The consultation Flashcards
Outline the contents of the planning and explanation section of the consultation using the Calgary-Cambridge guide
- Usually merge into one
- Explanation of findings from physical exam, test results, outcome of surgery etc.
- Planning based on this
- Explanations along the way as decisions made are not always clear to the client
What should be included in the planning stage of the consultation?
- Options for treatment, diagnostic tests required, prognosis
- Utilise shared decision making
- Return to client’s agenda and check concerns have been addressed
What is meant by compliance?
Thee owner following the recommendations you have given
What is concordance?
Making and following through shared decisions
What is chunking and checking?
Giving small pieces of information and checking after each that it has been explained clearly
What is signposting?
Signalling what has just been discussed and what will be discussed next
What is safety netting?
Give options before they are needed, meaning decisions are less of a shock to owner, and owner is aware of how to respond to different situations
What are the benefits of using shared decision making?
- Improves compliance
- Improves owner understanding
- Less likely to encounter resistance if things go wrong
- True informed consent
What is meant by relationship centred care?
- Balance between paternalism and client autonomy
- Characterised by joint venture between vet and client to provide optimal care to the animal
What are the characteristics of relationship centred care?
- Respect for client’s interests and perspectives
- Elicits clients opinion
- Recognition of client’s expertise
- Acknowledgement of animal’s role in environment/family
- Lifestyle and social aspects all considered i.e. farmer vs child’s pet
What techniques can be used in breaking bad news?
- Relationship building
- Warning shots
- Pauses
- Hope and reality balancing
- Shared-decision making
What is meant by a warning shot?
- Give some indication that bad news is about to be delivered
- Allows client to prepare self
What diagnostic methods are commonly used in farm animal practice to improve reproductive performance?
- Internal examination (rectal and vaginal)
- Ultrasound
What structures can be felt in rectal palpation of the reproductive tract of the cow?
- Cervix
- Uterus
- Uterine horns
- Ovaries
What can rectal palpation in a reproductive exam of the cow be used for?
- Assessment of uterine tone to give idea of stage of cycle
- Presence/absence of follicles/CLs on ovaries
What structures can be examine by ultrasound in the reproductive exam of the cow?
- Uterus
- uterine horns
- Ovaries
What information can be gained from ultrasound in the reproductive exam of the cow?
- Presence of fluid in the uterus
- Presence of a foetus
- Follicles or CLs on ovaries and their size
- Assess preganncy status
- Uterine pathology (infection, trauma)
- Ovarian pathology (e.g. cysts, rarely may find neoplasia)
- Stage of oestrus cycle as an educated guess
Describe the tone of the bovine uterus in oestrus?
High one
What is assessed in the vaginal exam of the cow?
- Vaginal mucus quantity
- Mucus consistency
- Presence of blood
What features of the history are of particular interest in a reproductive exam of the cow?
- Calving dates
- Oestrus dates
- Treatments received
What are the limitations of the common diagnostic methods in large animal reproductive examination?
- Easy to miss information
- Farmer may not give full history
- Ultrasound is only a short snapshot of a 21 day period
At what point in the cycle can the stage of oestrus be accurately determined in the cow and how?
- 1-2 days after ovulation
- Lots of clear mucus +/- small amounts of fresh blood
- Increased uterine tone
- No CLs or folllicles on ultrasound of the ovaries
- Looks like anoestrus but with vaginal exam, know that cow has ovulated 1-2 days ago
Briefly describe the hormonal changes in the oestrus cycle of the cow
- After ovulation, CL forms
- Present for 15 days, progesterone high
- Minimal greyish vaginal mucus
- Low uterine tone
- At end of luteal phase becomes prostaglandin sensitive
- Luteolysis due to natural prostaglandin release
- Now into oestrus, oestrogen rises and falls
- Uterine tone rises and falls
- At beginning mucus is increasing, at ovulation have copious clear mucus
- High GnRH leads to LH surge, leading to ovulation
- After ovulation CL begins to form
- Mucus decreases and is often blood stained, no large follicles found
What drugs are mainly used in the management of reproductive performance of cows?
- Prostaglandin
- Gonadotrophin Releasing Hormone
- Progesterone Releasing Intravaginal Device (PRID) or Controlled internal Drug Release (CIDR)