Year 3 Flashcards
expected versus unexpected death
Expected
Terminal care allows for the last stage of care when death is close
Palliative care allows for the correct management of symptoms leading up to the end of life
Unexpected
Shock of death from relatives and regret in inability to say goodbye or retract words said in fear and haste
Accidents involving multiple deaths may result is legal and media involvement
Death of children may be more shocking
WHO palliative care (7)
Provides relief from distressing symptoms and pain
Affirms life and regards death as a natural process
Neither hastens or prolongs death
Provides both supportive and social aspects of care
Supports pts in being as active as possible leading up to terminal phase
Provided support to families to help deal with illness and bereavement
MDT approach o both families and patients
Regards to a ‘Good@ death (4)
Pain free
At home surrounded by friends and family
expected and so conflicts/resolutions can be resolved
A death of personal Preference that resonates with the individuality of the pt
What Factors might affect global sustainability (6)
Material inequality Increased population and demand Decrease material availability Health care crisis Biodiversity Climate change
Why is Occupational Hx important
The History can help ID chronology - has the job caused the health problem, exacerbated a known illness or has the illness impacted work life
Allows shortened, more focused Hx if occupation is causing illness
determine if proper PPE is used, do others have similar symptoms, have you been travelling etc.
Look into
Hx of employment - places and jobs
Potential exposure to harmful substances/stimuli
Was proper PPE provided
were correct measures taken to optimise safety
Do other members of the work force have similar symptoms
So your symptoms get better when you are away from work
What is a Fit note (5)
Replaced sick note in 2010
Allows earlier discussions on the return to work/rehab
Contains considerations for employers to look at before signing off on return to work
Can only be created by a Dr
Is required for any employee off work for 7 consecutive days (including non-work days) - should not and effect on sick pay
Define Culture
Learned and shared beliefs that:
Guide thinking, actions, behaviours and emotions towards daily living
Sum of beliefs, behaviours, habits, likes and dislikes with a social norm
Transference
When the Pt or Dr related past experiences or emotions to a current situation.
Distorts reality regardless if emotions are positive or negative ( counter transference )
Creates barriers
Getting over Language Barriers
On-Phone Translators - Private rooms available for shared consultations with translators over the phone
On-site interpreters - Have them site on the same side as the patient and address them directly - they are there for the pts not you.
Only use family members AS A LAST RESORT - error, lack of knowledge, bias, selective communication
When Overcoming Language barriers
Speak Slowly and calmly and avoid medical jargon
Avoid first names and gestures
Be aware that spiritual/religious factors may be of influence
Swiss cheese Model
Safety netting is put in place (Neighbours Model - First year) in order to minimise risk of missing adverse events etc.
HOWEVER - All safety nets have weaknesses (the holes in the cheese) due to constant shifting and complexity.
What is empowerment
Generation of power in a group or individual that previously considered themselves unable to control situations based on their own biases
Ability to resist social pressure
Ability to apply effective coping strategies to difficult situations
Heightened consciousness of actions
Primary Prevention
measures taken to prevent onset of illness or injury
reduces probability/severity of illness or injury
Example of Primary Prevention
Vaccinations and Smoking cessation
What is secondary prevention
Early recognition of a disease (preclinical stage) in order to cure, prevent of lessen symptomatology
Examples of Secondary Screening
Cervical, Breast and Bowel screening
What is tertiary Prevention
Measures to limit distress or disability caused by disease
Health is Affected by
Genetics, access, environment, lifestyle
Access, Lifestyle and Environment can be Altered by…
Health Promotion - Activities or actions aimed at the encouragement of good health practices and disease prevention - may be planned or opportunistic
Health Education - Activities/actions developed around communication with the aim of changing an individual/groups knowledge, beliefs an thoughts about health
Health Protection - Actions/Activities aimed at factors that the public cannot control. these tend to be legislation, policies and codes that are aimed at preventing ill health and enhancing good health
Give an example of Health Promotion
Planned - Poster in GP waiting room
Opportunistic - Realistic discussion during an appt about smoking cessation
Give an example of Health Education
Adverts for health and Education Boards
Give an example of Health Protection
Smoking ban
What are the steps of the cycle of change
Pre-contemplation: patient thinks it might be beneficial to stop a certain habit/action
Contemplation: Patient is seriously considering the need to stop said habit/Action
Ready for Action: the Patient is ready to try a plan of action in order to help with the habit/action
Action: The patient carries out the plan put in place
Action can lead to one of 2 things
Regression - plan does not work and pt continues with Action/Habit
Maintenance - Pt successfully stops habit/Action
What 2 factors of childhood can have an effect on long term health
Establishing a healthy lifestyle - Growth and development through food and good activity
Role of parenting - Habits and lifestyle established in adolescence. More likely to copy parents behaviour - smoking etc.
Reasons for Parent presenting a child to the GP (6)
Acute illness, Inexperience, Single Parent, Parental worry manifesting as an ill child, Child abuse from a partner, Parental Anxiety/Depression
Things you can do as a GP to help an anxious patient/Parent (3)
Listen, Observed and read notes properly (parent and child)
Correctly and fully explain what and why you are doing something - examinations and investigations
Strike a balance between what needs to be done and what doesn’t
What is the recommended daily activity levels for children
60 minutes of moderate to vigorous activity a day
What has been implemented to help with activity goals
Daily mile
What might get in the way of activity goals
Finances - Inability to join private sports clubs and teams
What is the recommended Sleep for a child
8 - 10 hours
What factors might get in the way of a good nights sleep
Screen time, Anger, Over/under- exercising, Difficulty at school with work, Social worries
6 changes for realistic medicine
Build a personalised approach to care
Improve approach to shared decision making
Reduce unnecessary variations in practices/outcomes
Manage Risk Better
Reduce harm and waste
Become improvers and innovators
Vaccination Schedule
2mo - T, D, aP. Pv, Hib, Pn 3mo - T, D, aP. Pv, Hib, MenC 4mo - T, D, aP. Pv, Hib, MenC, Pn 12mo - Hib, MenC 13-15mo - MMR, Pn 3.4-5y - T, D, aP, Pv, MMR 12-13 girls - HPV 13-18 - T, D, Pv 18 - 24 - MenC \+65 - Pn + Flu
What is used to assess palliation level
Palliative performance scale
Euthenasia - 3 Types
Voluntary - At pts request
Non-voluntary - not at patients requenst
Physician assisted - Physician provides the advice an the means but does not necessarily carry out the act.
What might encourage job satisfaction
Job Security Ability to have work life balance Stable terms and conditions of work Financial stability The ability too feel confident in learning new skills and being challenged intellectually having the role of Dr appreciated
