Symptoms in the Pharmacy - Respiratory Conditions Flashcards
What is the Common Ailment Scheme (CAS)?
- free NHS service
- Patients can access for advice and treatment of 26 conditions through CAS.
What does the Common Ailment Scheme (CAS) involve?
- Patient registration with the pharmacy
- Private consultation with the pharmacist
- Advice on management and treatment where needed OR referral if necessary
Who can access the Common Ailment Scheme (CAS)
Any patient who LIVES in Wales or who is registered to a Welsh GP is eligible to access the Choose Pharmacy Service.
Exclusions from the CAS?
- Temporary residents whose usual address is not in Wales
- Care Home residents
Any exclusions for specific conditions?
- Age
- Pregnancy/breastfeeding
- If they have had the condition multiple times
What are the 26 conditions that can be treated under the CAS?
- Acne
- Athletes Foot
- Backache (acute)
- Chickenpox
- Cold sores*
- Colic*
- Conjunctivitis (bacterial)
- Constipation
- Dermatitis (acute)
- Diarrhoea*
- Dry eyes
- Haemorrhoids
- Hayfever
- Head Lice
- Indigestion/reflux
- Ingrowing toenail*
- Intertrigo/ringworm
- Mouth Ulcers
- Nappy rash
- Oral thrush
- Scabies
- Sore throat/tonsillitis
- Teething
- Threadworm
- Vaginal thrush
- Verruca
What is Choose Pharmacy?
confidential NHS electronic records system, which community pharmacists use to record details of NHS services they provide to you
Cold v Flu Symptoms
Both;
Cough
Runny/stuffy nose
Sore throat
Headache
Cold;
Congestion
Itchy/watery eyes
Feeling tired
Flu;
Fever
Body aches
Extreme fatigue
Cold more MILD than Flu
What is the most common complications of common cold?
- adults/older children = symptoms last about a week, cough can persist for up to 3w
- younger children, symptoms typically last 10–14 days
- Smokers tend to have more severe respiratory symptoms (including cough), and the infection is more prolonged.
Common cold info:
- Mild, self-limiting, viral (rhinovirus), upper respiratory tract infection
- General symptoms: nasal stuffiness and discharge, sneezing, sore throat, and cough. No known treatment improves the time course of infection
- Transmitted by either direct contact or aerosol transmission
- People can remain infectious for several weeks
- The most common complications aresinusitis, lower respiratory tract infections (LRTI), andacute otitis media
- Onset of symptoms after infection is sudden, reaching a peak at day 2–3, then decreasing in intensity
common symptoms for or signs for adults/older children;
- Sore or irritated throat
- Nasal irritation, congestion, nasal discharge (rhinorrhoea), and sneezing
- Nasal discharge is often profuse and clear at first but becomes thicker and darker as the infection progresses
- Cough, which typically develops after nasal symptoms clear
- Hoarse voice caused by associated laryngitis.
General malaise
Seasonal Influenza
what is it caused by?
Acute respiratory illness caused by RNA viruses of the family Orthomyxoviridae (influenza viruses
What are the most common complications of influenza in adults?
(they are respiratory in nature)
Acute bronchitis.
Pneumonia.
Exacerbations of asthma and chronic obstructive pulmonary disease (COPD).
Otitis media.
Sinusitis.
When do symptoms start to show with the seasonal Influenza?
2 days after exposure
Define Uncomplicated influenza:
coryza (inflammation), nasal discharge,cough, fever,gastrointestinal (GI) symptoms, headache, malaise, myalgia, arthralgia,ocular symptoms, and sore throat
Define Complicated influenza:
require hospital admission, involve thelower respiratory tract,central nervous system (CNS), or cause significant exacerbation of an underlying medical condition
Who are the ‘At risk’ groups for influenza?
Those with chronic respiratory, heart, kidney, liver, or neurological disease; diabetes mellitus (DM); or those who are obese orimmunosuppressed
Those > 65 years
Women who are pregnant (or women up to two weeks post partum)
Children aged < 6 months
Chronic respiratory diseases;
cannot be healed from it
e.g. asthma
Infections cause blood sugars to increase a lot;
if diabetic patient does not take insulin because they are not eating. Can be hospitalised bc sugar is not broken down by insulin
Children aged < 6 months
Why are they at risk for influenza
they’re kidneys are not fully developed
not a lot of medicines for their age available
more at risk for kidney injury
Management for seasonal influenza:
Drink adequate fluid
Take paracetamol or ibuprofen to relieve symptoms, rest
Stay off work or school until the worst symptoms have resolved (usually ~1 week)
Urgent admission to hospital should be considered for influenza if:
A complication such as pneumonia occurs
The person has a concomitant disease that may be affected by influenza (for example, type 1 diabetes)
There is suspicion of a serious illness other than influenza (for example,meningitis)
Purple rash
stiff neck
Cough - irritation in airways
reflex response to airway irritation
It is triggered by stimulation of airway cough receptors, either by irritants or by conditions that cause airway distortion
Cough can be acute (lasting < 3 weeks), sub-acute (lasting 3–8 weeks), or chronic (lasting > 8 weeks)
Commonly caused by a viral upper respiratory tract infection (URTI).
What are OTHER causes of cough?
Acute bronchitis
Pneumonia
Acute exacerbations of asthma
Environmental or occupational causes
Foreign body aspiration
How long does cough last if patient has LUNG cancer?
more than 3 weeks
hard to diagnose
Management of cough:
based on treating the underlying cause where it has been identified, or sequential trials of treatment to confirm or refute common causes
Offer self care; e.g. paracetamol or ibuprofen for pain and inflammation, if appropriate), and refer to smoking cessation if relevant
Referral to a respiratory physician should be arranged for people with a cough that does NOT respond to trials of treatment, if the diagnosis is uncertain/systemically unwell
Emergency referral
What is emergency referral for cough appropriate?
fro people with clinical features of foreign body aspiration.
What is Croup?
(laryngotracheobronchitis) is a common childhood disease
Usually caused by a virus (can’t be treated)
What are the symptoms of Croup?
sudden onset of a seal-like barking cough usually accompanied by stridor (predominantly inspiratory)
hoarse voice
respiratory distress due to upper-airwayobstruction
Symptoms usually worse at night
preceding 12–48 hour history of a non-specific cough, rhinorrhoea, and fever
What groups does Croup normally affect?
children between 6 months and 6years of age, with a peak incidence during the second year of life
What are the mild, moderate and sever symptoms of CROUP?
Mild = seal-like barkingcough but no stridor or sternal/intercostal recession at rest
Moderate = includeseal-like barkingcough with stridor and sternal recession at rest; no agitation or lethargy
Severe = includeseal-like barkingcough with stridor and sternal/intercostal recession associated with agitation or lethargy
A child should be immediately admitted when presenting with moderate or severe croup, or impending respiratory failure
How to manage croups?
- all kids, mild/mod/sev symptoms = receive SINGLE dose of oral dexamethasone (0.15mg per kg body weight)
- Mild croup can usually be managed at home
- self-limiting, symptoms resolve within 48hrs
- IF managed at home - paracetamol/ibuprofen can be used to control fever and pain
croups symptoms; when do they appear?
12- 14 hrs after exposure
If child is TOO unwell with CROUP to receive medication, inhaled budesonide (2mg mg nebulised as a single dose) or intramuscular (IM)
What is an alternative?
dexamethasome (0.6 mg/kg as a single dose) are possible alternatives
(lower dose)
what is Whooping cough?
Also known as pertussis
It is a highly infectious disease caused by the bacteriumBordetella pertussis
It is spread by aerosol droplets released during coughing, and disproportionately affects infants and young children
how long does the incubation period last for
usually about 7 days, and the person is infectious for 3weeks after the onset of symptoms
usually about 7 days, and the person is infectious for 3weeks after the onset of symptoms
The catarrhal phase lasts ~ a week and is characterised by the development of a dry, unproductive cough
The paroxysmal phase may last for a month or more and is characterised by coughing fits, whooping, and post-tussive vomiting. The person may be relatively well between paroxysms
The convalescent phase may last an additional 2 months or more, and is characterised by gradual improvement in the frequency and severity of symptoms
Whopping Cough is a _______ disease
notifiable
In the management of whooping cough:
People who are seriously unwell should be admitted to hospital (a low threshold is required for children aged 6 months or less)
An antibiotic = (usually a macrolide, such as erythromycin or clarithromycin) should be prescribed to all people with suspected or confirmed whooping cough with onset of cough within the previous 21 days.
Advise = should be given on rest, adequate fluid intake, and the use of paracetamol or ibuprofen for symptomatic relief
Children and healthcare workers should be advised to stay off nursery, school, or work until 48 hours of appropriate antibiotic treatment has been completed, or 21 days after onset of symptoms if not treated
Close contacts may require antibiotic prophylaxis
