Community Pharmacy and Practice (313) Flashcards
(106 cards)
1
Q
What is a wound defined as?
A
A wound is defined as an injury to living tissue caused by a cut, blow, or other impact: typically one in which the skin is cut or broken.
2
Q
What causes wounds?
A
- mechanical injury
- falls etc
- immobility → bed sores/pressure injuries
- burn
- underlying medical condition
- chronic illness → people with Diabetes can get infected wounds after a knock or scratch
- infections → post surgery/insect bites
3
Q
What factors should be considered when assessing wound healing?
A
- the age of the individual
- location of the wound
- medical factors - are they Diabetic?
- allergies - some people are allergic to plaster
- nutritional factors - malnourished heal slower
- shock + pain - may take longer to treat
- type of wound
- pre-existing injuries
- is it infected - slows healing
- the healing stage
- socioeconomic factors - can afford better care
- how deep is the wound?
4
Q
What are the signs of a wound?
A
The signs of a wound are:
- a cut to the skin
- graze
- redness/swelling
5
Q
What are the symptoms of necrosis?
A
- pain
- skin discolouration (redness, then through dark red/purple/black)
- swelling
- abnormal sensation i.e. tingling to then no sensation (numbness)
- skin appears hard, dry and waxy
- skin death and decomposition (gangrene)
6
Q
What type of dressings should be used on a necrotic wound with low exudate?
A
- hydrocolloid
- hydrogel
7
Q
What type of dressings should be used on a necrotic wound with moderate exudate?
A
- hydrocolloid
- foam
- hydrocolloid fibrous
8
Q
What does a sloughy wound look like?
A
Sloughy wounds will have dead yellow or black/yellow tissue that needs to be removed
9
Q
What types of dressing are suitable for a sloughy wound with low levels of exudate?
A
- hydrocolloid
- hydrogel
10
Q
What types of dressings are suitable for a sloughy wound with moderate levels of exudate?
A
- hydrocolloid
- alginate
11
Q
What types of dressings are suitable for a sloughy wound with heavy exudate?
A
- alginate
- capillary-acting
- hydrocolloid-fibrous
12
Q
What is the appearance of a granulating wound?
A
Red/pink tissue which is moist in appearance.
13
Q
What sort of dressings are suitable for a granulating wound with low levels of exudate?
A
- hydrocolloid
- low adherence
- soft polymer
- foam
14
Q
What type of dressings are suitable for a granulating wound with moderate levels of exudate?
A
- hydrocolloid
- alginate
- foam
15
Q
What type of dressings are suitable for a granulating wound with heavy exudate?
A
- alginate
- foam
- hydrocolloid
16
Q
What does an epithelialising wound look like?
A
An epithelialising wound is pink tissue that is a regeneration of skin surface.
17
Q
What sort of dressings are suitable for an epithelialising wound with low levels of exudate?
A
- low-adherence
- vapour-permeable firms and membranes
- soft polymer
- hydrocolloid
18
Q
What type of dressings are suitable for epithelialising wounds with moderate levels of exudate?
A
- soft polymer
- foam
- alginate
19
Q
What does an infected wound look like?
A
An infected wound will appear malodorous, oozing, infected with bacteria.
20
Q
What type of dressings are suitable for wounds with signs of infection and low levels of exudate?
A
- honey
- low-adherence
- iodine
- hydrocolloid
21
Q
What type of dressings are suitable for a wound with signs of infection and moderate levels of exudate?
A
- hydrocolloid
- foam
- honey
- alginate
- iodine
22
Q
What type of dressings are suitable for a wound with suspected infection and heavy exudate?
A
- hydrocolloid
- foam
- alginate
23
Q
What are the general roles of vitamin A within the body?
A
Vitamin A helps form and maintain healthy teeth, skeletal & soft tissue, mucous membranes & skin. It helps the body’s natural defence against illness and infection. It also helps vision in dim light.
24
Q
What are common dietary sources of vitamin A?
A
- cheese
- eggs
- oily fish
- fortified low-fat spreads
- liver
- spinach
- carrots
- kale
- sweet potato
- red peppers
- mango
- papaya
25
What is vitamin A's effect on wound healing?
* Aids cellular regeneration
* Reduces risk of infection by supporting proper immune function
26
What is the role of vitamin C?
Vitamin C is needed for growth and repair of tissues in all parts of your body. It is used to form an important protein used in **making skin**, **tendons**, **ligaments** and **blood vessels**. **Heal wounds** and form **scar tissue**.
27
What is vitamin C's role in wound healing?
* important co-factor in **collagen formation** (for skin, tendons, ligaments, blood vessels).
* important for proper immune system function, as is **anti-inflammatory**
* **antioxidant** to inhibit damage to body cells
28
What are good dietary sources of vitamin C?
* oranges and orange juice
* red and green peppers
* strawberries
* blackcurrants
* broccoli
* brussel sprouts
* potatoes
29
What is the role of vitamin K?
Vitamin K is important for **blood clotting** to prevent excessive bleeding.
30
Who is most at risk of a vitamin K deficiencies?
* Newborn infants
* heavy drinkers
* those that are severely malnourished
* those with digestive disorders affecting absorption (crohn's, coeliac)
31
What are good dietary sources of vitamin K?
Vitamin K is found in **leafy greens**, **vegetable oils** and **cereal grains**.
32
What is the role of zinc?
* Required for the function of over **300 enzymes**
* All **proliferating cells** require zinc to function
* Processing **carbohydrates**, **fat** and **protein** in food
33
What is zinc's role in wound healing?
* Zinc is involved in collagen and protein synthesis
* cell proliferation
* immune function
* blood clotting
34
What are good dietary sources of zinc?
* meat
* shellfish
* dairy products (such as cheese)
* bread
* cereal products
35
What are the roles of copper within the body?
* plays a role in making **red blood cells**
* helps the body form **collagen**
* important for **neuron signalling**
36
Why is copper specifically important for wound healing?
Too little copper can lead to **neutropenia**, which will reduce immune function resulting in **increased risk of infection** and risk to open wounds.
37
What are good dietary sources of copper?
* nuts
* shellfish
* offal
38
What are cytotoxic drugs?
Cytotoxic drugs are a group of medicines with contains substances toxic to cells **inhibiting their growth or replication**.
39
What are some conditions cytotoxic drugs are used to treat?
* cancers
* rheumatoid arthritis
* multiple sclerosis
40
How would taking cytotoxic drugs affect wound healing?
* cytotoxic drugs interfere with cell replication
* no proliferation of new healthy cells in wound healing
* dampen defence mechanisms
* increased infection risk
* strength of new tissue formed is reduced
41
What are risk factors (of the wound itself) for it to become infected?
* contaminated (dirt/pus/bodily fluids)
* there was something in the wound
* has a jagged edge
* is longer than 5cm
* caused by a bite (animal or human)
42
What are the symptoms of wound infection?
* **swelling**, **redness** and increased **pain** in the affected area
* **pus** forming in/around the wound
* feeling 'generally **unwell**'
* high temperature (**38°C**)
* **swollen glands**
43
What are personal risk factors that could lead to slower wound healing?
* age of patient (over 65)
* smoker
* overweight
* medical conditions which weaken immune function
* HIV, cancer, diabetes
* medications which affect immune function
* eg steroids, radiotherapy, chemotherapy
* foreign object present in the wound
* decreased blood flow to the wound
44
What is oedema?
Oedema is a **build up of the fluid** in the body which causes the affected tissue to become **swollen**.
45
What are some common causes of oedema?
* sitting or standing for too long
* pregnancy
* kidney disease
* heart failure
* chronic lung disease
* thyroid disease
* liver disease
* malnutrition
* medications
* corticosteroids
* medications for high blood pressure
* the contraceptive pill
* blood clot
* varicose veins
* leg injury
* burns
46
What are some symptoms (other than swelling) of oedema?
* skin discolouration
* pitting (skin dips in when touched)
* aching limbs
* stiff joints
* weight gain
47
What are some treatments for oedema?
* elevate feet
* weight loss
* regular exercise
* avoid standing for long periods
48
What is lymphoedema?
Lymphoedema is **swelling** in the legs caused by a **blockage in the lymphatic system**, or an **inherited condition**.
49
How is lymphoedema different from oedema?
Unlike oedema, lymphoedema is a **long-term condition** that can cause discomfort, pain and a loss of mobility.
50
What are some treatments to ease the effects of lymphoedema?
* compression stockings
* skin care
* lymphatic massage
* elevation
51
What is the function of compression hosiery?
Compression hosiery provides **support** in a **controlled** manner.
52
Where is the support greatest in an item of compression hosiery?
Compression hosiery is designed so that compression is **greatest at the ankle** and decreases up the leg.
53
How many classifications of compression hosiery are there?
**Three**. Classes I, II and III
54
What is the pressure exerted at the ankle in class I compression hosiery?
In class I compression hosiery, the pressure exerted at the ankle is **14 - 17 mmHg**.
55
What degree of support does class I compression hosiery offer?
Class I compression hosiery offers '**light**' support.
56
On what condition(s) might class I compression hosiery be used?
Class I compression hosiery might be used on **mild varicose veins** (eg in **pregnancy**).
57
What is the pressure exerted at the ankle by class II compression hosiery?
Class II compression hosiery exerts pressure of **18 - 24 mmHg** at the ankle.
58
What degree of support do class II compression stockings offer?
Class II compression hosiery offers a '**medium**' degree of support.
59
On what condition(s) might class II compression hosiery be used?
Class II compression hosiery might be used to **prevent ulcers** in venous disease and for **severe varicose veins**.
60
What is the pressure exerted at the ankle by class III compression hosiery?
Class III compression hosiery exerts pressure of **25 - 35 mmHg** at the ankle.
61
What degree of support do class III compression stockings offer?
Class III compression hosiery offers a '**strong**' degree of support.
62
On what condition(s) might class III compression stockings be used?
Class III compression hosiery might be used to **prevent ulcers** and **post DVT**.
63
What are the most common reasons for prescribing compression hosiery?
* prevention and treatment of **ulceration**
* prevention and treatment of **varicose veins**
* control of **oedema**
* prevention of **DVT**
64
How does compression hosiery work?
1. **counteracts** the effects of **venous hypertension** in **superficial veins**
2. **empty** the veins and allow the **calf muscle** to pump and return **blood to the heart**
3. circulation is **increased**, reducing the chance of oedema and DVT
65
How would you measure a patient for thigh stockings?
1. **circumference** of the **thigh** at the **widest** part
2. **circumference** of the **calf** at the **widest** part
3. **circumference** of the **ankle** at the **narrowest** part
4. **length** of the **foot**
66
What information must be included on a prescription for compression hosiery?
1. compression class (I, II or III)
2. knit type (eg ribbed)
3. open or closed toe
4. thigh length
5. size
6. colour
67
How many charges will a person who requires their compression hosiery for compression purposes receive?
A person who requires their compression hosiery for the purpose of compression will be charged **two** times.
68
How many charges will a person who requires their compression hosiery for lymphoedema receive?
A person who requires their compression hosiery for the treatment of lymphoedema will receive **one** charge.
69
What is a stoma?
A stoma is a small **surgical opening** on the surface of the **abdominal wall**, it diverts the flow of **waste products**.
70
What are the different types of ostomy?
* ileostomy
* colostomy
* urostomy
71
What is brought to the abdominal wall for an ileostomy?
The **small intestine** is brought to the abdominal wall to create an ileostomy.
72
Where would you find an ileostomy?
An ileostomy will be on the **right hand side** of the abdomen.
73
What is brought to the abdominal wall to create a colostomy?
The **large intestine** is brought to the abdominal wall to create a colostomy.
74
How is a urostomy created?
**Ureters** drain into a detached piece of **ileum** brought to the abdominal wall.
75
What are the two main different ostomy products available?
* one-piece
* two-piece
76
What are the two parts of a two-part ostomy product?
* skin barrier
* ostomy pouch
77
How often do drainage ostomy products need to be changed?
Drainage ostomy products typically need to be changed **1 - 2** times a day.
78
How often do closed system ostomy products typically need to be changed?
Closed system ostomy products typically need to be changed **3 - 4** times a day.
79
What is urinary incontinence?
Urinary incontinence is passing urine when you do not mean to.
80
What are different types of urinary incontinence?
* bedwetting
* stress incontinence
* overflow incontinence
* urge incontinence
* mixed incontinence
81
Which is the most common type of urinary incontinence?
**Stress incontinence** is the most common form of urinary incontinence.
82
What causes stress incontinence?
Occurs because the **pelvic floor muscles** are weakened.
83
What is urge incontinence type of urinary incontinence?
Urge incontinence is when a person gets an **urgent desire** to pass urine. The bladder muscle **contracts too early** and the normal control is reduced.
84
Which two types of incontinence does mixed incontinence incorporate?
Mixed incontinence is a combination of **stress and urge incontinence**.
85
What causes overflow incontinence?
Overflow incontinence is caused by an **obstruction** to the outflow of urine which prevents the normal emptying of the bladder.
86
What can be done about urinary incontinence?
* assessment
* urinalysis
* residual urine
* vaginal and anal examination
* urodynamics
87
What are the two main types of catheter?
* nelaton
* foley
88
What is a nelaton catheter?
Nelaton catheters are **single lumen**, used for drainage and then **removed**.
89
What is a foley catheter?
A foley catheter is a **double lumen** catheter. Has an **inflatable balloon** to retain the catheter in the bladder.
90
How can you tell the difference between a male and female catheter?
A male catheter will be **longer** than a female catheter.
91
What are examples of different types of care homes?
* residential care home
* nursing home
* mixed residential + nursing
* hospice
* children's
* mental health
92
What regulations and policies need to be considered and adhered to when supplying medications to care homes?
* wholesale dealer's license
* SOPs
* medicines regulations
* health and safety
* COSHH
* data protection
* safeguarding
* equalities act 2010
* misuse of drugs act
* sexual offenders act
* care act 2014
* CQC
93
What are monitored dosage systems (MDS)?
Monitored dosage systems (MDS) are medication storage devices designed to simplify the administration of medication doses.
94
What has to be considered when setting up a new MDS system?
* staff levels
* time management
* very time consuming process
* size of the dispensary
* lots of dossette boxes take up space
* increase in stock levels of medicines
95
Why is it vital for a pharmacy with an MDS system to have a good relationship with the nursing home?
* establish good lines of communication
* keep up to date with any changes
96
Why would a controlled drug not be suitable for an MDS?
**Legal issues** surrounding its use. Would be easily accessible to anyone if not kept under lock and key (and not the point of a dossette box).
97
Why would PRN medications not be suitable for an MDS?
PRN medication would not be suitable for an MDS because they are **not given at set times of the day**, they are *when required*.
98
Which patients might benefit from an MDS being in place?
* those on several medications
* confused
* learning disabilities
* blind - Braille / alarmed boxes
99
What might be some advantages of an MDS in nursing homes?
* allows patients to keep a level of independence
* medicines can be given or taken
* reduces workload of nurses
* easier for third party administration
* reduces errors
* full audit trail
* all medications are in one place
* reduces need for space for the patient
* improves compliance
* segregated by time
* neat and tidy
100
What are some disadvantages of an MDS in nursing homes?
* requires increased storage space in pharmacy
* the responsibility is on the patient to take their medication
* secondary dispensing errors
* easily accessible to everyone (including children)
* could render the product and patient prone to abuse
* delays to medication changes
* reduced hygiene
* renders some products unlicensed when removed from packaging
* transportability issues
* difficult to use with limited dexterity
* time consuming for pharmacy - need more staff
* can't put hygroscopic medications in
* not all forms are suitable
* staff complacancy
101
What are some requirements that must be present on a MAR chart?
* patient's name
* GPs name
* date
* what regular medication they're on
* any PRN medications
* has the patient refused? why?
102
What are the risks associated with a prescription delivery service?
* the medication being given to the wrong person
* a patients son took all of his mothers medicines (?she was elderly, surely her son was an adult and that could've happened if he collected all the medicines from hospital too?)
* a patients next door neighbour accepted the delivery, has a drug problem
* medicines delivered through letterbox
* eaten by dogs
* delivery drivers mixing up medicnes
* medications left on doorsteps
* then stolen
* delivered to the wrong address
103
What do you need to ensure when setting up a pharmacy delivery service?
* do not cause conflicts of interest
* restrict a patients choice of pharmacy
* unduly mislead patients intentionally or by mistake
104
When delivering medications to a patients home, what should you do if the patient isn't at home?
105
What are the risks associated with delivering an MUR service?
* the area is not confidential for the patient
* the area designated for MURs limits the use of a patient chaperone
106
What are the contractual requirements for an MUR service?
* MURs can only be provided by registered pharmacists who have an MUR certificate and the pharmacy contractor is required to provide a copy of such certificates to the PCT prior to entering into an arrangement to provide MURs
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