What are the three reasons you do a DNACPR?
Resus unlikely to be successful
The pt does not want it
It may be successful but would result in a QOL that is not to the pts benefit
What percentage of hospital CPR is successful roughly?
20% - lower if significant co-morbidities
Causes of blood on urinalysis?
ONNIT
Obstruction Neoplasm Nephritic syndrome Infection Trauma
What three things are required for consent to a procedure to be valid?
- Consent must be informed
- Consent must be voluntary
- Patient must have capacity
What is involved in explaining a procedure for consent?
Explain what it is Explain why we are doing it Explain Before, during and after Explain the risks and benefits Explain any alternatives
Assess capacity
What are the fraser guidelines for contraceptive consent in children?
The child understands the advice
They cannot be persuaded to tell their parents
Likely to continue having sex
Physical/mental health may suffer without contraception
It is in their best interests
Warfarin counselling structure?
Check for contraindications
- Active bleeding, or risk of
- Pregnant
How treatment works
- Blocks vitamin K, which helps to stop your blood forming clots, thins the blood.
Treatment course and how taken
- Once daily (usually in the eve)
- 3 months DVT, 6 Months PE, lifelong for AF
S/Es
- Bleeding - safetynet for any significant blood loss
- Diarrhoea rash, hair loss, nausea
- Avoid alcohol binges, liver, spinach NSAIDS and aspirin.
Monitoring
- INR days 3, 4 and 5
- Regular checks in warfarin clinic
- Warfarin booklet
Methotrexate counselling structure and content?
Check for contraindications
- Pregnancy
- Immunodeficiency
- Breast-feeding
- Active infection
- Hepatic impairment
How the medication works
- Suppresses inflammation and the immune system
- Stops folic acid synthesis
Treatment course and how taken
- Once a week tablet
- Take folic acid on another day
- Dose is built up slowly
- Long term if effective
- Takes 3-12 weeks to work
S/Es
- Hair loss
- Headaches
- GI disturbances
- Myelosupporession - if infections, unexpected bruising seek medical help
- Liver and lung toxicity
Monitoring
- FBC, LFTs U&Es
- Before starting then every 2 weeks until established, then every 2 months
Insulin counselling structure and content?
Check for contraindications
- None
How it works
- Allows cells in your body to take up glucose and use it for energy
- Insulin reduces the sugar in the blood
Treatment course and how you take it
- depends on their regime
- 90 degree angle in suncut tissue
- Vary sites, abdomen, buttocks and thigh
S/Es
- Weight gain
- Sharps injuries
- Hypoglycaemia - management
- Lipodystrophy
Monitoring
- Cap glucose before each meal and before bed
- High or low sugar symptoms
Bisphosphonate counselling structure and content?
Contraindications
- Pregnancy
- Dysphagia
- Peptic ulcer
- Renal impairment
- Sit upright for 30 mins?
How it works
- Stops the bone bening broken down and strengthens new bone
- Lifestyle can also help
Treatment course and how it’s taken
- Either once a day or once a week
- Swallow with a full glass of water
- 30 mins before food (in the morning)
- Upright for 30 mins after taking it
- Long term course
S/Es
- Heartburn and indigestion
- Headaches
- Bowel habit
- Urgent advice for: UGIB, Dysphagia, Osteonecrosis of jaw
Monitoring
- Dental check ups
Two places you swab for MRSA?
Nasal and groin
General structure to a explaining disease station?
- Normal anatomy
- What the disease is and what causes it
- Risks/complications
4 .Management
Immunisation schedule?
2, 3 4 months, 1 year, 3 years 4 months, girls 12-13, teens.
2 months
- 6 in one
- rotavirus
- pneumococcal
- meningitis B
3 months:
- 6 in 1
- rotavirus
4 months
- 6 in one
- pneumococcal
- Meningitis B
1 year
- MMR
- Pneumococcal
- Men B
- Hib B
- Men c
Preschool (3 y, 4 m)
- MMR
- 4 in one
Girls 12-13
- HPV
Teens
- 3 in 1
- Men ACWY
6 in 1
- Diptheria
- Polio
- Tetanus
- Pertussis
- Hib
- Hep B
4 in 1
- Diptheria
- Polio
- Tetanus
- Pertussis
3 in 1
- Diptheria
- Polio
- Tetanus
quick developmental review?
3 weeks
- Smiling
3 months
- Turn to sound
6 months
- Sitting up
18 months
- Walking
18 months
- first words
3 years
- Short sentences
Bronchoscopy counselling structure and content?
What it is
Why needed
Before, during after
- Before: 6 hours no food, 2 hours no fluid, stop anticoags, and do clotting
- During: Midazolam and lidocaine spray for all
- After: No eating or drinking for 2 hours, No driving, alcohol, or signing legal documents for 24 hours. Keep someone with you for 24 hours.
Risks
- Lung damage
- Infection
- Bleeding
Alternatives
- Imaging?
ICE
Capacity
Gastroscopy counselling structure and content?
What it is
Why needed
Before, during after
- Before: 6 hours no food, 2 hours no fluid, stop antiacid meds 2 weeks before
- During: Midazolam or lidocaine spray
- After: No eating or drinking for 2 hours (if throat spray), No driving, alcohol, or signing legal documents for 24 hours. Keep someone with you for 24 hours - if midaz.
Risks
- perforation
- Infection
- Bleeding
Alternatives
- Imaging?
ICE
Capacity
Colonoscopy counselling structure and content?
What it is
Why needed
Before, during after
- Before: 1 day before only clear fluid, bowel prep afternoon before and morning of.
- During: Midazolam
- After: No driving, alcohol, or signing legal documents for 24 hours. Keep someone with you for 24 hours.
Risks
- perforation
- Infection
- Bleeding
Alternatives
- Imaging?
ICE
Capacity
Structure and content for a counselling station about surgery?
WIPE
Confirm op
What they know so far, any questions they want to ask
What is, why needed
Before
- Pre operative assessment, mobility and independence assessment, history and examination
- Pre op investigations, including imaging, ECG, blood tests
- Consent taken by a surgeon
- (risks and benefits)
- fasting - 2/6
During
- Anaesthetic room with nurse
- Meet anaesthetist, insert cannula and give anaesthetic, fall asleep
After
- Wake up in recovery area
- May have tubes from the operation
- Pain control
- VTE prophylaxis
- Physio/OT
Risks
- Most are rare and we minimise the risk as much as possible.
- Anaesthetic reaction
- Bleeding
- Damage to nearby structures
- Infections of the wound or systemic
- VTE
- Pain
- Fluid collections
Alternatives
Ask for any questions, ICE
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