exposure, after applying SPF50 = 50 x10mins = it should take 500 mins to sunburn hence protected for 50 times longer - UVA star rating ranges from 0 to 5, shows UVA radiation absorbed by sunscreen compared to UVB, 5 stars provides highest protection
- Apply generously, to all areas of skin that are exposed, apply 20-30 mins before sun exposure, reapply if go into water, apply before insect repellants/moisturisers
6
Q
What is Travellers’ Diarrhoea?
A
- Passing unformed stools 3 or more times in 24 hours with either abdominal pain, nausea/vomiting, fever
- Mainly caused by bacteria usually Escherichia coli, Campylobacter, Salmonella and Shigella, spread by consumption of contaminated food or water
- Increased risk in less developed countries, poor
hygiene = contamination of food & water - Usually occurs in first week of travel
- Advise hand hygiene, food hygiene and drinking clean water
7
Q
How to manage travellers’
diarrhoea?
A
- Self-limiting, usually lasts 3-5 days
- Prevent dehydration – drink plenty of fluids especially young/elderly
- Oral rehydration salts e.g. Dioralyte sachets (GSL/P), O.R.S tablets
- Mild/moderate symptoms: Antimotility drug e.g. Loperamide = = 2 straight away then 1 after each bowel movement(Imodium) (GSL/P), (over 12 years)- short term
- Antibiotic use not routinely recommended
- Prophylaxis in high risk patients – Ciprofloxacin (POM) - as a precaution
- Self care – wash hands with soap and water, drink bottled water, cook food thoroughly
8
Q
Preventative measures for DVT
A
- Move around as much as possible ( sit in seat nearest to aisles so you can get up & walk)
- Do calf exercises
- Stay well hydrated
- Avoid excessive alcohol
- Increased risk - Anti embolism stockings/graduated compression stockings/flight socks
- Aspirin not recommended for prophylaxis of
travel DVT/PE
9
Q
What is Deep Vein Thrombosis (DVT)?
A
- Long distance travel - on flight from sitting to long , increased periods of immobility, slower blood flow increases risk of blood clots in a deep vein
- Pulmonary embolism (PE) – blood clot blocks blood vessel in lungs
- Risk factors – history of DVT/PE, heart/lung disease, over 60 years old, obesity, pregnancy + if patients take combined oral contraceptive pill can cause DVT
- Symptoms of DVT: redness, swelling in 1 leg, warm skin, throbbing pain in 1 leg, swollen hard veins
- Symptoms of PE: difficulty breathing, chest pain, coughing up blood
- Seek immediate help
10
Q
What is Malaria?
A
- Parasitic infection transmitted to humans by a bite of an infected female anopheles mosquito
- Blood transfusion from infected individual can cause malaria
- Generally bite between sunset and sunrise
- Mainly occurs in tropical regions, majority of cases in Africa
- Preventable and curable if diagnosed and treated promptly
- Potentially life-threatening disease - 1500 uk reported annually
- Risk of severe disease for pregnant women, children, elderly, immunocompromised = severe complications
10
Q
‘ABCD’ of Malaria Prevention
A
- Travellers are advised to follow ABCD approach to prevent malaria
A – Awareness of risk = know whether the areas they are travelling to are high or low risk
B – Bite prevention = not bitten = no malaria
C – Chemoprophylaxis – use of appropriate malaria prevention tablets
D – Diagnosis – prompt diagnosis and treatment - Make them aware of the symptoms so they can seek treatment 7 be aware
11
Q
Malaria prophylaxis
Awareness of risk
A
- Country specific malaria prophylaxis guidance resources:
- UK Health Security Agency - Advisory Committee on Malaria Prevention (ACMP)
- NaTHNaC/Travel Health Pro
- BNF
- Community pharmacy chains
- www.gov.uk foreign travel advice
- NHS Fitfortravel
- Stick to one resource for consistency of advice & guide patient using that one resource
11
Q
Advisory Committee on Malaria Prevention (ACMP)
A
- Expert group for UK Health Security Agency
- Formulate guidelines for healthcare professionals on malaria prevention for travellers from the UK
- commissioned by the UK Health Security Agency to protect health of British travellers
- Provide national guidance on travel health for healthcare professionals based on ACMP recommendations
- Country specific travel advice - infection risks, vaccine recommendations, disease outbreaks worldwide
- Advice line for healthcare professionals
12
Q
ACMP
A
13
Q
NaTHNaC/Travel Health Pro
A
- Tells you the risk high or low
- what anti-malarials are recommended
14
Q
BNF
A
- tells you the risk
- reccomended actions
- anti-malarial drugs if any
15
Q
GOV.UK
A
- gives foreign travel advice
- actions to take
16
Q
NHS Fitfortravel
A
- Mainly for patients
- Free travel advice for UK public
- Maintained by Travel and International Health
Team of Public Health Scotland (PHS) - Country specific
- Health risks, vaccine requirements, malaria risk
- Health travel news
- Outbreaks of diseases, relevant to UK
17
Q
Bite prevention
A
- Guaranteed way to avoid contracting malaria
- if you are not bitten = no malaria
- Insect repellent’s – stop mosquitoes landing on skin = chemical that you spray or apply on the skin & mosquitoes are repelled
- Clothing - prevents mosquitoes reaching skin, wear loose fitting clothes with long sleeves, high neckline, trousers, socks especially at dawn and dusk
- Accommodation - Keep doors/windows closed in the evening/night, mesh screens on windows/doors, stay in air-conditioned rooms
18
Q
Symptoms of malaria
A
- Headache
- stomach = nausea & vomiting
- spleen = enlargement
- Muscle = pain , fatigue , convulsions
- Joints= pain
- Skin = fever, shivering ,jaundice
- Respiratory system = Dry cough
18
Q
Malaria Diagnosis
A
- Any illness especially fever, cold, flu like
symptoms that occur within 1 year and especially
within first 3 months of return may be malaria - Advise patients to seek immediate help and
specifically mention risk of exposure to malaria - Even if recommended precautions against malaria were taken
18
Q
Insect repellents
A
- Repels mosquitoes from landing on the skin
- DEET (N,N-Diethyl-m-tolumide) – most effective and commonly used insect repellent
- conc of 50% recommended for malaria areas - first choice
- Conc above 50% not to be applied directly to skin as causes skin irritation
- Less than 50%, apply more frequently
- Safe to use in pregnancy, breast feeding, children over 2 months
- Available as aerosol, pump spray, wipes, roll on, lotions, plug in (GSL)
- Other insect repellents: Icaradin (Picardin), Eucalyptus citriodora oil, IR3535
- Avoid citronella products, garlic, vitamin B supplements - ineffective
- Correct application is important, apply to all areas of exposed skin every 3-4 hours, apply after sunscreen, wash hands after applying, reapply after washing/swimming
18
Q
Chemoprophylaxis =
Taking malaria prevention medication
A
- Antimalarial tablets do not prevent mosquito bites but help stop spread of infection and symptoms
- No regimen is 100% effective but antimalarial medication with bite prevention measures provides significant protection
- Ensure appropriate for destination according to guidelines, tailored to individual
- Full clinical history – medical conditions, current medication, allergies
- Antimalarial tablets are taken before ( build tolerance) , during and after visiting the malarial area
- Differ in dosage, side effects, regimen
18
Q
Mosquito Nets
A
- Create barrier between mosquito/insects and
skin, especially when sleeping - More effective if impregnated with insecticide
- Nets can be retreated with insecticide
- Different varieties available for indoors/outdoors
- Ensure no visible holes, enough space so that net does not rest against skin
18
Q
Anit- malarial drugs ( chemoprophylaxis)
A
18
Q
What are travel vaccinations?
A
- Reduce risk of contracting certain diseases from other countries by being vaccinated
- Vaccinations are available to protect against:
Hepatitis A, Meningococcal meningitis, Poliomyelitis, Tetanus, Typhoid fever, Yellow fever - Available from GP, private travel clinics
18
Q
Other considerations
A
- When taking medication abroad, check rules of the country you are travelling to, contact embassy
- Carry medication in hand luggage, keep in original packaging, ensure sufficient supplies ( 2-3 supply compared to what you need for tha period)
- Carry a list of prescribed medication
- Controlled Drugs - letter from GP
- Copy of vaccine records
- Proof of travel health insurance
- Contact card – details of next of kin
19
Q
First Aid Kit
A
- Tailor so specific to individual, travel destination
- Wound care – bandages, dressings, plasters, blister plasters, steri strips, gauze, sterile saline solution, antiseptic wipes, sling, tweezers, safety pins, scissors, disposable gloves, sterile eye wash
- Thermometer = to monitor fever
- Pain killers e.g. Paracetamol, Ibuprofen
- Antihistamines e.g. Cetirizine, Loratadine
- Antihistamine/Corticosteroid creams e.g. Mepyramine, hydrocortisone cream for bites/stings
