PROCEDURE COUNSELLING Flashcards

Question

INDUCTION OF LABOUR what are the different ways of inducing labour?

Answer 1

- membrane sweep (finger in vagina + sweeping neck of womb, helps to separate membranes from cervix + release hormones) - prostaglandins (inserted as gel, pessary or tablet into vagina) - balloon catheter - amniotomy - oxytocin IV infusion

Answer 2

ADVANTAGES - reduce risk of complications - lower risk of perinatal death DISADVANTAGES - may affect other birth choices (may not be able to have water birth on midwife led unit) - more painful than spontaneous labour

Answer 3

- when vaginal delivery poses significant risks (e.g. placenta praevia) - unable to tolerate labour( e.g. heart failure) - breech presentations - previous c-section or uterine surgery (increased risk of rupture)

Answer 4

ADVANTAGES - reduce likelihood of requiring induction - can take place at home or during outpatient appt DISADVANTAGES - may not start labour on first attempt

Answer 5

ADVANTAGES - quicker - involve less discomfort than mechanical methods DISADVANTAGES - hyperstimulation (contractions too frequent/last too long) - womb can be injured - not suitable for some women (previous c-section) - S/E = nausea, vomiting + diarrhoea

Answer 6

ADVANTAGES - less likely to cause hyperstimulation - minimally invasive - do not require medications DISADVANTAGES - may be uncomfortable + cause cramping - may take longer - small risk of cord prolapse (emergency + requires immediate intervention)

Answer 7

ADVANTAGES - releases hormones that start contractions - necessary before oxytocin DISADVANTAGES - done during vaginal exam which can be uncomfortable (can discuss pain management options)

Answer 8

ADVANTAGES - increase number + strength of contractions DISADVANTAGES - can make contraction more painful - baby's heartbeat needs to be continuously monitored (some birthing options may not be available)

Answer 9

- will be monitored closely - will discuss alternatives or possible c-section - will support + explain all options so you can make the best decisions

Answer 10

- introduction - ICE - patient history (why you need dialysis) - what is dialysis? - how does it work? - haemodialysis (pros + cons) - peritoneal dialysis (pros and cons) - closing consultation

Answer 11

normally = kidneys filter blood + require waste products which are turned into urine - when kidneys don't work, excess fluid + toxins build up in body as they are not removed - dialysis artificially cleans blood to remove waste

Answer 12

passes blood on one side of filter with dialysis fluid on other side membranes act as sieve to filter waste into dialysis fluid which is then disposed of

Answer 13

- using external machine which acts as kidney - can be done in dialysis centre or in home - done 3 days per week - each session lasts 3-4hrs - can be sat or lying down during session - requires AV fistula (operation 8wks before starting dialysis)

Answer 14

PROS - 3-4 dialysis free days per week - dialysis centres are widely available - meet other people undergoing treatment - performed by healthcare professionals CONS - restricted fluid intake - restricted diet - low BP (dizzy or sick) - sepsis - muscle cramps ( due to sudden changes) - feeling itchy (due to build up of salts and minerals between sessions) - require surgery to create AV fistula - complications from fistula - plan life around dialysis sessions - need to travel to centres

Answer 15

two options - continuous fluid in abdomen + perform 4 fluid changes per day but not connected to machine - machine replaces dialysis fluid during sleep

Answer 16

ADVANTAGES - performed at home - less restriction on diet + fluid intake - performed by patient - no needles - easier to travel + go on holiday DISADVANTAGES - must be done everyday - need abdominal catheter - risk of peritonitis - responsibility for own health - scarring of peritoneum - weight gain - rise in blood sugar if diabetic - hernias

Answer 17

- introduction - ICE - benefits of transfusion - risks - potential alternatives - what does transfusion involve? - how they may feel during + after transfusion - obtaining consent

Answer 18

IDEAS - do you know why we suggested a blood transfusion? - have you/anyone you know had one before? - do you know what it involves? CONCERNS - is there anything that worries you? - is there anything you don't understand? EXPECTATIONS - how do you hope receiving a transfusion will help you? - do you have anything you particularly want me to cover?

Answer 19

- relieve symptoms of anaemia - prevent damage to organs associated with anaemia - all earlier mobilisation + quicker recovery after operation, acute illness or injury

Answer 20

- identification error (receive wrong blood type causing severe reaction. Will wear ID bracelet + confirm name + DoB before starting) - reactions e.g. fever, chills or rash - small risk of build up of fluid in lungs causing breathlessness (tell someone if feeling unwell) - infection of hep B, C or HIV (less than 1 in 1 million, blooding is extensively tested) - formation of antibodies (harder to match blood in future - iron overload (if long term treatment)

Answer 21

- iron replacement therapy (tablet or IV) - cell salvage (blood lost during surgery is collected + transfused back to patient) - erythropoietin injection (stimulates body to make own RBCs) - doing nothing medications to reduce chance of requiring transfusion - tranexamic acid - iron supplements

Answer 22

- small sample of blood taken to check blood group + sent to lab for testing - cannula inserted into vein - asked to give name + DoB, this is checked with ID bracelet + details on donor bag - blood will slowly flow from bag down tube into vein - takes 2-4 hrs for each bag of blood - temperature, BP and pulse checked before, during + after transfusion

Answer 23

- sharp prick when cannula inserted - should not feel anything during transfusion - some people feel fever/chills (paracetamol + slow transfusion rate) - may have bruise from cannula - contact GP if feeling unwell particularly in first 24hrs but anytime in next 2wks. Important if chest or back pain, difficulty breathing or change in colour of skin or urine

Answer 24

- ask if happy to proceed - ask if they have any further questions or concerns (can give time to think) - check if any allergies - check if they have special type of blood or been given alert card

Answer 25

- introduction - explain screening programme - stool sample collection - results

Answer 26

- test for people >60 to use at home - collect single sample of poo in small plastic bottle + posting to lab - test is used to check for tiny amounts of blood in poo - does not diagnose bowel cancer but it is a simple way to find out if extra tests are needed

Answer 27

- write date on bottle - catch poo using container or toilet paper - scrape stick along poo until all grooves filled - push stick into bottle + close cap - wash hands - do not reopen bottle - seal envelope + post to lab

Answer 28

- results posted within 2 weeks - normal = no blood in poo so do not need to do anything. Will be invited to do test again in 2yrs - abnormal = blood in poo. Does not necessarily mean you have bowel cancer. Will be offered another test called a colonoscopy where thin tube with camera is inserted into back passage

Answer 29

- introduction - ICE - what is ECT? - what is it used for? - what are the potential benefits? - how many sessions are required? - what does it involve? (before, during and after treatment) - side effects - risks - closing consultation

Answer 30

- electroconvulsive therapy = psych treatment where pt is put to sleep with general anaesthetic + small electrical energy directed to brain - induces small controlled seizure - medication given to relax muscles so damage is minimised - closely monitored throughout - so brief that there is no need for intubation - thought to reorganise networks of brain that are disordered

Answer 31

- severe depression (resistant to multiple therapies) - severe depressive episode causing harm to patient - catatonia - severe or ongoing mania

Answer 32

- one of the most effect treatments for severe depression (70-80% repsonse rate) - most patients see improvement within 2wks - can work together with antidepressants to stabilise mood

Answer 33

twice weekly treatment for 6-12 sessions at a time reassessed after every treatment may stop before end of course may require maintenance ECT at longer intervals

Answer 34

- required to by nil by mouth for 6hrs - anaesthetist carries out pre-procedure assessment - psychiatrist assess mental health act + capacity status - attached to EEG machine to continuously monitor brain activity - short acting anaesthetic is administered - muscle relaxant administered - mouth guard used to protect teeth + tongue

Answer 35

- can be uni or bilateral - electrode placed on temples - electrical energy applied to brain (lasts 5 seconds) - induces controlled seizure for over 15 seconds to be considered successful - if seizure lasts >180s it is terminated with benzodiazepine - if unsuccessful, two further administrations can occur in each session

Answer 36

- will wake up in recovery room - doctors and nurses will be there to look after you

Answer 37

- short term memory loss (long term = rare) - retrograde amnesia (memory loss immediately before/during ECT) - post ECT headache - muscle aches - brief confusion/drowsiness following anaesthetic

Answer 38

- mainly related to anaesthetic use (airway issues, reaction to anaesthetic, dental damage) - prolonged seizure - not respond to treatment - no absolute contraindications - relative contraindications: = recent MI or stroke = raised ICP = active bleeding = retinal detachment

Answer 39

- reduce likelihood of symptoms

Answer 40

- pain, bleeding, infection - bile leakage (will be monitored after op, can drain fluid) - post-cholecystectomy syndrome (bile leakage causing fever, sickness. Very rare (1 in 100)) - damage to bowel/blood vessels - blood clots (will be given blood thinning medication)

Answer 41

- if keyhole, can be discharged same day - take things easy for a few weeks - avoid heavy lifting for 2-3 weeks (open surgery = longer) - need someone to stay with you for first 24hrs - cannot drive yourself home

Answer 42

abnormal build up of fluid in the abdomen common cause = chronic liver disease

Answer 43

- purpose is to drain fluid - common and effective treatment - will be examined or use USS to find best place for drain - involves inserting a large needle into abdomen and then inserting a drain - the drain will be there for a few hours - can be painful (will use local anaesthetic to numb area) - will be given a solution called human albumin solution through veins after a specific volume of fluid has been drained. This replaces fluid lost + helps maintain blood volume

Answer 44

COMMON - tiredness - low blood pressure - abdominal pain - not successful procedure - leakage from drain site for up to 72hrs (can require a stitch) UNCOMMON - infection RARE - damage to organs

Answer 45

- makes sure medication flows + distributes evenly in lungs to where it needs to be - can be more likely to have asthma attacks which can be life-threatening - asthma is very common - using medication correctly will mean less likely to require reliever

Answer 46

- test puff away from mouth - check expiry date - hold upright - take off cap - give it a good shake - breathe in and out gently without mouthpiece in mouth - put lips around mouthpiece ensuring no gaps - breathe in slowly + press inhaler as you do - keep breathing for nice deep breath until lungs are full - take out inhaler + hold lips together for 10s - then breathe out gently - wait 30s before taking another dose

Answer 47

rinse mouth out reduces chance of bad taste and side effects

Answer 48

RELIEVER - palpitations - tremor - may not work in acute attack STEROID - thrush (rinse out after use)

Answer 49

if 10 puffs of reliever inhaler doe not relieve symptoms, call an ambulance

Answer 50

- inflammation of appendix - appendix = small outpouch of the gut attached to large intestine - can get inflamed when something blocks the exit into the intestine - not sure of role, but studies show it is reservoir for good gut bacteria (can live without)

Answer 51

- usually via keyhole (few small cuts) - given antibiotics beforehand - usually be able to go home next day

Answer 52

- if untreated, can burst + make you unwell (require more surgery) - pain and bruising (give painkillers) - shoulder pain from gas - constipation (drink plenty of fluids + eat fibre, avoid codeine) - bleeding, infection, scarring

Answer 53

- a long flexible tube made out of latex - goes into bladder to drain it

Answer 54

- involves removing clothing + underwear - will have a chaperone - clean area to reduce chance of infection - put numbing gel into urethra + wait a few minutes - insert catheter into urethra until it reaches bladder - will inflate small balloon at the end of the catheter to make sure it stays in place - catheter will be attached to a bag to collect urine

Answer 55

- infection - leakage - bladder spasms - damage to urethra and surrounding structures (rare, let me know if you are in pain at any point)

Answer 56

- routine test for women aged 25-64 - screens for cervical cancer (cancer women can get from early age) - tests for HPV virus

Answer 57

- virus lots of people carry around without realising it - most types are asymptomatic - some forms can cause genital warts - a few types increase the risk of cervical cancer (they are called high risk HPV) these types do not cause warts which is why a smear is required

Answer 58

- insert a plastic device called a speculum into vagina - allows visualisation of cervix (neck of womb) - small brush is used to take a sample of cells from cervix - should not be painful but can feel uncomfortable (can stop at any time) - may cause a small amount of vaginal bleeding (can provide sanitary towel afterwards) - will need a chaperone

Answer 59

- any possibility of pregnancy - last period - any irregular bleeding - any pain

Answer 60

- if HPV identified, will look at cells for any unusual changes - if no HPV, result will be reported as normal and you will have another test in 3-5yrs (depending on age)

Answer 61

will be sent for colposcopy = an appointment to have a closer look at the cervix using a camera

Answer 62

- taking a sample of fluid that surrounds brain and spinal cord (CSF)

Answer 63

- will lie on side - numb area of lower back (should only sting a bit) - take CSF using a fine needle - should take 30 minutes

Answer 64

- headache (stay hydrated, take paracetamol, avoid caffeine) - back pain (rest, paracetamol) - infection and bleeding RARE - cerebral herniation (brain moves from normal position = dangerous) - nerve damage (tingling, pain, weakness and numbness)

Answer 65

if develop fever, unusual bleeding or weakness/tingling/numbness return to A&E