the WHO define 3 categories under which disability can be described - list these 3 categories and give a brief explanation of each
- body structure and function impairment - is defined as abnormalities of structure, organ or system function (organ level)
- activity limitation - is defined as a changed functional performance and activity by the individual
- Participation restrictions - defined as the disadvantage experienced by the individual as a result of the impairments and disabilities (interaction at social and environmental level)
give 4 examples of how the definitions of disability could apply to the average child who has cerebral palsy and learning difficulties.
- damage to motor area of brain
- damage to cognitive area of the brain
- limited mobility
- learning difficulty
- exclusion/difficulty participating in certain activities (riding a bike and certain sports)
in general, what might be the effect of a disabled child on their parents, siblings, peers and teachers? give 2 examples under each heading
parents
- over-protection of disabled child
- increased risk of child abuse
- marital problems
siblings
- resentment for how much time parents spend with other sibling
- may have to develop a carer role
Peers
- friend may be stigmatised along with the disabled child
- may need to adapt to activities to include the other friend
Teachers
- may have a lack of training and understanding of the disability
- lack of willingness to integrate in mainstream activities
Name 6 other recognised causes of disability worldwide
- communicable disease
- non-communicable disease
- alcohol
- tobacco
- mental illness
- malnutrition
- drugs abuse
- iatrogenic drugs
- obesity
list 4 medical factors which may influence the uptake of medical care for any patient
- duration
- visible disease
- new symptoms
- increasing severity
- psychological impact of symptoms.
list 6 non-medical factors which may influence the uptake of medical care for any patient
- crisis (relationship difficulty, loss of job)
- peer pressure (wife/friend sent me)
- patients beliefs
- patient expectations
- social class
- culture
- economic implications
- age
- gender
- access
- media
briefly describe the inductive reasoning model and its benefits
- can be used for patients with vague/unexpected symptoms
- can be used in inexperienced doctors
- involves systematic and comprehensive history and examination
- often involves investigations - blood tests and scan
- evidence is then assessed to find an explanation for symptoms
give a brief description of how hypothetico-deductive reasoning may be used in a patient presenting with chest pain
- doctors experiences generates a differential diagnosis from presenting symptoms
- specific questions are used to establish diagnosis, giving consideration to conditions requiring urgent medical attention such as an MI
- examination and investigation are used as appropriate to help establish diagnosis
give a brief description of how pattern recognition may be used in a patient with chicken pox
- doctors previous experience will allow them to recognise the natural history of disease and pattern/types of spots
- this allows the doctor to draw a conclusion from the pattern and reach a certain or near certain diagnosis of chickenpox
using your knowledge of the WHO definition of health, list 3 aspects of health that may be affected by cardiac failure and give an example of the possible effects on health under these categories
physical
- reduced mobility
- requirement for medication
Psychological
- anxiety that illness may become worse
- depression secondary to long term condition
Social
- reduction in working hours
- loss of earnings if time off work
list 5 example in differences of care provided by a patient’s GP and their secondary care doctors?
- GP is responsible for care for much longer - secondary care is only involved once cardiac symptoms developed
- GP is responsible for all of his medical care, not just his cardiac illness. secondary team will only deal with specific illness (breadth vs depth)
- secondary care doctors have easier access to investigations than GPs
- risk and uncertainty relating to patient health is more likely to be accepted by GP than secondary care doctors - GP is more likely to use time, try empirical treatment
- quality of Doctor/patient relationship to be improved by continuity of care in general practice, although patient with long term conditions will also have a good quality relationship with secondary care
- Opportunistic health care and health promotion more likely to occur in General Practice
- multiple short appointments in GP vs longer less frequent appointments in secondary care
- GP will act as a gatekeeper to secondary care. secondary care doctors rarely employ a gatekeeper role.
list 2 advantages and three disadvantages of house calls for the patient
ADVANTAGE
- convenience (no travelling)
- social contact
- may be able to let GP see difficulties they have in home environment
DISADVANTAGES
- invasion of privacy
- some will feel defined to clean
- lack of ability to see doctor of choice
- lack of defined time for visit
- not every examination can be performed at home, so may be delay in diagnosis
list 10 members of the healthcare team who may be involved with a patient’s care in their home and give a short description of each of their roles in their house
- GP - day2day medical support
- district nurse - dressings
- home carer - practical tasks
- pharmacist - advice on medication
- social worker/care manager - advice on benefits
- occupational therapist - adaptation of living environment to maximise independence
- Physiotherapist - continue to improve mobility and stability
- dietician - advice on improving appetite
- GMED/NHS24 - out of hours care for unexpected deterioration
- community psychiatric nurse - assessment and management of low mood
- parkinson’s nurse specialist - specialist advice to patient and family/friends - assist in the support groups
