PROCEDURE COUNSELLING Flashcards
ENDOSCOPY (GASTROSCOPY)
what are the general steps for endoscopy counselling?
- introduction
- ICE
- quick patient history
- what is a gastroscopy?
- why is it performed?
- what are the alternatives?
- preparation
- what happens during the procedure?
- what are the side effects and risks?
- closing the consultation
ENDOSCOPY (GASTROSCOPY)
what should you explore with ICE?
IDEAS
- what do you already know about endoscopy?
CONCERNS
- is there anything worrying you about having an endoscopy?
EXPECTATIONS
- what were you hoping we would cover? is there anything specific you want us to focus on?
ENDOSCOPY (GASTROSCOPY)
what should you discuss for patient history?
- reason why they are having endoscopy done
ENDOSCOPY (GASTROSCOPY)
how do you explain what an endoscopy is?
- test to examine upper digestive tract
- Upper GI = oesophagus, stomach + first part of small intestine called duodenum
- long thin flexible tube passed through mouth down oesophagus to stomach + duodenum
- images are relayed to screen
- may take some small samples of cells
ENDOSCOPY (GASTROSCOPY)
how would you explain why an endoscopy is performed?
- used to diagnose + monitor certain conditions
- recommended when symptoms such as painful swallowing, persistent heartburn or indigestion that does not go away, nausea or vomiting, bringing up blood
- an monitor conditions like GORD or diagnose pre-cancerous and cancerous changes
ENDOSCOPY (GASTROSCOPY)
how would you explain the alternatives to endoscopy?
- barium swallow
- less invasive and does not involve sedation
- drink barium liquid, which appears white on x-ray
- can see outline of oesophagus + stomach
- cannot see direct view of walls + cannot take samples
- still useful to see any mobility problems in GI
ENDOSCOPY (GASTROSCOPY)
how would you explain the preparation?
- receive letter with appointment
- tell clinic if taking medications, especially blood-thinners or allergies
- acid-reducing meds are stopped 2 weeks before test to increase detection. Can cause increase of symptoms but doesn’t cause harm
- on day, stop eating 6hrs before + stop drinking 2hrs before
ENDOSCOPY (GASTROSCOPY)
how would you explain what happens during an endoscopy?
ON ARRIVAL
- before procedure, must give written consent confirming you understand risks + agree to proceed
- will be offered local anaesthetic spray or sedative
- local anaesthetic = throat and mouth go numb, reducing gag reflex + make procedure easier + more comfortable
- sedative = awake but relaxes you, helps you feel calm. Given through IV in arm
GASTROSCOPY
- lie on left side
- given plastic mouthpiece to protect teeth
- scope placed in mouth + asked to swallow
- scope will be advanced down
- air passed into stomach to aid seeing lining = may feel bloated
- not painful + does not affect ability to breathe or swallow, may be uncomfortable
- may take pictures + take small samples for further testing
ENDOSCOPY (GASTROSCOPY)
what do you need to warn about sedative option?
- given through IV in arm
- should not drive for 24hrs after
- need someone to pick you up + stay with you until effects wear off
- do not drink alcohol
- do not operate heavy machinery
- do not sign legal documents
ENDOSCOPY (GASTROSCOPY)
what happens after the procedure?
- taken to recovery room, nurses look after you
- if throat spray = can drive + continue day. Don’t eat or drink for 1 hour until feeling in throat comes back
- if sedated = need someone to pick up + stay with you for 24hrs.
- before leaving someone will go through results with you
ENDOSCOPY (GASTROSCOPY)
how would you explain the risks and side effects?
very safe procedure but there are potential risks and side effects that should be considered
SIDE EFFECTS
- gagging + retching (reassure this is natural response)
- sore throat
- bloating or nausea immediately after (due ti aur)
- abdominal pain
- minor bleeding when biopsy taken
RISKS
- damage to teeth or dental work
- aspiration (small bits of food to fall into lungs + cause infection, this is why stomach must be empty)
- perforation (rare, can cause bleeding, infection + tear which requires operation to repair)
- Seek medical attention if you vomit blood, severe abdo pain, fever or difficulty breathing after
ENDOSCOPY (GASTROSCOPY)
how should you close the consultation?
- summarise points discussed
- thank patient for time
- offer a leaflet
- wash hands
COLONOSCOPY
what are the steps for colonoscopy counselling?
- introduction
- ICE
- quick patient history
- what is a colonoscopy?
- why is it performed?
- what are the alternatives?
- preparation
- what happens during the procedure?
- side effects and risks
- closing the consultation
COLONOSCOPY
what should you include in patient history?
- why they need a colonoscopy
COLONOSCOPY
how would you explain what a colonoscopy is?
- test to look inside colon/large bowel
- long thin flexible tube with camera on end is passed into back passage
- have clear view of bowel + may take samples
COLONOSCOPY
how would you explain why a colonoscopy is performed?
- when you have symptoms such as blood in poo, change in bowel habit or unexpected weight loss
- used as screening test for bowel polyps + bowel cancer (screening test = when no symptoms, aiming to catch disease early)
- polyps = little growths, majority are not serious. When found, they are removed + tested as there is a chance they could grow into cancer
COLONOSCOPY
how would you explain what the alternatives are to colonoscopy?
- CT virtual colonoscopy
- less invasive + doesn’t require sedation
- x-ray + computer created detailed model of large bowel
- not allow direct view of bowel wall
- cannot take samples
COLONOSCOPY
what is the preparation?
- bowel needs to be empty to have a clear view
- if bowel not clear, test may need to be repeated
- will be given diet sheet of food you can and cannot have in few days before scan
- drink lots of fluid
- must take strong laxative day before to clear bowel
- will cause diarrhoea so will need to stay close to toilet
- on day, will not be able to eat but can drink until 2hrs before
COLONOSCOPY
how do you explain the colonoscopy procedure?
ON ARRIVAL
- sign consent form to say you understand + agree to risks
- offered sedation to make you more relaxed
COLONOSCOPY
- lie on left side with knees up to chest
- need to do finger exam of back passage before scope is inserted
- scope placed in back passage + inflate bowel with air to make it easier to move
- may ask you to change position to improve view
- scope will go through whole large bowel, relaying images
- will remove any growths + may take samples
COLONOSCOPY
what happens after the procedure?
- taken to recovery room
- someone needs to pick you up + stay with you for 24hrs
- cannot drive for 24hrs
- someone will explain results before you leave
- biopsies can take multiple weeks
COLONOSCOPY
what are the side effects and risks?
SIDE EFFECTS
- nausea
- bloating
- crampy abdo pain
- minor rectal bleeding (normal to have small amount of blood in poo in days following
RISKS
- allergy to sedation, equipment or materials
- heavy bleeding
- bowel perforation (seek medical attention if abdo pain, heavy bleeding or fever afterwards)
- incomplete exam
- may miss pathology (not 100% perfect)
INDUCTION OF LABOUR
what are the steps for discussing induction of labour?
- introduction
- ICE
- patient history (reason for induction + how pregnancy has gone so far)
- what is induction?
- what are the indications?
- check contraindications
- methods (with advantages and disadvantages)
- unsuccessful induction
- closing consultation
INDUCTION OF LABOUR
how would you explain what induction of labour is?
- usually labour occurs naturally between 37-42 weeks
- if continuing pregnancy involves significant risk to you or baby = offer induction
- induction = when interventions are used to help start labour
- need to go to maternity unit for monitoring
- requires internal exam to determine how ready cervix is for labour + guide best method
- medication + mechanical methods
INDUCTION OF LABOUR
what are the indications?
- pregnant beyond 41 weeks = higher risk of complications e.g. c-section, NICU + stillbirth
- prelabour rupture of membranes (if waters break >24hrs before labour starts there is higher risk of infection, induction reduces risk)
- maternal medical condition that makes it safer to deliver earlier e.g. diabetes, HTN or heart disease
- concern for baby (growth or health)
INDUCTION OF LABOUR
what are the different ways of inducing labour?
- 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
INDUCTION OF LABOUR
what are the advantages and disadvantages of induction?
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
INDUCTION OF LABOUR
what are the contraindications to induction?
- 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)
INDUCTION OF LABOUR
what are the advantages and disadvantages of membrane sweep?
ADVANTAGES
- reduce likelihood of requiring induction
- can take place at home or during outpatient appt
DISADVANTAGES
- may not start labour on first attempt
INDUCTION OF LABOUR
what are the advantages and disadvantages of prostaglandins?
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
INDUCTION OF LABOUR
what are the advantages and disadvantages of mechanical induction (balloon catheter)?
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)
INDUCTION OF LABOUR
what are the advantages and disadvantages of amniotomy?
ADVANTAGES
- releases hormones that start contractions
- necessary before oxytocin
DISADVANTAGES
- done during vaginal exam which can be uncomfortable (can discuss pain management options)
INDUCTION OF LABOUR
what are the advantages and disadvantages of oxytocin?
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)
INDUCTION OF LABOUR
how would you explain what happens after unsuccessful induction of labour?
- will be monitored closely
- will discuss alternatives or possible c-section
- will support + explain all options so you can make the best decisions
DIALYSIS
what are the steps for dialysis counselling?
- 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
DIALYSIS
how would you explain what dialysis is?
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
DIALYSIS
how would you explain how dialysis works?
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
DIALYSIS
how would you explain how haemodialysis works?
- 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)
DIALYSIS
what are the pros and cons of haemodialysis?
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
DIALYSIS
how would you explain what peritoneal dialysis is?
two options
- continuous fluid in abdomen + perform 4 fluid changes per day but not connected to machine
- machine replaces dialysis fluid during sleep
DIALYSIS
what are the advantages and disadvantages of peritoneal dialysis?
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
BLOOD TRANSFUSION
what are the steps for blood transfusion counselling?
- introduction
- ICE
- benefits of transfusion
- risks
- potential alternatives
- what does transfusion involve?
- how they may feel during + after transfusion
- obtaining consent
BLOOD TRANSFUSION
what should you discuss during ICE?
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?
BLOOD TRANSFUSION
what are the potential benefits?
- relieve symptoms of anaemia
- prevent damage to organs associated with anaemia
- all earlier mobilisation + quicker recovery after operation, acute illness or injury
BLOOD TRANSFUSION
what are the risks?
- 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)
BLOOD TRANSFUSION
what are the alternatives?
- 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
BLOOD TRANSFUSION
how would you explain what an infusion involves?
- 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
BLOOD TRANSFUSION
how might the patient feel during + after transfusion?
- 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
BLOOD TRANSFUSION
what should you discuss when obtaining consent?
- 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
BOWEL CANCER SCREENING
what are the steps for bowel cancer screening counselling?
- introduction
- explain screening programme
- stool sample collection
- results
BOWEL CANCER SCREENING
how would you explain the screening programme?
- 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
BOWEL CANCER SCREENING
what are the steps for stool sample collection?
- 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
BOWEL CANCER SCREENING
how would you explain results?
- 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
ECT
what are the steps for ECT counselling?
- 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
ECT
how would you explain what ECT is?
- 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
ECT
what is it used for?
- severe depression (resistant to multiple therapies)
- severe depressive episode causing harm to patient
- catatonia
- severe or ongoing mania
ECT
what are the potential benefits?
- 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
ECT
how many sessions are required?
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
ECT
what happens before ECT session?
- 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
ECT
what happens during ECT session?
- 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
ECT
what happens after ECT session?
- will wake up in recovery room
- doctors and nurses will be there to look after you
ECT
what are the side effects?
- 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
ECT
what are the risks?
- 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
CHOLECYSTECTOMY
what are the benefits?
- reduce likelihood of symptoms
CHOLECYSTECTOMY
what are the risks?
- 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)
CHOLECYSTECTOMY
what are the recovery details?
- 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
ASCITIC DRAIN
how would you explain what ascites is?
abnormal build up of fluid in the abdomen
common cause = chronic liver disease
ASCITIC DRAIN
how would you explain the procedure?
- 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
ASCITIC DRAIN
what are the risks?
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
INHALER TECHNIQUE
why is it important to have correct technique?
- 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
INHALER TECHNIQUE
what is the correct technique?
- 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
INHALER TECHNIQUE
what should you do after using a steroid inhaler?
rinse mouth out
reduces chance of bad taste and side effects
INHALER TECHNIQUE
what are the side effects?
RELIEVER
- palpitations
- tremor
- may not work in acute attack
STEROID
- thrush (rinse out after use)
INHALER TECHNIQUE
what is the safety netting advice?
if 10 puffs of reliever inhaler doe not relieve symptoms, call an ambulance
APPENDICECTOMY
what is appendicitis?
- 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)
APPENDICECTOMY
what is the procedure?
- usually via keyhole (few small cuts)
- given antibiotics beforehand
- usually be able to go home next day
APPENDICECTOMY
what are the risks/complications?
- 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
CATHETERISATION
what is a catheter?
- a long flexible tube made out of latex
- goes into bladder to drain it
CATHETERISATION
how would you explain the procedure?
- 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
CATHETERISATION
what are the risks?
- infection
- leakage
- bladder spasms
- damage to urethra and surrounding structures (rare, let me know if you are in pain at any point)
CERVICAL SMEAR
how would you explain what a smear is?
- routine test for women aged 25-64
- screens for cervical cancer (cancer women can get from early age)
- tests for HPV virus
CERVICAL SMEAR
what is HPV?
- 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
CERVICAL SMEAR
what is the procedure?
- 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
CERVICAL SMEAR
what questions do you need to ask before a smear?
- any possibility of pregnancy
- last period
- any irregular bleeding
- any pain
CERVICAL SMEAR
how would you explain interpretation of results?
- 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)
CERVICAL SMEAR
what happens if there are changes to cells?
will be sent for colposcopy = an appointment to have a closer look at the cervix using a camera
LUMBAR PUNCTURE
what is a lumbar puncture?
- taking a sample of fluid that surrounds brain and spinal cord (CSF)
LUMBAR PUNCTURE
what is the procedure?
- will lie on side
- numb area of lower back (should only sting a bit)
- take CSF using a fine needle
- should take 30 minutes
LUMBAR PUNCTURE
what are the side effects?
- 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)
LUMBAR PUNCTURE
what is the safety netting advice?
if develop fever, unusual bleeding or weakness/tingling/numbness return to A&E
