Information giving Flashcards

Question

discuss treatment options for COPD with a patient including cessation of smoking

Answer 1

* Treatment --\> * The damage to the lungs caused by COPD is permanent, but treatment can help slow down the progression of the condition * **Stopping smoking** - the most important thing you can do * **Inhalers and medications** - help make breathing easier * **Pulmonary rehabilitation** - a specialised programme of exercise and education * **Surgery or a lung transplant** - this is only an option for a *very small number* of people * The outlook for COPD varies from person to person. The condition can't be cured or reversed, but for many people treatment can help keep it under control so it doesn't severely limit their daily activities

Answer 2

* Explain need for warfarin * Directions for taking warfarin * Missed doses * Monitoring warfarin * Side effects * Interactions

Answer 3

* Explain need for warfarin * Warfarin is an oral anticoagulant- a medicine that stops blood clotting * Clotting is a complex process involving substances called clotting factors, which are produced by the liver and help to control bleeding. They work with cells that trigger the clotting process (platelets) to ensure that blood clots effectively * To produce some of the clotting factors the liver needs a good supply of vitamin K, but warfarin works to block one of the enzymes (proteins) that uses vitamin K to produce clotting factors, meaning it disrupts the clotting process, making it take longer for the blood to clot. * Warfarin is prescribed for people who’ve had a condition caused by a blood clot, such as a stroke, heart attack, DVT or pulmonary embolism * Warfarin may also be prescribed for people at an increased risk of developing harmful blood clots such as those with a replacement heart valve, an irregular heart rhythm (atrial fibrillation), a blood clotting disorder known as thrombophilia or those at an increased risk of blood clots following surgery

Answer 4

Directions for taking warfarin It is important to take warfarin exactly as directed and not to change the dose unless advised to (the aim of therapy is to decrease the blood's tendency to clot, but not stop it clotting completely so the dose may be changed) It is taken once a day, usually in the evening (and it's important to take your dose at the same time each day, before, during or after a meal) How long you take warfarin for depends on your condition

Answer 5

Missed doses If you normally take warfarin in the morning but forget to, take it as soon as you remember (however if it’s time to take your next dose don’t take a double dose to catch up) If you normally take warfarin in the evening but forget to, take it if you remember before midnight (if not, leave it)

Answer 6

Monitoring warfarin You'll have regular blood tests at your GP surgery or local anticoagulant clinic to make sure your dose is correct The international normalised ratio (INR) is a measure of how long it takes your blood to clot. The longer it takes your blood to clot, the higher your INR. Your INR will be used to determine the dose of warfarin you need to take. INR needs to be 2-3 When you start taking warfarin, you may be given a yellow booklet about anticoagulants, which explains your treatment

Answer 7

Side effects * Contraindicated in: pregnancy, severe hypertension, high risk of internal bleeding (e.g. stomach ulcer), bleeding disorders * Bleeding (blood in urine/faeces, severe bruising, long nosebleeds, bleeding gums, cough up blood, unusual headaches, increased bleeding during period)- take care with shaving, brushing teeth, gardening, sewing, contact sports * Skin rashes * Hair loss * Interactions * Medications- alert HCPs before taking other medicines (avoid herbal medicines, supplements, aspirin/ibuprofen (paracetamol is ok)) * Diet- decrease foods with vitamin K (green leafy vegetables (spinach/broccoli), vegetable oils, cereal grains) * Alcohol- do not drink more than 14 units per week * Always inform dentists/surgeons * Sports- avoid contact sports, martial arts and kick boxing * Body piercings- not recommended

Answer 8

* Patients at risk * History of DVT/PE, cancer, stroke, heart disease, inherited tendency to clot (thrombophilia), recent surgery (pelvic region/legs), obesity, pregnancy, hormone replacement therapy * Before you travel * See your GP before you travel (don’t leave this until the last minute in-case you need to buy medication, compression stockings etc) * Compression stockings significantly reduce your risk of DVT and leg swelling, by applying gentle pressure to the ankle to help blood flow. They come in a variety of sizes at different levels of compression, but it is vital they are measured and worn correctly, therefore take advice on size and proper fitting from a HCP * During travel (journey \>6hrs) * Wear loose, comfortable clothing * Wear elastic compression stockings * Drink plenty of water * Avoid drinking excessive amounts of alcohol because it can cause dehydration * Avoid taking sleeping pills because they can cause immobility * Perform simple leg exercises (regularly flex your ankles) * Take occasional short walks when possible (down plane aisle if flying, or by stopping at service stations if driving)

Answer 9

* Spray- when pain develops, spray 1-2 times under the tongue, close mouth immediately and pain should ease within 1 minute * Tablets- when pain develops, place 1 tablet under the tongue, allow to dissolve and pain should ease within 1 minute * If 1st dose doesn’t work, take a 2nd dose after 5 minutes * If pain continues for 15 minutes, call an ambulance * Administration PRIOR to exercise will provide better relief than administration AFTER onset of pain * Spray/tablets should be carried at all times * Spray is preferred to tablets due to a longer shelf life * Side effects include headache and flushing (due to vasodilation)

Answer 10

1. What is a gastroscopy? 2. Who has a gastroscopy? 3. What happens during a gastroscopy? 4. What preparation is required? 5. What happens after a gastroscopy? 6. How reliable is a gastroscopy? 7. What are the side effects of a gastroscopy?

Answer 11

* _What is a gastroscopy?_ * A common routine test where a HCP looks into the upper part of your gut- this includes the oesophagus (gullet), stomach and duodenum- using an endoscope * An endoscope is a thin, flexible telescope (as thick as the little finger) which is passed through the mouth, into the oesophagus and down towards the stomach and duodenum * The endoscope tip contains a light and a tiny video camera so the HCP can see inside the gut * The endoscope also has a side channel, down which various instruments can pass, for example the HCP may take a small sample (biopsy) from the inside lining of the stomach by using a thin grabbing instrument passed down a side channel * _Who has a gastroscopy?_ * It is advised if you have symptoms such as recurring indigestion, recurring heartburn, upper abdominal pain, vomiting, difficulty swallowing, or other symptoms thought to be coming from the upper gut * Conditions that can be confirmed/ruled out include- * Oesophagitis- redness on the oesophagus lining * Duodenal and stomach ulcers- small red craters * Duodenitis and gastritis * Cancer

Answer 12

_What happens during a gastroscopy?_ * The HCP numbs the back of your throat using local anaesthetic spray * You may also be given a sedative injection to help you relax- this can make you drowsy but doesn’t put you to sleep like a general anaesthetic * You lie on a couch, have a plastic mouth guard between your teeth (for protection), and will be asked to swallow first section of the endoscope before the HCP pushes it further down * The video camera at the endoscope tip sends pictures to a screen, which the HCP observes for abnormalities * Air is passed down the endoscope to make images easier to see (can cause feelings of fullness/belching) * Samples of the inside lining of the gut (biopsies) may be taken depending on why the test is done and what they see- these are sent for laboratory testing * The endoscope this then gently pulled out * The procedure usually takes 10 minutes- however allow 2hrs for the whole appointment (preparation, sedative, procedure itself and recover) * The procedure doesn’t usually hurt but may feel slightly uncomfortable _What preparation is required?_ * The hospital department will send you instructions before the procedure occurs * You shouldn’t eat 4-6hrs, but small sips of water are allowed \<2hrs before the test * If you have a sedative, you will need somebody to accompany you home * Medication may need to be temporarily stopped

Answer 13

_What happens after a gastroscopy?_ * Most patients can go home after resting for 30mins after the procedure * If a sedative has been used, you may wait slightly longer, and you cannot drive/drink alcohol/operate machinery for 24hrs * The HCP will write a report and send it back to your GP- biopsy results take a few days to process _How reliable is a gastroscopy?_ * Helpful for seeing abnormalities of the upper gut, however it may not detect a small number of cases of early ulcers/cancer * Sometimes a repeat procedure is advised if persistent/worsening symptoms _What are the side effects of a gastroscopy?_ * Mild sore throat * Feeling tired (if sedative was used) * Occasionally, the endoscope causes some damage to the gut leading to bleeding/infection/perforation * Immediately consult a doctor if any of the following occur \<48hrs- * Worsening abdominal pain * Fever * Difficulty breathing * Vomiting blood * A small number of people have a heart attack or stroke during/after a gastroscopy. These tend to be older people who are already in poor health. These serious complications are rare in most people who are otherwise reasonably healthy.

Answer 14

* Feeding tubes can be used to provide nutrition while you're recovering your ability to swallow. They may also be required in severe cases of dysphagia that put you at risk of malnutrition and dehydration, and they can make it easier for you to take the medication you may need for other conditions. * There are 2 types of feeding tubes- * Nasogastric (NG) tube- a tube passed through your nose and down into your stomach * Percutaneous endoscopic gastrostomy (PEG) tube- a tube is implanted directly into your stomach * Nasogastric tubes are designed for short-term use, and the tube will need to be replaced and swapped to the other nostril after about a month. PEG tubes are designed for long-term use and last several months before they need replacing. * PEG tube- * Pros- hidden under clothing, need replacing less often than NG tube * Cons- breathing problems, internal bleeding, bowel perforation, inflammation/infection, blockage * Before procedure- HCP discusses the procedure, risks, benefits, questions * The procedure- takes 20-30mins and occurs in endoscopy unit. Sedative is given, mouth guard put in the mouth, endoscope passed through the mouth guard over back of tongue and into the stomach, antiseptic cleans the outer skin over the stomach, PEG tube inserted, once in place a small plastic disc inside the stomach stops the tube being pulled out and another plastic disc on the outside stops the tube falling into the stomach * After procedure- feed can be given 4hrs after insertion

Answer 15

* Diabetes can reduce the blood supply to your feet and cause a loss of feeling known as peripheral neuropathy. This can mean foot injuries do not heal well, and you may not notice if your foot is sore or injured * Risk of complications can be greatly reduced if you are able to control blood sugar levels, blood pressure and cholesterol levels * Foot care tips- * See the NHS podiatrist at least once a year * Keep your feet clean and free from infection * Wear shoes that fit well and don't squeeze or rub (ill-fitting shoes can cause corns and calluses, ulcers and nail problems) * Never walk barefoot, especially in the garden or on the beach on holidays to avoid cuts and try to avoid sitting with your legs crossed so you don't constrict your blood circulation * Cut or file your toenails regularly * Urgent help should be sought if- * Breaks in the skin of your foot, or discharge seeping from the wound * Skin over part/all of the foot changes colour and becomes more red, blue, pale or dark * Extra swelling in your feet where there was a blister or injury * Redness/swelling around an ulcer or in an area where you've previously been warned to seek immediate attention

Answer 16

Dietary advice- * There is no longer a diabetic diet and patients should be able to continue to enjoy a wide variety of foods as part of a healthy diet * Eating 3 meals a day- avoid skipping meals, and space breakfast/lunch/evening meal out over the day to help control appetite and blood glucose levels * Include carbohydrates in your diet, but as all carbohydrates affect blood glucose levels be conscious of the amounts you eat. Healthier options include wholegrain bread, whole-wheat pasta and basmati/brown/wild rice as they are generally more slowly absorbed (they have a lower glycaemic index) and help to keep your digestive system working well * Cut down on fats (particularly saturated fats) which are found in foods made of animal products like butter, cheese, red/processed meats, palm oil, coconut oil, ghee, cakes and pastries * Eat more fruit and vegetables (5 portions a day) * Include more beans and lentils * Aim for at least 2 portions of oily fish per week * Limit sugar and salt intake by limiting the amount of processed foods * Drink alcohol in moderation (all alcohol contains calories so cutting back further can help with weight loss) * Newly diagnosed patients can be referred to a dietician for more specific advice and guidance if necessary Exercise- * Regular exercise is especially important for people with diabetes because it helps with blood sugar control, weight loss and high blood pressure * People with diabetes who exercise are less likely to experience a heart attack or stroke than those who do not exercise regularly Smoking- * Giving up smoking is one of the most positive things a person can do to both improve health and reduce the risk of long term complications associated with diabetes * If patients feel ready to quit, can be given information about the stop smoking service Blood pressure- * High blood pressure is related to an increased chance of complications, particularly in people with diabetes, and these include problems with the eyes, kidneys, and heart (stroke, MI) * The symptoms of blood pressure may not show unless blood pressure becomes very high and so it is important that your blood pressure level is checked each year * Blood pressure targets for diabetes are \<135/85mmHg for T1DM and \<140/80mmHg for T2DM

Answer 17

* A hypo is when your blood glucose level is too low (\<4mmol/L), which can happen if the balance of diabetes medication you take (especially insulin), food you eat and physical activity you do sometimes isn’t right * Testing blood sugar regularly can help to stop a hypo before getting symptoms * Symptoms and signs- * Trembling/shaking, sweating, anxious/irritable, pale, palpitations, tingly lips, blurred vision, hungry, feeling tearful, tiredness, headache, lack of concentration * Causes- * Missing/delaying a meal or snack, not having enough carbohydrate at your last meal, doing a lot of exercise without having extra carbohydrate/reducing your insulin dose, taking more insulin than required, drinking alcohol on an empty stomach * Prevention methods- * Change eating routines or adjust insulin (if there is a pattern) * Adjusting insulin during stress/illness Adjusting insulin during temperature changes

Answer 18

* Blood pressure is recorded with 2 numbers * Systolic pressure (higher number) is the force at which your heart pumps blood around your body * Diastolic pressure (lower number) is the resistance to the blood flow in the blood vessels * As a general guide, high blood pressure is \>140/90mmHg, ideal blood pressure is between 90/60mmHg and 120/80mmHg, and low blood pressure is \<90/60mmHg * If blood pressure is too high, this puts extra strain on your blood vessels, heart and other organs such as the brain, kidneys and eyes * This can increase risk of life threatening conditions such as heart disease, heart attacks, strokes, heart failure, peripheral artery disease, aortic aneurysms, kidney disease and vascular dementia * If you have high blood pressure, reducing it even a small amount can help lower your risk of these conditions * Lifestyle changes- * Reduce the amount of salt you eat and have a generally healthy diet * Cut back on alcohol if you drink too much * Lose weight if you're overweight * Exercise regularly * Cut down on caffeine * Stop smoking * Try to get at least six hours of sleep a night Medications can also be used if lifestyle adjustments do not improve blood pressure

Answer 19

* HIV vs AIDS * HIV (human immunodeficiency virus) is a virus that damages the cells in your immune system and weakens your ability to fight everyday infections and disease. * AIDS (acquired immune deficiency syndrome) describes a number of potentially life-threatening infections and illnesses that happen when your immune system has been severely damaged by the HIV virus. * AIDS cannot be transmitted, but HIV can * There's currently no cure for HIV, but there are very effective drug treatments that enable most people with the virus to live a long and healthy life * Transmission- * Found in body fluids e.g. semen, vaginal and anal fluids, blood, and breast milk * Anal/vaginal sex without a condom * Sharing needles, syringes or other injecting equipment * Transmission from mother to baby during pregnancy, birth or breastfeeding * Prevention- * Using a condom for sex * Post-exposure prophylaxis * Pre-exposure prophylaxis * Treatment for HIV to reduce the viral load to undetectable * If you use drugs, never share needles or other injecting equipment (syringes, spoons, swabs) * In pregnant HIV positive women, give anti-viral therapy, elective caesarean section and advise against breastfeeding

Answer 20

* Introduction, consent, confidentiality * Ask permission to discuss HIV testing * Reason for taking test * Routine for patients at GUM clinic, otherwise ask if specific reason patient has asked for the test * Ever had a test before * When, what was the result * Exposure risk * Have you had any sexual experience that you would consider putting you at high risk of getting HIV? * When was the last time you had sex? * Male/female partner * Type of sex: oral, vaginal, anal * If anal: receiving or inserting * Contraception used * Condoms used * For men: Have you ever had sex with men? * How many partners have you had in the last 3 months? * Have your partners been tested for HIV? * Where were your partners from? (high-risk area?) * Have you had sex with someone who was HIV positive? * Have you ever worked as a sex worker? * Have you ever received a blood transfusion? * Basics of the test * How the test works * Point of care test- antibody test which is a finger prick blood test, gives results in a few minutes, result is either negative or reactive (if reactive must be confirmed with antigen blood test), 99% accurate * When they will receive the result * Window period- the test will not show whether you have contracted HIV within this period (past 1-3months). You should still have a test today but if you have had high-risk activity within the last 1 or 3 months then you should come back for another test if this one is negative. * How effective it is * False positives/negatives- rare but can happen * Benefits and risks of the test * Does the patient have an expectation of what the result will be * Advantages- prolonged good healthcare, reduced anxiety, treatable and manageable condition * Disadvantages- stigma, rejection from partners/family/job * How would they cope with a positive result? (do they have appropriate support) * Agreement to test * Summarise what you have said * Check they have understood everything and ask if they have any questions * Are you happy to have an HIV test today?

Answer 21

* Introduction and check name and consent * Explain results of DEXA scan and blood tests, ask what patient knows about osteoporosis * Explain osteoporosis- condition affecting bones causing them to be weak and brittle and more likely to fracture * Suggest causes- high dose steroids, post menopausal, lack of calcium/vit D in diet, eating disorder, FHx * Lifestyle changes- diet high in calcium, exercise (weight bearing and resistance exercises), quit smoking, reduce alcohol, medical management (Ca/vit D tablets, bisphosphonates) * Bisphosphonates- how they work, why they are used (slow rate that cells break down bone) * Administration- tablet or injection * Side effects- oesophagitis (sit up when swallowing tablet), jaw necrosis * Actively involve patient * ICE

Answer 22

Preparation * Consider the patient, aims, objectives, info needed & approach. Check agenda * Check the patient’s agenda. What do they know already? How much information do they want or need today? Gather info * Gather important info needed about the patient for concordance\* Context * Explain purpose/context of information. Give an indication of your agenda: ‘I would like to speak to you about three things today…’ Chunking * Give small amounts of information at a time. If it occurs to you that you might be speaking too much; stop and check… Frequent checks * Periodically check: ‘how you feeling about this?’ or ‘what do you think about this so far?’ etc. This is to allow the person ‘processing’ time, to check understanding and fit info to patient needs Interaction * Encourage conversation and questions e.g. ‘please stop me if you don’t understand something’; Listen to the patient! Linking * Try if possible to address what the receiver already knows/ understands/ does / believes - and identify any dilemmas/difficult Language * Calibrate to the patient. Check whether you share the same understanding of terms and use some of their words if possible. Avoid or explain jargon Check pacing * ‘How is this going for you so far?’, ‘Am I going too fast?’ Check what has been understood * Ask the person to summarise what they have understood/remembered in order to check you’ve explained correctly Cue recall * Ask the person to re-cap important aspects discussed (‘what about the side effects?’) Invite questions * What other information would be helpful? Additional help * Drawings/diagrams/prepared leaflet/support group/referrals etc…

Answer 23

ICS/preventer: Inhaled steroids have fewside effects, especially at lower doses. Thrush (a yeast infection in the mouth) and hoarseness may occur, although this is rare. Rinsingthe mouth, gargling after using the asthma inhaler, and using a spacer device with metered dose inhalers can help prevent these side effects. Thrush is easily treated with a prescription antifungal lozenge or rinse. SABA/reliever 'taken too much': You may notice that your heart beats more quickly than normal and that you feel shaky. These side effects aren't dangerous, as long as you don't also have chest pain. They usually go away within 30 minutes or a few hours at most

Answer 24

* Action * Timeline * How to take * Length of treatment * Effects - time before seen * Tests * Important SEs * Complications * Supplementary advice

Answer 25

* Start * introduction and explain why you are there * build a rapport before launching into explanation * ask if the patient knows why they are here * ask them to talk about what has happened up until this point * assess their prior knowledge - ask WHAT they know about condition/Tx already * describe what you are going to talk about e.g. your structure and if that would be helpful? and ask if they want to discuss anything else?

Answer 26

* Consider diagram * CHUNK AND CHECK * important! explain small bits at a time and check they understand the info and ask if they have any questions; pausing after each section * speak slowly and clearly and empathetic and listen for/to patient concerns

Answer 27

* Summarise what you have talked about and make a plan * check they've understood everything * always offer something e.g. a leaflet, wesite, specialist nurse contact, follow up appointment *NB: let the patient guide the consult and decide what they want to talk about, follow cues and ask what they want to know and their worries. ICE! Avoid med jargon, be aware if you maybe breaking bad news (empathy, considerate)*

Answer 28

* **normal** anatomy/physiology * what the disease is * cause * problems is causes and complications * management

Answer 29

* explain what it is * reason for it * explain procedure details (before, during, after) * risks and benefits * if asked to get consent then check their understanding, get them to weigh up pros and cons & ask them why they chose their answer

Answer 30

* first, briefly check for any contraindications to the treatment * check condition understanding * how treatment works * treatment course and how its take * side effects * (ATHLETICS)

Answer 31

A - prevents bone from being broken down and by helping to rebuild new bone; but also lifestype factors such as exercise, no smoking (we can help) and eating a well balanced diet T - 1x weekly or smaller dose daily H - swallow tablet with full glass of water; \>30mins before food or anything other than water & be upright for 30 minutes after swallowing L - long term E - N/A T - dental checkups before starting them regularly (osteonecrosis of jaw risk) I - SE = headache, heartburn, bloating, indigestion, GI (d&C, black stools, abdo pain) C - jaw osteonecrosis & CI = preg, dysphagia, stomach ulcers; severe renal impairment S- website e.g. www.Nos.org.uk

Answer 32

A- thins the blood (blocks vitamin K, the vitamin used by the body to make proteins that cause the blood to clot) T - once daily (usually in the eve) H- tablets L - DVT=3 months, PE = 6 and AF = life Effects - time before; 2-3 days T- 5mg for 4 days then **test INR** on **Day 5 & 8** adjust dose accordingly. Started concomitantly with LMWH if immediate effect is required. regular INR checks by anticoag clinic - regularity determined by INR stability I -mportant SE = bleeding (1-2%)- come back if any unusual bleeding e.g. bruises, dark stools, cuts taking long to heal. Also D, N, rash, hair loss. Reacts with CYTOP450 interactors, steroids. Contra: pregnancy, haem stroke, sig bleeding, and caution in pts with high falls risk S- supplementary advice: avoid liver, spinach, cranberry juice, alcohol binges; no NSAIDs/aspirin, given anticoag boook

Information giving Flashcards

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