Explaining procedure Flashcards
(12 cards)
General questions
What patient knows
What procedure is called and what is involved
Explain pre-procedure information where needed (e.g. eating, laxatives etc)
Basic anatomy and physiology (e.g. Prostate makes PSA)
Clarify the indications, benefits & risks
Risks and benefits of alternatives (e.g. not having it done)
Equipment involved
Post procedure care and follow up ( if needed) including time of work & what to do with any complications
ICE
Check understanding & any questions
LP
LA (lignocaine)
Needle between two bodies below level of cord
Small amount of fluid is collected. done for Dx
Complication: CSF leak, bleeding, infection
Overnight stay
Have to be done lying flat and remain for 4 hours to reduce post punctural headache
Lad: biochem (protein, glucose, WCC, C&S,), Viral PCR, Blood/Xanthochromia, Oligoclonal bands, opening pressure
CT usually done before
Parental consent
Check What they know, explain procedure and risk (x3) and benefit
Post procedure plans
Are they jehova’s witness (possible child may need blood, consultant will be involved in decision)
Bleeding tendency for child?
Child
Cant refuse treatment if parent has consented
Can consent to their own procedure without parental consent if Gillick competent
Can give blood to child in emergency without consent
ERCP
Procedure consent similar to OGD
(Midaz and numb spray)
Has contrast agent, connected to Xray machine.
Can check patency of duct, get for gall stones and take biopsy
May need to insert stent. They may need stent removal in future
Complications: unsuccessful, perforation, pancreatitis, pain, infection
MRCP usually done first but ERCP allows for Tx as well as investigation
TURP extra points
Explain BPH
Via Urethra prostate removal
Alternatives: Meds, Catheterisation
RF: ED, incontinence, retrograde ejaculation (infection risk), bleeding, infection, TURP syndrome (where fluids used are absorbed and dilute blood and make cold)
Condition can recur
Post: stay in hospital overnight, catheterised,. will be seen in clinic for follow up.
Explaining points
Explain verbally
Extra marks for physical explanation
Amniocentesis
Test done as blood test indicate baby is risk of downs (following triple or quadruple-if late pres)
–> Also done to Tx polyhydramnios
This test not mandatory but offered to all mothers who at increased risk to allow them to make plans for termination
Elicit parents concerns about downs and about procedure
Procedure: USS identify foetus, needle withdraws small amount of amniotic fluid
Risks: miscarriage (1%), infection, rhesus (sensitisation), injury to baby
RF: severe pain, contractions, PV bleeding, fever,
Post: go home today, seen in outpatient clinic in several weeks with results
Draw if poss
Alternative: Chorionic venous sampling is done earlier on (11-14 weeks)
Liver biopsy
Procedure: LA, USS guided. Biopsy needle through the skin into the liver, complications: bleeding and infection. Avoid contact sport & heavy lifting for short period.
RF: site looks infected, bleeding, abdominal pain
Follow up in few weeks for results
Liver Vs Lung biopsy
USS for Liver & Kidney and Lung CT guided
Bronchoscopy
GA or Local can be done
Allows visualisation and biopsy
Similar to ERCP but in lungs
Chest drain
To drain air or fluid
Done for diagnostic and therapeutic reasons
Bottle kept below level of insertion to allow fluid to drain with gravity
Complications: infection, bleeding, discomfort, lung damage, failure (usually due to wrong place insertion or obstruction)
Post procedure: left in over night, Taken out if draining stops or if very slow.
Ix: Protein, LDH, biochem, pH, gram stain, acid fast bacilli, microscopy, culture and sensitivity
