OPIC Workbook

Question 1

How should you examine someone who has just experienced a fall?

Answer 1

A functional assessment of their mobility – how do they mobilise, what with and what is their gait like

Cardiovascular examination – include an ECG and a lying and standing BP (at immediate, 3 and 5 minutes)

Neurological examination

Musculoskeletal examination – assess their joints

Question 2

List 3 falls assessment tools

Answer 2

Timed Up and Go (TUG) Test: This test measures the time it takes for an individual to stand up from a standard armchair, walk three meters, turn around, walk back to the chair, and sit down again.

The Turn 180 Test: Used to evaluate an individual’s ability to turn around in confined spaces

Multifactorial falls risk assessment : used if 2+ falls in the last 12 months

Question 3

Give some risk factors for osteoporosis

Answer 3

low BMI
alcohol excess, current smoking
history of glucocorticoid use
rheumatoid arthritis
history of parental hip fracture

Question 4

List the medications used to treat osteoporosis and the adverse effects associated with them

Answer 4

Bisphosphonates e.g alendronate - jaw necrosis, oesophagitis

Vit D - nausea, dyspepsia

Vit C- renal stones

Denosumab - monoclonal antibody - UTI / abdo pain / rash

Question 5

Besides FAST and ROSIER, name 4 stroke assessment tools

Answer 5

National Institutes of Health Stroke Scale (NIHSS)

The Alberta Stroke Programme early CT score (ASPECTS) - for MCA stroke

The Oxfordshire Community Stroke Project (OCSP) Classification

Modified Rankin Scale

Question 6

What is the TOAST classification?

Answer 6

helps clinicians tailor treatment strategies to address the underlying cause of the stroke, such as anticoagulation for cardioembolic strokes or antiplatelet therapy for large-artery atherosclerosis

Question 7

What tool can be used for Stroke risk assesment following TIA?

Answer 7

ABCD2 score

Question 8

What tool is being used to replace the HASBLED tool to quantify the risk of bleeding with anticoagulation in AF? Also, how do you use this tool?

Answer 8

ORBIT!

Question 9

What is the PRISMA-7 tool?

Answer 9

Used to assess frailty - if ‘yes’ to 3 or more questions they require further clincial review

Question 10

What causes pressure ulcers?

Answer 10

decreased movement
decreased oxygen and blood flow

Question 11

Give 4 factors that increase risk of developing pressure ulcers

Answer 11

malnourishment: poor wound healing
incontinence: irritant to skin
lack of mobility
pain (leads to a reduction in mobility)

Question 12

What are the common sites for pressure ulcers to develop?

Answer 12

sacrum
back of the head
heel

Question 13

Name 3 screening tools used to assess pressure ulcers

Answer 13

Waterlow
Braden Scale
Norton

Question 14

How can pressure ulcers be managed?

Answer 14

Hydrocolloid dressings and hydrogels
Avoid soap
Consider referral to the tissue viability nurse
Surgical debridement may be beneficial

Question 15

How may you estimate height from a patients ulna length?

Answer 15

Measure between the point of the elbow (olecranon process) and the midpoint of the prominent bone of the wrist (styloid process)

Compare this value against the MUST chart

Question 16

How can you estimate BMI from mid upper arm circumference (MUAC)?

Answer 16

Measure the distance between the acromion and the olecranon process . Mark the mid-point.
Ask the subject to let arm hang loose and measure around
the upper arm at the mid-point, making sure that the tape
measure is snug but not tight.

If MUAC is <23.5 cm, BMI is likely to be <20 kg/m2

If MUAC is >32.0 cm, BMI is likely to be >30 kg/m2

Question 17

What are the 5 principles of the Mental Capacity Act 2005?

Answer 17

Principle 1 – A presumption of capacity
Principle 2 – The right to be supported when making decisions.
Principle 3 – An unwise decision cannot be seen as a wrong decision
Principle 4 – Decisions made on a patients behalf should be in their best interests
Principle 5 – Go with the least restrictive option possible