Year 4 H&S Flashcards
Social & medicolegal implications of epilepsy (4)
- Driving & Employment Barriers (legal requirement to inform DVLA after 1 seizure. Cannot drive until 6 months seizure-free)
- . Social participation (e.g. photosensitive events)
- *Pregnancy *- teratogenic meds (Sodium Valproate) & providing care for baby. Note AEDs safe generally in breast-feedig.
- Mental health depression & stigma
Preventing spread of meningococcal disease (3)
- Post-exposure prophylaxis (Ciprofloxacin) to close contacts in 7 days prior to onset
- Public Health notification
- Chidhood vaccination
Define euthanasia, assisted suicide and “doctrine of double effect”
Euthanasia: deliberately ending someone’s life to to relive suffering
Assisted suicide: assisting someone to end their own life
Doctrine of Double Effect: for example giving a patient a drug to improve symptoms which inadvertedly shortens their life (not deemed immoral, not illegal and doesn’t count as euthanasia)
Distinguish palliative care and end-of-life care
Palliative: relief of a symptom/problem relating to illness without intention to cure or prolong life. Can be delivered alongside disease-directed therapy and can be started at any point in the disease process.
EoL care of paitents in the last year of their life (variable)
List 3 tools used to identify patients at EoL and how are they categorised?
SPICT, GSF-PIG, RADPAC. People at EoL are categorised 5 ways:
* 1. Advanced/incurable/progressive condition
* 2. General frailty + co-existing conditions
* 3. Chronic condition - at risk of dying from acute illness
* 4. Life-threatening acute condition
Define frailty
Distinctive health state related to the aging process where multiple body systems gradually loose their built-in reserves
List 3-4 ways of measuring frailty
- Phenotype Model (Fried) - >3 patient characteristics is predictive of frailty
- Rockwood Clinical Frailty Score - clinical score from 1-8
- Rockwood Cumulative Deficit Model - number of deficits accumulated / time = frailty index
- Electronic Frailty Index (for GPs)
What simple assessments could you do during a consultation to quickly assess frailty? (2 physical, 1 patient self-questionnaire)
- Gait speed (>5 sec to cover 4 metres)
- TUGT (>10 sec to get up, walk 3 metres, sit down)
- PRISMA 7 (>3 reqs review)
List the 4 “frailty syndromes” (geriatric giants) - aka categories of patients in elderly care
- Immobility
- Incontinence
- Falls
- Delirium/dementia
What is included in the Comprehensive Assessment for Older People?
A holistic plan with recommendations for managing geriatric patients. Includes:
1. Identifying frailty (scoring systems and assessments eg TUGT)
2. Care plan
2. Medication review
3. Referal to geriatrician/old age psych if appt
4. Address underlying physical causes
What does the Care and Support Plan include?
A personalised patient-centred plan including
* Management goals for the patient.
* Anticipatory plans - urgent care, escalation, EoL.
* Named contact
* Physical, mental and social support
What is “Fit for Frailty”
A campaign by the BGS with guidance for managing patients with frailty
Osteoporosis: primary prevention & secondary prevention
Primary: lifestyle (weight bearing exercises), optimise/strop offending meds (e.g. steorids), dietary (increase Ca2+ and Vitamin D)
Secondary: Alendronic acid (bisphosphonates) first line for diagnosed osteoporosis (T-score -2.5 from DEXA scan).
Understand the role of the multi-disciplinary team in rehabilitation
REHAB MDT
**Neurologist: **overall responsibility for patient, diagnosis & investigation, prescribing/altering medication/intervention, monitoring progress.
OT: making adaptions for home & Providing support and advice for coping with ADLs
SALT: following dysphasia caused by stroke. Swallowing assessment.
Social workers: involved in social care (managing ADLs, coping at home, family involvement)
Nursing staff: may be reqd to visit the home to give meds, do basic care, check complications
Congitive threrapy - improve memory and cognitive function after sroke
Behavioural therapy: overcoming mental health problems such as depression or PTSD
Home therapy: brain stimulating games
Physio: regain function of limbs affected, balance and co-odrination
Limitations of sucessful rehab
BARRIERS AT 3 LEVELS: PATIENT, STAFF AND ORGANISATIONAL.
- Depends heavily on patient engagement - e.g. engaging in physiotherapy and SALT requires the patient’s motivation
- Can be a long process to recovery, not always linear, may have some set-backs - some deficits may be permanent
- Patient’s comorbidities may prevent successful rehab - e.g. if recovering from surgery unable to partake in physiotherapy
- Not enough specially trained staff
- Pts are limited by access to rehab services - postcode lottery - services (e.g. social workers) are not provided equally throughout the country
