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33 Cards in this Set
- Front
- Back
Medical history intro |
Hello, my name is ben. I am a pharmacy student at the university of sunderland. Can i ask your name and age please?. Nice to meet you. Just to et you know ive washed my hands and everything discussed will remain confidential. IS it ok i make notes? Whats been bothering you? |
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Steps for medical history: |
Polly has pretty damn fine sexy stockings Presenting medical complaint, history of presenting medical complaint Onset, Pain, Quality/quantity, radiation, severity, timing, UR ideas. Past medical history Family history THEN RED FLAGS (ALL FOR THE RELRVANT STATION AND COVER MOST FOR OTHERS |
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RESPIRATORY RED FLAGS |
WBBCCC |
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GI red flags |
WSIANBS |
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MISC red flags |
VMTAP |
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MUR intro |
Hello, my name is ben, i am a student pharmacist at the university of sunderland. Can i ask for your name and age please? Is it ok if i conduct a Medicine review? Is it ok if i take notes? everything discussed will remain confidential. I have washed my hands. is it ok if i pick up your medicine during this. |
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MUR |
Allergies OTher meds (OTC, CREAMS, insulin, recreational) Dose Demonstrate technique and give 3 bits of advice for each med |
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EVOHALER Demonstration |
Remove cap. Shake, Exhale, FIt mouth over mouthpiece. ACtuate whilst inhaling deeply. Hold breath for 10 seconds. Exhale. |
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EVOHALER advice |
May use with a spacer device. Requires carefulactuation/inhalation coordination. Dexterity aids available If any mist coming out of inhaler/mouth afterwarads syggests incorrect use |
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Accuhaler demonstration |
Hold flat. Open disc. Prime with lever. Exhale. Fit mouth to mouthpiece. Suck. Hold then exhale slowly. Close disc. |
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Accuhaler advice |
Has a dose counter. Do not store in humidenvironment [e.g. Bathroom]. Rinse mouth after use. Requires adequate inspiratory flow. |
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Turbohaler demonstration |
Unscrew & remove cap. Hold upright. Twist base until 'click'. Exhale. Fit mouth to mouthpiece. Suck. Hold then exhale slowly. |
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Tubrohaler advice |
Has a dose counter. Do not store in humidenvironment [e.g. Bathroom]. Rinse mouth after use. Dexterity aids available. Retain upright. Not possible to double dose. |
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Handihaler demonstration |
Open inhaler. Remove capsule frompackaging. Insert capsule. Close device. Hold upright. Push button. Exhale. Fit mouth to mouthpiece. Suck. Hold then exhale slowly. |
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handihaer advice |
Do not store in humid environment [e.g. Bathroom]. Rinse mouth after use. Wash mouthpiece monthly. Requires adequate inspiratory flow. Only expose capsules for use. May have no taste evident. |
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How to use a spacer |
Take at least two deeply heldbreaths per puff of inhaler. Or breath through mouthpiece. Wash once a month; leave to drip dry. Replace yearly. |
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Physical examination into |
Hello my name is Ben, i am a student at the university of sunderland, can i ask your name and age pelase? Just to let you know ive washed my hands and anything discussed here wil remain confidential. If you feel discomfort at any point just let me know. |
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General inspection |
Im looking at the general health of the patient. They are not in any obvious pain or distress, skin tone is normal i.e not pale/flushed/signs of cyanosis. Observing their breathing for any signs of strain, doesnt seem to be any. no obvious use of accessory muscles to breath which may suggest COPD. Would also measure respiratory rate |
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Hand inspection |
Start by feeling the temperature of the skin, checking for poor perfusion or infection. THen check capillary refill by squeezing end of finger for 5 seconds and observing the blood return within 2 seconds, indicates normal perfusion. Check for tar stains around the fingers which may indicate the patient is a smoker. Next check for fine tremor in the hands by asking the patient to hold them outright, palms facing the ground- fine tremor is a sign of b2 agonist overuse. CHeck for asterixis by getting the patient to hold their hands out and check for CO2 flaps, a sign of CO2 retention. Check the radial pulses comparing for rate and rythm. |
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Face inspection |
Observe skin tone for signs of pallor or cyanosis. Looking if the patient has pursed lips or nasal flaring which could be signs of strained breathing that occurs in COPD patients. Open mouth and look under tongue for any signs of central cyanosis. Look at the eye for any yellowing of the sclera which would indicate jaundice. Compare the eyes to eachother, looking for any significant difference in pupil size or in terms of one eyelid drooping. Could indicate horners sign wich could indicate a apical lung tomour. FInally, look under the lower eye lid for pale conjuctiva,a sign of anemia |
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Chest inspection |
First ask the patient to expose chest. |
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Palpation of the patient. |
Firstly palpate the lymph nodes, which if raised may indicate infection. Start with the cervical nodes on both sides of the neck. Palpate the supraclavicular lymph nodes above the shoulds and finally the axilla lymph nodes within the arm pits ( look up locations ask othe rpeople which ones they did) THEN assess the alignment of the trache (may be uncomfortable, tell me at any time). If it was deviated from a central position it could indicate a pneumothorax (air in pleural cavity, haemothorax or possible presence of a tumour. I would then palpate both the anterior, sides and posterior of the chest, Firstly for tenderness, by running my open hands over the skin. Secondly to examine chest expansion i would examine the movement and distance between my ahnds thumbs during inhalation and expiration. FInally, i would exam vocal fremitus by asking the patient to repeat 99 during palpation with an open palm. Differences in skin resonance might indicate consolidation of fluids |
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Percussion of the chest |
Purpose is to identify areas of tympany and dullness. where dullness may indicate underlying fluid accumulation and consoldiation. I would compare the soudns form one side to its mirror position, listening to any differences in tone. Percuss on both anterior and posterior of the chest. In the latter case ensuring the patients arms were folded in front of them. |
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Auscultation of the chest |
During auscultation i would ask the patient to breath through their mouth. I would listen at a range of positions using the diaphragm of the stethoscope, assessing the sound over a full inspiration and expiration cylce. At each point get the patient to say 99, againt listening for any difference sin tone or volume which be be suggestive of consolidation. WHile listening to the locations on the psoterior, i would ask them to cross their arms in front of them. front, back , sides. |
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Wheeze |
Continuous musical tones, sign of collapsed airway lumen |
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Crepitations |
Crackling noise, signifies opening of collapsed airways |
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pleural rub |
squeaking/ grating sound. sign of inflammed pleura (infection) |
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Additional checks of respiratory examinatiom |
Inspect and palpate both legs of the patient, assessing temperature (for perufsion.infection), looking for any swelling. (odema/heart failure) and inflammation, and questioning regarding tenderness and pain (e.g calf pain suggestive of DVT > pulmonary embolism) a difference between the legs may be suggestive of a injury or DVT. A further additional check is looking at the base of the back for the characteristic swelling of sacral oedema, a sign of heart failure |
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EASi breath demonstration |
One inhalation ONCE daily at the same time each day. Close |
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Easi breathe counselling |
Don't keep in bathroom/humid area. Adequate inspiratory flow dont cover vents on top |
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Respimat counselling |
when twist the bottom to release dose, keep cap on top? ?? |
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nodes |
submental underchin Submandibular under jaw bone cervical down line where jvp wouldbe supraclavicular above collar bone would check auxilarry |
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