random Flashcards
smoking cessation
WRATH
w - willingness to quit: assess how much they smoke, if they have symptoms of dependence and if they have tried to quit before
r - reasons to quit - ask what their reasons are and advise reasons e.g. health, money, confidence and control
a - adverse effects of smoking - not only cancer but other chronic disease
t - triggers - what theirs are and how to tackle them
h - help - give them the quitline number - talk about pharmacological support
OCP
why do they want it (do they need emergency contraception?)
do they have any contraindications (active liver disease, migraine with aura, previous VTE, hormone dependent ca, smoking, previous stroke/TIA, cardiovascular disease)
action: two female hormones - stop ovulation, increase cervical mucous, thin endometrium
timing/how to take it: take it oral daily, sugar pills
length of treatment
effect reached: if take it at the start of period starts immediately - otherwise 7 active pills - missed pill rule
tests
important side effects: common side effects: headache, breast tenderness, spotting, nausea, mood changes important side effects: thrombosis
contraindications: already covered
supplementary information: does not prevent STIs! use condoms - more info in the box
sexual history
number of partners - in last 3 months, in last 12 months
gender of partners
type of sex
protection
last sex episode - with a regular partner?
need for emergency contraception?
high risk sex - overseas, intoxicated, paid for sex
ever had an STI?
ever had an STI check?
screen for sexual assault
other high risk BBV behaviours, tattoos, IVDU, prison
explaining screening
why they want the test (only if PSA) underlying risk any symptoms what they know about the anatomy/pathophys about the test - pros and cons
giving results
explain what the result means for the patient
take a history of test results so far/symptoms so far
take a history of their risk (e.g. CV risk)
discuss need for further ix
discuss initial mx plan (lifestyle and pharmacological)
fever in a returned traveller - travel details
dates of travel season of travel destination - country, region and environment purpose of trip visiting friends or family? style of travel sick contacts transportation - use of animals street food untreated water uncooked meat sexual contacts tattoos/piercings IVDU animal bites insect bites immunisations swimming in fresh water
fever in a returned traveller - associated sx
rash jaundice lymphadenopathy hepatomegaly splenomegaly bleeding diarrhoea constipation vomiting fevers rigors cough abdominal pain myalgia arthralgia headache seizures
over 50 health check
PDFOS SNAPs diabetes osteoporosis skin cancer age appropriate screening
cognitive impairment
memory loss
language difficulties
visuospatial difficulties
apraxia
agnosia
severity: risk Qs: wandering, aggression, leaving gas on, driving
time course: acute, chronic, fluctuating, step wise
context: head injury, illness, stroke, stressors
associated features: depression, hypothyroid, psychotic sx, parkinsonism, geri’s screen (incontinence, falls)
past history: CV disease, stroke, parkinsons, psych
family history: memory loss
social hx: ADLs, advanced care directive, MEPOA
falls hx
event: witness/headstrike/injuries/LOC/preceding sx
aggravating factors: urinary urgency, mobilising at night
length of lie
intrinsic factors: can’t see, can’t walk, can’t think
extrinsic factors: environment, footwear, multifocals, walking aids
medications: benzos, anti hypertensives
past medical hx: previous falls
social hx: ADLs, advanced care plan, MEPOA
warfarin counselling
A: thins blood
T: take once daily - don’t take two doses at once
H: oral - evening after blood test
L: 3 months DVT, 6 months PE, AF lifelong
E: 2-3 days - may need bridging clexane
T: tests - daily for the first week, twice weekly for week 2, weekly from week 3 until stable and then every 2-4 weeks
I: H&M, bruising, head injuries, blood in urine
C: pregnancy, other medications, alcohol, diet
S: info, path nurse, booklet to track INRs
confirm death
confirm patient is NFR
confirm patient ID
check for response - verbal, tactile
airway + breathing: visually assess for respiration, auscultate for 2 mins for lung sounds
circulation: central pulse, auscultate for heart sounds for 2 minutes
disability: pupil response
psych hx
intro confidentiality demographics DSM criteria (HOPC) psych screen: mania, psychosis, depression, anxiety, PTSD risk ax DAG forensic hx past psych hx medications past medical hx fhx shx premorbid personality
