ILA Flashcards
1
Q
What are the main principles for palliative care symptom management?
A
- Accurate assessment of patients physical, psychological, social and spiritual needs (Holistic approach)
- MDT approach
- Patient centred care
- Accurate record keeping
2
Q
How to help control nausea and vomiting?
A
- Antiemetics with consideration of route of administration.
- Avoiding foods/strong smells/eating small portions/ regulation of bowel habits.
3
Q
How to help control dyspnoea?
A
- Oxygen therapy/nebulisers and treat causes.
- Fans, breathing techniques through self management.
4
Q
How to help control constipation?
A
- Minimal symptoms but can affect quality of life badly.
- Usually due to opioids, effects of disease or poor appetite or dehydration.
- Use of laxatives about making defecation more comfortable instead of increasing the frequency.
- Stimulant laxatives can be used such as Senna or osmotic laxatives such as Macrigol.
- Suppositories or enemas can be used alternatively.
5
Q
How to help control anxiety/depression/agitation?
A
- These can be controlled through antidepressants/counselling/mindfulness etc.
- Usually due to the patient being lonely, poorly managed symptoms, constipation, their thoughts and feelings towards their disease and their future.
- ‘Terminal’ agitation can often occur in the last few days or hours of life.
6
Q
How to help control pain?
A
- WHO analgesic ladder ranging from paracetamol to morphine.
- Syringe pumps can be used to give constant pain relief, in particular for patients with dysphagia or vomiting.
7
Q
How to help control fatigue?
A
- Exercise diary, daily conservative plan or physical activity if possible.
8
Q
How to help control excessive respiratory secretions?
A
- Can be distressing for patients and their families.
- Due to build of fluid within the airway that leads to gurgling or rattling.
- Repositioning patient to upright position to encourage drainage is important and potential to use Atropine to reduce saliva.
9
Q
How to help control dehydration and lack of appetite?
A
- This can be caused through dysphagia.
- Management of dysphagia includes soft food diet, thickened liquids, extra oral support and artificial diet.
- Speech and language referral required.
- Moistening of lips can help with thirst and preventing cracked lips through ice cubes and wet sponges.
10
Q
What is palliative care?
A
- Holistic way of providing comfort to patients and their families during an end of life illness. It can be patients with cancer, end stage organ failure, the elderly or frail.
- Looking at social, psychological, physical and spiritual needs.
- Many patients at end of life die in hospital despite having preferred to be at home.
11
Q
What is the gold standard framework?
A
- A primary care based approach to formalise best practise and patient centred care.
- 5 main goals include managing symptoms, identifying patient wishes in terms of their preferred place to die, also ensuring staff or educated as well as competent and confident.
- 3 main processes involve identifying needs, accessing them and putting a plan in place with the patient.
12
Q
What is the Liverpool care pathway?
A
- Initially created for generalist staff in hospital but extended to GP and care homes/
- Used in the last few days and weeks of life.
- Assessing physical, psychological, social and spiritual.
13
Q
What are the best practise points?
A
- MDT, assessing patient and carers regularly, anticipate needs, note them down and work out how to solve the, communication and also discussion around preferred place of death and ensure it is noted.
14
Q
What members of the MDT?
A
- GP, DN, hospices, social services and families.
15
Q
What challenges are felt in palliative care?
A
- Lack of 24 hour care, struggles for equipment, limited specialist palliative care, inequalities in terms of care and also favouring towards palliative care, lack of communication.
16
Q
What is euthanasia?
A
- Deliberately ending a person’s life to relieve suffering. Usually due an incurable condition.
17
Q
What types of euthanasia?
A
- Voluntary - where the patient has capacity and communications their wish to die.
- Non voluntary - where the patient is unable to communication and someone else makes a decision for them, potentially through previous concentrations.
- Active - deliberately causing.
- Passive - withholding/withdrawing treatment.
18
Q
What is assisted suicide?
A
- Encouraging someone or deliberatley assisting someone with death.
- All illegal and could be charged with manslaughter.
19
Q
What are advanced directives?
A
- Decisions made by a patient in advance, whilst they have capacity to outline their preferences in terms of their end of life care - specifically the refusal of life sustaining treat - also known as ‘living wills.’
20
Q
What are advanced statements?
A
- Patients personal preferences about the way they are cared for and specifics related to their quality life.
- Type to refuse and when to refuse it.
21
Q
DNACPR
A
- Don’t attempt resuscitation.
- CPR = Chest compression, electrical or artificial stimulation and /or use of medication.
- Can lead to fractured ribs, spleen and liver and brain damage.
22
Q
What is a good death?
A
- Treating the patient as an individual with respect and dignity, without pain and symptoms in familiar surroundings with patients they wish to be with.
23
Q
What is lasting power of attorney for Health and Welfare?
A
- This gives a person a right to trust someone to make decisions when they lose mental capacity and patient decides if this includes life sustaining treatment.
24
Q
What are the 7C’s?
A
- Communication, coordination, control of symptoms, continuity of care, continued education, carer support and care in the dying phase.
25
What are the 3 central processes of GSF?
1. Identify key group of patients (using a register and agreed criteria)
2. Assess their main needs both physical and psychosocial.
3. Plan ahead for problems, including out of hours services.
26
What is shared decision making?
- HCP should give all the information and facts in order to make an informed decision, discussing the risks and benefits of the options. Patients given the opportunity to ask questions and reflect.
27
What are ethical conflicts in decision making?
- Explaining the risks of procedures - patient doesn't need all info, clinician bias and difficulty understanding.
28
CHA2DS2VASC Score
- Used to predict stroke risk in patients who have AF.
- Increased score leads to increased risk.
- Score of 2 or more = anticoagulation with warfarin, INR 2-3 or DOAC.
29
HASBLED Score
- Scoring to assess the risk of 1 year bleeding risk in a patient who is on anti coag for AF.
- Score of 3 or more would indicate high risk and caution needed.
- Warfarin should be given to patients as its more easily reversible.
- Higher weighting.
30
ABCD2 Score
- Assess stroke risk following the 7 days after a TIA - based on age, BP, clinical features, duration of TIA and diabetics.
31
QRISK2 Score
- Prediction algorithm of the person developing CVD over 10 years.
32
How are falls prevented?
- Framework to reduce the number of falls causing serious injury and effective treatment and rehab for those that do fall.
- Older people should be asked about falls at routine apts, risk assessment carried out, DEXA scanning for osteoporosis and referral.
- Limited funds and resources and also resistance.
33
What are intrinsic factors for falls?
- Age related such as reduced visual ability, reduction hearing and muscle strength and tone.
- Pathological such as endocrine, neuro and endocrine.
34
What are extrinsic factors for falls?
- Obstacles, bad lightening, inadequate footwear and clothing.
35
What are fits/seizures?
- Sudden burst of electrical activity within the brain, leading to temporary affects of function.
- It can be occur anywhere between seconds and minutes.
36
What are the types of fits?
- Focal = one area of the brain with/without loss of consiusness.
- General = absence (staring into space), tonic (muscle stiffness), atonic (loss of muscle control), clonic (rhythmic jerking) and myoclonic (sudden briefing jerks).
37
What are syncope?
- Sudden loss of consciousness, usually associated with lack of ability to maintain postural tone.
38
What are they types of syncope?
- Vasovagal (usually caused by prolonged periods of sitting, emotinal stress, pain, heat and alcohol)
- Cardio (Structural heart disease or anything that decreases cardiac output)
- Orthostatic hypotension (Common in elderly, reduction in 20 mmHg in systolic and 10 mmHg in diastolic BP within 3 minutes)
39
What does elderly care involve?
- On admission to hospital: A detailed and accurate patient record, review assessment and give estimated discharge date.
- During admission: Regular MDT and assess for discharge.
- 48 hrs prior to discharge: Inform MDT, initiate referrals, contact agencies for patient equipment, order medicine and arrange transport.
- Day of discharge: Contact family and carers to confirm follow up care, check documents, send letter to GP, reinforce behaviours.
- Follow up: Initiate care package with GP.
40
What psychosocial factors should be considered in terms of dermatological skin conditions?
- Stigmatisisms, decreased body image and self esteem, withdrawal, anxiety/depression, OCD, scratch itch cycle, sexual and physical relationship issues, decreased quality of life, covering up of the skin.
41
Common triggers for skin conditions?
- Allergens such as pollen, pet dander, house dust mites, fungus, mould, environmental triggers such as cold dry weather, dampness and also dietary factors such as cows milk eggs, gluten, wheat and peanuts, soya as well as stress and emotional triggers.
42
What are the rules around self prescribing?
- Legal in the UK but discouraged by the GMC.
- This is due to issues with overdosing, addiction, lack of adequate documentation, risk of ADR's and independant judgement.
- Can use in emergency situations.
43
What are complications associated with obesity in pregnancy?
- Increased risk of gestational diabetes, miscarriage, pre eclampsia, difficulties with birth, larger baby, increased risk in need for instrumental delivery.
44
What are complications associated with conceiving later in life?
- Increased miscarriage, pregancy related hypertension or gestational diabetes, twins/triplets, pre eclampsia or complications with delivery.
45
Definition of pre eclampsia
- A condition/complication of pregnancy that is characterised by high BP and protein in the urine.
- Most commonly presents between 24 to 26 weeks - seen later in pregnancy.
46
Risk factors for pre eclampsia
- Conditions such as diabetes, kidney issues, high BP, previous history of pre eclampsia.
- First time pregnancies, more than 10 year gap in pregnancy, over 40, BMI more than 35, family history or more than one babies.
47
Presentation of pre eclampsia
- High BP and protein in urine.
- Mild usually mild symptoms.
- Severe = severe headache, vision problems, nausea/vomiting, pain below the ribs or feeling generally unwell.
- Medical emergency = pre eclampsia convulsions, HELLP or stroke.
48
Management of pre eclampsia
- High risk patients could be commenced on 75mg aspirin.
- Focus on lowering BP and managing symptoms.
- Mild = managed by frequent antenatal visits, checking symptoms and BP and protein.
- Severe = admitted to hospital, bed rest, anti convulsants, medication.
- Only cure is delivering the baby.
49
What is gestational diabetes?
- Usually seen in 2nd and 3rd trimester.
- OGTT is given between 24 and 28 wks.
- Management is with diet, exercise and medication.
- Risks include pre eclampsia and jaundice in the baby.
50
What is pre conceptual care?
- Defined as provision of biomedical, behaviour and social health interventions for women and couples before conception.
- Identifies healthy behaviours, minimising risk factors, looking at wider determinants and giving pre conceptual dietary advice - Folic acid supplements, vit A, liver, liver should be avoided.
51
What are antenatal appointments?
- Between 7 and 10 apts.
- 8 - 14 weeks - dating scan and nuchal translucency ultrasound offered.
- 18 - 21 weeks - organ growth and sex.
52
What are the screening tests for Down's Syndrome?
1. Combine test - 10 - 14 weeks, bloods and nuchal translucency ultrasound, bloods look for increase hCg and decreased pregnancy associated plasma proteins.
2. Quadruple test - less accurate, changes in 4 proteins, can be affected by mothers who smoke or assisted conception.
53
What are the diagnostic tests for Down's Syndrome?
1. Chorionic villius sampling - screening test postitive then diagnostic screening is offered. 11 to 14 weeks and takes sample of chorionic villus samplying.
2. Aminocentesis - 15th and 20th weeks
54
What is health related quality of life?
- Broad concept that incorporates the patients perceptions, illness experience and functional status in terms of their condition.
- Good way of indicating the continued assessment and impact of a condition on a patient.
55
What are the classifications of diarrhoea?
- Acute = less than 14 days.
- Persistent = more than 14 days
- Chronic = more than 4 weeks
56
What is the Bristol Stool Chart?
- Identify the type of stool
- Type 1 and 2: constipation
- Type 3, 4, 5 : Normal
- Type 6 and 7: Diarrhoea
57
What are red flags to think about in terms of acute diarrhoea?
- Blood in the stool or weight loss = Colorectal cancer/IBD
- Recent hospital admissions/care home stays and the use of antibiotics - C.diff
- Dehydration - major complication = increased pulse rate, hypotension, decreased urine output, reduced skin rigor, dry mucous membranes.
58
What are red flags to think about in terms of chronic diarrhoea?
- Weight loss, abdo pain, changes to bowel habits, blood or mucous in the stool, abdo mass or rectal mass.
59
What are diverticular?
- Pouches of mucosa extrude through the colonic muscular wall via weakened areas near blood vessels, forming divericula.
- Diverticulitis implies inflammation, which occurs when faeces becomes obstructed the neck of diverticulum.
- Cause are unknown but risk factors include smoking, obesity, NSAIDs, history of constipation and family history.
- Presentation includes diarrhoea/constipation, left illiac fossa pain, pain fever and nausea, bloating.
- Investigations includes colonoscopy, CT and bloods (Increased WBC)
- Management includes pain relief, high fibre diet and use of antibiotics
60
What should be considered when thinking about taking a history of chest pain?
- Current chest pain? if not when was the last episode of chest pain? how long did it last? was it less than 12 hours ago?
- Onset and nature
- Any relieving or precipitating factors
- Associated symptoms
- Previous episodes of chest pain
61
Definition of depression
- Persistent low
62
What are some post op complications seen in obese patients?
- Increased risk of infection, intraoperative blood loss and longer open times.
- PE/DVT, AKI, sepeteciaemia, heart issues, lung blockage or collapse, shock and bleeding.
63
What is ALT?
- An enzyme released by the body to metabolise proteins.
- If the liver is injured or not functioning correctly then ALT is high.
- Very high during acute hep, but normal in chronic hep.
64
What is AST?
- An enzyme released by both the liver and the heart.
- It isn't organ specific so increased levels could be due to injury of either organ.
- Very high during rapidly progressing hep.
- Important to think about AST:ALT ratio in terms of long term complications.
65
What is ALP?
- An enzyme released by both the liver and the bone.
- Raised during inflammation, bone disease or blocked bile ducts.
- Gallstones tends to show increased ALP and billirubin before AST or ALT.
66
What is bilirubin?
- Released by the spleen and conjugated in the liver to be excreted from the body.
- If total or unconjugated levels are high it suggests haemolytic jaundice or perinicous anaemia.
- If conjugated levels are high it's due to liver injury - bile duct blockage/liver blockage, hep, trauma, AKI, alcohol absue, cirrhosis , DILI
67
What is substance misuse?
- Described as the use of harmful substances such as drugs or alcohol that are used for non medical purposes.
68
What is a drug?
- A substance other than food or water that when taken into the body causes physical and/or psychological change.
- Can be illict (cannabis, cocaine or heroin) or prescription such as antidepressants, painkillers or sedatives.
- Also alcohol and tobacco.
69
What is a gateway drug?
- A drug that seems less harmful that patients begin to use and then spiral out of control using more harmful substances.
- An example is cannabis
70
What is non compliance?
- This when a patient refuses to or fails to comply.
- Could refer to refusing to take amedication or just not completeing the medication as prescribed.
- Could be physican, patient or medication.
71
What is addicition?
- A physical and/or psychological need for substance due to a continued regular use of a substance - can be highly addictive or less addictive.
72
What are medically unexplained symptoms?
- Persistent bodily complaints for which adequate examination (including investigations) doesn't reveal sufficiently explain a diagnosis or pathology
- Examples include muscle/joint/back pain, headaches, tiredness, faint, chest pain or palpitations.
73
What are the causes of medically unexplained symptoms?
- Unknown but thought to be linked with psychological distress or disturbance, childhood trauma or an individuals personality and psychological cahracteristics and predispositions.
74
What are the risk factors of MUS?
- Female, child abuse/trauma, serious illness/death of close family member
75
What treatment is there for MSU?
- CBT, stress management, mindfulness, physical exercise or antidepressants
76
What is screening?
- Identifies people who doesn't yet show symptoms in order to analyse a patients predisposition for develiping a disease.
77
What are the different stages of cancer diagnosis?
- It causes anxiety and uncertainty.
- Stages include awareness, receiving the diagnosis, dealing with the diagnosis, family reactions and preparation for the future.
78
What are the different stages of cancer survivorship?
- Acute, extended and permanent
79
What is screening?
- Application of a test to a population who aren't showing any overt signs/symptoms of the disease thats being screened for, in order to detect at a stage when treatment is most effective.
- Not diagnostic
80
What are the Wilson and Junger 1965 criteria?
1. Important health problem
2. Natural history well known
3. Recognisable at an early stage
4. Treatment beneficial at an early stage
5. Suitable accurate tests
6. Acceptable tests
7. Adequate provisions to cope with screening, diagnosis and treatment
8. Screening at intervals for insidious onset
9. Harm outweighs benefit
10. Cost balance
81
What are the different types of screening?
- Screening of the whole population or a sub group
- High risk/ selective = patients considered high risk
- Multi phasic screening = applying 2 or more screening programmes to a large population at the same time
82
What is sensitivity?
- The percentage of patients identified to have the disease that is being screened for
83
What is specificity?
- The percentage of patients who don't have the disease and also got a negative test
84
What is positive predictive value?
- Overall number of patients that screened positive for the disease and had this confirmed by diagnostic testing
85
What is negative predictive value?
- Overall negative result from the test of patients who haven't got the disease and also had a negative test.
86
What is a stoma?
- An external opening where the bowel is brought up onto the stomach
- Can be used for patients that have had bowel resections - so for example those who have had colorectal cancer, or iBD
- Permenant or temporary
87
What types of stomas are there?
- Colonsectomy - colon brought to the surface, usually on the left hand side, where stools are solid and can either be end or loop.
- Ileostomy - ileum, stool is fluid and can be temporary or permenant.
88
What is artificial feeding?
- Liquid prep into the stomach, duodenum or jejunum or rarely rectum
89
What is enteral nutrition?
- Tube feeding when gut is working normally
90
What is parenteral feeding?
- When the gut can't cope, nutrients through blood stream
91
What is PEG feeding?
- Non communication from mouth ahd stomach
92
What is domestic abuse?
- Physical, emotional and sexual abuse in couple relationships or between family members.
93
What are space occupying lesions?
- Most commonly malignacies but could be abscess or a haematoma.
94
What is the presentation of space occupying lesions?
- Rapid onset suggest cerebrovascular where as more gradual onset indicates space occupying lesions.
- New headache - with symptoms of ICP
- New headache with focal or non focal symptoms
- New headache which is progressively worse over time
- New headache associated with cancer or HIV
- New onset seizures/epilepsy
95
What is TMJ dysfunction?
- Temporamandibular joint dysfunction
96
What is analgesia induced headache?
- Chronic overuse of triptains, NSAIDs, opioids or paracetomol.
97
What are the classifications of back pain?
- Mechanical, systemic or referred back pain.
98
What are the examples of mechanical back pain?
- Lumbar strain/sprain, degenerative disc, spondylolysis, compression fractures and sarcoilitis.
99
What are the examples of referred pain?
- Aortic aneurysm, acute pancreatitis, acute pyelonephritis, renal colic and PUD.
100
What are the red flags of back pain?
- Fever, chills, night sweats and/or unexplained weight loss.
- History of malignancy/ IVDU
- Spincheter disturbances
- Profound/progressive neurological deficit
- Age < 20 or >50
- Trauma/ high speed injury
101
What are the the pharmacological management?
- Pharm = NSAIDS
| - Non pharm = self management, exercise, manual therapies, psychological therapies
102
Definition of Cauda Equina
- Surgical/medical emergency
- Condition affecting the bundle of nerve roots and nerves at the lumbar spine
- Nerve roots become compressed, cutting off sensation and movement - prevents motor and sensory function to the legs and bladders.
103
Causes of Cauda Equina
- Herniated disk, bony mets, myeloma, infection, fracture, abscess or narrowing of the spinal cord.
104
Presentation of Cauda Equina
- Lower motor neurone disease
- Sudden or gradual onset, bilateral but asymmetrical symptoms.
- Loss of motor function and sensation to the muscle
- Saddle, inner thigh and perineal numbness
- Urinary retention and faecal incontinence
- Lack of reflexes
105
Investigations of Cauda Equina
- Good history
- MRI
- Myelogram
106
Management of Cauda Equina
- Urgent neurosurgical decompression: Laminectomy for disc protrusions, radiotherapy for tumours and decompression for abscess
107
What are the levels of paralysis?
- Depends on the level of the spine that the injury occurred.
- Complete = loss of all sensation, along with ability to move the limb.
- Incomplete = retain some sensation but loss of motor function
108
What is paraplegia?
- Chest/waist down - affects both legs
- Usually in the thoracic, lumbar, sacral spine
- Resp function can be affected.
109
What are tetraplegia?
- Paralysis from cervical spine or 1st lumbar
| - Both arms and legs
110
What is the management of paralysis?
- Immediate treatment, steroids and recovery + rehab
