Communication Stations Flashcards

1
Q

What is the general framework for communication stations?

A

Introduce yourself
Establish a plan
Establish patient’s initial understanding (open Qs)
Ask if patient has questions or concerns
Explain procedure/test/procedure (avoid jargon, use diagrams, check understanding)
Conclude with a brief summary, give leaflet and offer to meet again/give contact info

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the target INR for people with AF, PE, DVT, Mechanical valver?

A

2-3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How would you start a warfarin counselling consultation?

A

‘We recommend that you start taking a new medication called warfarin because of your —-. Have you heard of warfarin?
I’d like to explain how warfarin works and why it has been recommended that you take this medication’

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How would you describe warfarin to a patient?

A

A medication that thins you blood, reducing the risk of blood clots forming in your heart, lungs and legs. This is why it is important to take it regularly’

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What important bits of information do you need to include in a warfarin consultation?

A

Impact on life (diet, alcohol, activities)
Blood test monitoring and yellow book
Doses and timings, what to do if you miss a dose
What to watch out for/emergency bleeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What should you warn the patient to look out for and contact GP or NHS-24 immediately?

A
Bleeding or severe bruising
Prolonged nose bleeds
Coughing/vomiting blood
Black tar like bowel motions
Haematuria
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are some common patient concerns about taking opiates

A

Will I become addicted
Will morphine make me die sooner
If I take morphine now, will it mean it won’t work later on when I really need it?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How would you address the concerns that opiates won’t work later on if you start them now

A

Tolerance does occur but it doesn’t mean that the drug won’t work, you may just need higher doses
When pain worsens it is usually due to disease progression but the dose can be increased.
Emphasise the use of regular medication and extra to control breakthrough pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

List the common side effects of opiates and what can be done to combat them

A

Constipation (use prophylactic Senna or lactulose)
Nausea (common but clears after 1 week, cover with anti-emetic)
Drowsiness (usually acute, alternative fentanyl considered)
Myoclonus (esp renal impairment, reduce dose/change opioid)
Hallucination (reduce dose)
Tolerance (increase dose for genuine pain control)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is usually given for breakthrough pain?

A

Oramorph

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What opiate is more appropriate in patients with renal dysfunction?

A

Alfentanil

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What other things do you offer a patient in chronic pain?

A
Referral to chronic pain clinic
Spiritual/emotion support
Relaxation techniques and mindfulness
Acupuncture/aromatherapy
TENS (transcutaneous electrical nerve stimulation)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Name 8 modifiable risk factors for cardiovascular disease

A
Smoking
Dyslipidaemia
Hypertension
Obesity
Excess alcohol
Excess salt
Lack of exercise
Environmental stress
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Lifestyle advice

A
WAFFLES
Weight (BMI 20-25)
Alcohol
Fruit and veg (5-8 portions a day)
Fat (reduce total)
Low salt
Exercise (30 mins per day, ideally every day)
Smoking cessation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the technique for breaking bad news?

A
SPIKES
Setting
Perception
Invitation
Knowledge
Empathy
Strategy/summary
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What does the setting involve for breaking bad news

A

I have given my bleep to a colleague, found a private room, curtains drawn

17
Q

What does the perception step of SPIKES involve?

A

What do they know so far?
Current expectations
Concerns of relative

18
Q

What does the invitation step of SPIKES involve?

A

Establish whether they want to find out more information

19
Q

How do you tell people the bad news once you’ve found out that they want to know?

A

Convey important information, emphasise care that will be done and comfort
Check understanding
Show empathy and recognise response
Explore response further, allow silence, offer tissues
Form a strategy and summary to close the conversation
Give opportunity to speak again
How are you getting home?

20
Q

How do you respond to a dementia patient when they tell you they ‘have to find their parents and let them know they are okay’?

A

Don’t correct them by orientating them, they may get distressed
Don’t collude with them because that would involve lying.
Instead, gently redirect them by saying ‘I will make sure your family are informed about what it going on. Who is in your family?’

21
Q

Other tips for speaking to a dementia patient

A

Introduce yourself and start by calling them a formal name (eg Mrs Morris) and then find out their preferred name.
Don’t stand over them
Patience, steer conversation when you can
Minimise other distractions and stimuli
Keep questions simple

22
Q

How can you find out what’s really going on with a patient with dementia?

A

Talk to nursing staff/OTs to find out baseline functioning level and pattern of behaviour
Get a good collateral history from carers/family
Find out about what their usual response to pain is

23
Q

What do you do it a dementia patient doesn’t understand what you are saying?

A

Ensure they can hear you (hearing aids/speak louder)
Use visual cues
Try saying things in a different way

24
Q

Name some ‘challenging behaviour’ in patients with dementia

A
Wandering
Restlessness
Agitation
Incontinence
Perseveration (repetition)
Paranoia
Sleeplessness/’sundowning’
Hallucinations
Physically or sexually inappropriate behaviour
25
Q

How do you deal with challenging behaviour from patients with dementia?

A

Validate: acknowledge the persons behaviour as a personal expression, not simply a symptom of the dementia.

Emotional connection: understand the emotional context behind the behaviour.

Reassurance: Anything from presence and a calming voice, to a gentle hand on their arm.

Activity: being occupied is a great anxiety-reliever! This can help to reduce agitation and give the person the feeling of purpose