HSC10

A stethoscope is a simple device that channels sound from a small metal dish along two tubes to the GP’s ears. By placing the stethoscope against the patient’s body in various places, a GP is able to listen to the heart, arteries, lungs and digestive system. For example heart arrhythmias will sound different from the normal, regular two noise heartbeat.  

Breathing will sound noisy if the airways are obstructed or if there is excess fluid present in the lungs. A stethoscope can be used to measure blood pressure.  

Visual examination means looking at the affected part of the body. This can reveal conditions such as arthritis, and skin rashes. Patients might be asked to partly undress to aid visual examination and some find this embarrassing.  

During the consultation with the patient, the GP will take Medical History. This includes: 

-asking the patient to describe what is wrong and listening carefully to the patient’s replies 

-asking key questions about the persistence, duration and intensity of symptoms. For example the 

-GP might ask “does it hurt all the time or only sometimes?” and “is it a sharp pain, or more like a dull ache?”  

-GP uses an interview technique called the ‘clinical interview’, in which questions asked are influenced by the replies to previous questions.  

A GP is also likely to ask about: 

Previous illness and treatment,Whether or not the patient is currently receiving any 

other treatment or medication, The patient’s lifestyle (exercise, smoking, drug use and alcohol consumption) and occupation , Previous history of disease in other family members 

Palpation means feeling part of the patient’s body with the fingers. This helps to detect abnormalities in organs, such as tumours or swellings that can be felt through the skin.  

A GP might measure a patients temperature using a thermometer placed in the mouth. Alternatively an infrared ear thermometer might be used. A reading of around 37°C is normal. Temperatures of 39°C and above indicate a fever, which can occur with a number of infectious disease, such as flu or meningitis.   

After asking patients questions and taking their medical history a GP might then conduct a physical examination in order to detect further signs of disease.   

A physical examination can involve:  

 visual examination  

 use of stethoscope 

 palpation  

 percussion 

 reflex testing  

 measuring temperature  

 measuring blood pressure  

Blood pressure measurement is useful in assessing the condition of the patient’s cardiovascular system. Blood pressure is measured using an apparatus called a sphygmomanometer. A hollow rubber cuff is placed around the patients arm. A pump is used to inflate the cuff which prevents blood flowing to the artery to the hand.  Air is slowly let out of the cuff leaving just enough space for the compressed artery to let blood through. The pressure gauge is attached to the 

tube records the reading. There are two readings systolic and diastolic.  

High blood pressure (hypertension) is a fairly common conditions 

(particularly among older people and obsess individuals.) It can increase the risk of strokes and kidney disease. Low blood pressure (hypotension) is not necessarily a sign of disease. Low blood pressure can be a sign of diabetes. 

GP’s can use computers in several ways to aid diagnosis. One way is by looking at a database that includes a patient’s medical records, to check for previous illnesses and treatments. Another way is by using clinical decision support systems (CDSS).  

These systems enables GPs and other health care workers to access information complied by experts in diagnosing and treating a wide range of diseases. (Advantage) CDSS can help reduce medical errors in diagnosis and treatment. (Disadvantage) However practitioners can rely on it too much instead of improving their own knowledge and expertise.  

Percussion is a diagnostic technique in which a GP holds one or two fingers against the patient’s body then taps these fingers with the other hand while listening to the resulting sound. This is useful for assessing the condition of the lungs. A hollow sound indicated that the lung is clear of fluid. If someone has fluid in their lungs it will sound dull and muffled. This can happen with pneumonia.  

Reflex testing enables a GP to detect damage to nerve pathways. The patellar (or knew‐jerk) reflex is tested when the leg is relaxed and the weight of the leg is supported entirely by the thigh. A point just below the patella (kneecap) is tapped using a rubber hammer. This stretches the tendon and sends a nerve impulse from the spinal cord. This triggers another never impulse from the spinal cord, which triggers the thigh muscle to contract. The result is that the lower leg jerks upwards.  

Absence of a reflex response might indicate damage or disease to the nerve pathway or spinal cord. This might aid a GP to assess whether a person’s back pain is caused by a problem with the spine or whether it’s caused by a muscle strain.  

Know that following some screening tests further diagnostic testing may be used. Understand how dysfunctions can be tested and monitored using: 

 Diagnostic imaging to include the principles of and use of x‐rays, contrast x‐rays, CT/PET scanning, radionuclide scanning, MRI and ultrasound scanning. 

 Tissue biopsy, i.e. removal of a tissue or a cell sample which is then examined under a microscope and/or subjected to biochemical tests. 

 Electrocardiography, including attachment of electrodes to the chest, wrists and ankles to display the electrical activity of the heart as a trace on a moving graph or screen. 

 Body fluid sampling to include the removal of blood samples. 

Refers to range of techniques that produce images (two‐dimensional and sometimes three‐dimensional). Main purpose of these techniques is to investigate the appearance of internal organs, which otherwise could not be visually examined without opening the body surgically. Staff who operate imaging equipment are called radiographers.  

One advantage of all imaging techniques have over methods such as biopsies or surgical investigation is they are non‐invasive. They do not penetrate the patient’s body. As a result, they cause no pain or physical discomfort.  

X‐rays are a type of electromagnetic radiation. X‐rays have an extremely short wave length. This short wavelength enables them to penetrate some materials that light and radio waves cannot pass through. For example they can go through the soft tissues of a person’s body. However they cannot pass through metal or a thick piece of bone. This property of x‐rays make them ideal for imaging certain structures inside a person’s body.  

An X‐ray machine produces an invisible beam of X‐rays, which are directed at a specific part of the patient’s body for example, the left wrist. Underneath the wrist is placed a sheet photographic paper in an envelope (to prevent it from being exposed to light). The X‐rays pass through the patient’s wrist and the envelope and cause a change in the photographic paper. The paper is then developed like an ordinary photographic negative, producing an x‐ray. The negative shows bones as light and soft tissue as dark. This is because denser tissues such as bones and heart muscle absorb more of the radiation than soft tissues do.     

X‐rays can be used to examine soft tissue structures. Abnormalities of the heart and lungs often show up as shadows on an x‐ray image. However, hollow or fluid‐filled organs, such as those of the digestive tract (oesophagus, stomach and intestine) are more difficult to image, so a special technique is used to observe this. The method involves putting a contrast medium into the patient’s digestive tract. This is a liquid containing metal salts that are opaque to x‐rays. Lead salts would work quite well but they are poisonous, so a harmless solution of barium sulphate in water is used instead.  

There are two ways of getting this into the digestive system. One way is to get the patient to swallow the liquid. This is called a barium swallow or barium meal. Depending on which part of the digestive tract is to be imaged, some time is allowed to pass and then X‐ray images are taken.  

The other way of getting the barium sulphate solution into the digestive tract is by pumping it into the patient’s rectum. This is called a barium enema, and is used to image the large intestine. X‐rays can be used to examine parts of the circulatory system, particularly the heart. The contrast medium used in this case is a dye containing iodine, which is injected via a catheter. An X‐ray of the heart produced in this way is called an angiogram.  

Advantages

-Quick and easy to use.  X‐ray negatives can be developed while the patients waits  

-Cheaper compared to other imaging methods  Cannot image most soft tissues unless contrast medium is used  

-Painless  

Disadvantages 

-The radiation can cause damage to the body cells, in some cases can lead to cancer.  

-Poor quality two‐dimensional images 



A computed tomography (CT) scanner makes use of X‐rays to produces an image of a slice or cross‐section of the body. The patient lies on a table, which gradually slides into a cylinder containing the scanner. At the same time, the scanner rotates around the patient, entitling pulses if X‐rays and receiving whatever radiation has passed through the body. Information from a set of X‐rays and receiving whatever radiation has passed through the body. Information from a set if X‐ray receivers is processed by computer software to produce an image in the form of slices. CT scanning is also known as a CAT scan.  

CT scanning is useful is useful for detecting and examining conditions affecting the brain, such as the damage caused by head injury, tumours and strokes. The digest tract can be imaged with the use of contrast media.   

Advantages 

-Images produced are much clearer and so show more detail.

-They enable the examination to be carried out in three dimensions. Unlike other imaging methods, CT scanning can produce images of structures encased in bone most importantly, the brain. 

-Painless and can scan whole body  Equipment is large size compared with conventional X‐ray machines     

Disadvantages 

-Radiation used is potentially harmful.  

-High cost of the equipment 



Radionuclides are radioactive forms of common elements, known as isotopes. Radioactive isotopes of carbon, nitrogen, oxygen, fluorine and iodine are used. The isotopes chosen are those that decay quite quickly, which means that the level of radioactivity declines rapidly and does not pose a significant risk to the environment. These are combined with other elements to produce radioactive versions of substances often found in or easily absorbed by the body such as glucose.  

The resulting radioactive substances are introduced into the patient’s body, usually in the form of a drip into a vein, and accumulate in the target organ. A number of scanning techniques can be used to collect the radiations (in the form of gamma rays) emitted from the organ being investigated. One of these methods is a PET which will be explained below.  

 

Positrons are subatomic particles like electrons, but with a positive charge. They are emitted from some radioactive materials in the course of normal radioactive decay. PET scanning make use of this process to study chemical (metabolic) processes going on inside body organs. Radionuclides are introduced into the patient’s body, as described above. After a time interval (during which the radionuclides will have been taken up by body tissues) the patient is placed on the table that slides into the scanner, in a similar way to MRI.  

A receiver in the scanner detects the radiation emitted from one slice or cross section of the body. A computer is then used to process the date to produce a coloured image, in which the brightest colours (red and yellows) indicate the most radiation. The highest levels of activity will be seen in those areas that are using most glucose, i.e. those areas that are functioning actively. This is useful in investigating the brain – unexpectedly dark areas are not functionally normally or the blood flow is lower than normal. This can diagnose conditions such as stroke or Alzheimer’s. PET scanning can also be used to observe heart functioning.  

Advantages 

-Is more effective than other methods in detecting malfunctions in the brain  

-Painless

Disadvantages 

-The level of risk caused by the radioactivity in radionuclide scanning is similar to that of a CT scan 

-Requires a supply of expensive chemicals with radioisotopes  

Advantages 

-Is more effective than other methods in detecting malfunctions in the brain  

-Painless

Disadvantages 

-The level of risk caused by the radioactivity in radionuclide scanning is similar to that of a CT scan 

-Requires a supply of expensive chemicals with radioisotopes  

MRI scanning takes place in a large, horizontal cylinder, which can accommodate a person’s whole body. The cylinder is equipped with a powerful electromagnet. This is made up of coils of wire that, when a current is passed through, produce a strong magnetic field. This field is so strong that it caused charged particles in the hydrogen atoms that make up body tissues to become aligned in the same direction, like a row of tiny magnets. Then a strong pulse of radio waves vibrates these particles, knocking them out of alignment. The particles produce detectable radio signals as they fall back into alignment, which are detected by a receiver. The strength of the emitted radio waves depends on the type of tissue they came from, for example, tissues that contain many hydrogen atoms (such as fat) produce a bright imagine, while those that contain little or no hydrogen (such as bone) appear black. The data produce an image of a cross‐section or slice of the 

patient’s body. A whole series of these slices can be imaged, to produce a three‐dimensional image of body structures and organs. Computer manipulation can be sued to turn the images so that a practitioner can observe any abnormalities. Sometimes contrast media is sued to produce clearer images of structures such a blood vessels.  

The method is particularly useful for imagining the brain and joints.  

Advantages 

-Produces a three‐dimensional image 

-Shows greater contrast between normal and abnormal tissues than a CT scan  

-Does not produce harmful radiation and is completely safe  

Disadvantages 

-Equipment is expensive compared with an X‐ray machine  

-Some patients feel anxious when enclosed by the machine, which is noisy when operated.  

Ultrasound scan uses a transducer/probe which produces high frequency sound waves. These sound waves penetrate through soft tissue. The practitioner places the transducer on the skin over the part of the body that is being scanned. An oily gel is used to sure there is good contact between the transducer and the skin. The transducer/probe is placed on the patient’s skin. The transducer requires a receiver that detects the sound waves. This is connected to a computer that processes the data 

from the transducer and then the computer creates an image. An ultrasound may show any abnormalities in in a patient’s body.  

This technique is commonly used to scan a fetus in the womb. The image quality is poor but the technique does enable practitioners to see the fetus moving.  

Advantages 

-Carries low risk of harm/no radiation so can be used in some situations where X‐rays cannot. 

-Produces a real‐time moving image   

-Inexpensive compared to MRI scans  

Disadvantages 

-This technique cannot penetrate bone and so cannot be used to scan the brain.  

-poorer image/unclear image (in comparison to other scanning techniques) 

Tissue biopsy involves taking a sample of living tissue from  the patient’s body for examination, usually under a microscope.  Tissue biopsies are performed in various ways. One technique is a to insert a hollow needle into the tissue. The needle captures a cylinder core of tissue which can be extracted and analysed. This technique is used to obtain samples of breast tissue in cases where physical examinations or mammography has revealed a lump.    

 A punch biopsy uses a large‐diameter needle to remove a disc of skin around 4mm in diameter. 

The sample can then be examined.  

 Another technique is through surgery in order to expose the tissue and cut out a sample. This is used where a larger sample is required, as is sometimes necessary in diagnosing breast cancer.  

 A smear test involves scraping a small sample of epithelial cells from a membrane. Examples include the cervical smear, which can diagnose cervical cancer, and the buccal smear, in which sample of cells is taken from the cheek wall inside the mouth.  

 A similar procedure uses a tiny nylon brush attached to an endoscope to collect epithelial cells from the bronchi and lungs.  

 Chronic villus sampling CVS is offered in pregnancies where there is a high risk of the baby having genetic disorders – cystic fibrosis, sickle cell anaemia and muscular dystrophy. CVS involves taking a small tissue sample from the lining of the placenta at around 10 weeks into pregnancy. The sample is obtained by passing a needle through the abdomen wall 

(transabdominal approach). Chromosome analysis of the biopsy gives a good indication of the presence of chromosomal abnormalities. 

 Advantages 

-Provide clear evidence of the presence of disease or abnormality whereas scans produce images of tissues, biopsies study the content of the tissue itself. This reduces uncertainty in a diagnosis.   

Disadvantages 

-It can be invasive and painful.  

Electrocardiography can help to diagnose disorders of the circulatory system, including heart arrhythmias (irregular heartbeat) and heart attacks (myocardial infarctions.)  

Electrodes are attached to the patient’s skin by means of sticky pads. Wires link the electrodes to a machine that records the electrical activity of the heart. The recording of this activity (called an electrocardiogram) is examined by a cardiologist, who is trained to recognise disorders from irregular patterns of heart activity.  

The electrical activity is caused by the nerve impulses that trigger 

contractions in different parts of the heart muscle. The recording can be in the form of a wavy line on paper or a moving line on a monitor screen.  

In a healthy heart, a typical wave shape is produced and this electrical pattern is nearly the same for every heartbeat. Deviations from this shape, or difference between different beats of an individual heart, can indicate damage to heart muscle tissue or irregular nerve signals that produce arrhythmias. Cardiologists label different parts of the characteristic wave pattern with the letters P, Q, R, S and T. These are used to describe the various actions of the heart as the different chambers 

(atria and ventricles) contract.  

Electrodes on the chest collect data relating to the activity of the heart muscles. Electrodes placed elsewhere on the body reveal the activity of arteries and veins.  

Advantages 

-Non‐invasive – it allows the activity of the heart to be studied without opening the chest 

(i.e. major surgery).  

-The equipment is small and relatively small and inexpensive.  

Disadvantages 

Although ECG can reveal that there is a problem, further investigation (e.g. including an imaging technique) is likely to be needed to find out exactly what is causing it.  

A urine sample can be collected by a patient at home, on a visit to a GP’s surgery, or in a hospital. The sample can be tested chemically – for example, to detect the level or glucose present. It can also be tested for infectious disease agents, such as bacteria, by growing cultures from the specimen. Urine tests can be used to diagnose kidney diseases, urinary tract infections and diabetes, as well as revealing the presence of drugs and abnormal levels of ions such as sodium or potassium.  

Blood tests can reveal a wealth of information about a patient’s condition for example: 

 the level of glucose ‐ important in diagnosing diabetes 

 the level of cholesterol ‐ associated with cardiovascular disease 

 the number of red blood cells ‐ important in diagnosis anaemia 

 can also reveal presence of drugs  

 levels of nutritionally important materials e.g. calcium  

A complete blood count test is performed by a machine that measures haemoglobin levels and the number of red blood cells, white blood cells and platelets per ml of blood. This can provide evidence of viral and bacterial infections, immunodeficiency diseases, vitamin deficiencies, cancers and many other conditions.   

Mucus can be collected from mucous membranes – for example, in the mouth, throat or vagina. Cells from this mucus sample can be cultured (grown) and examined under the microscope for the presence of bacteria or viruses.  

Amniotic fluid is the watery liquid surrounding the fetus in the womb. It is this liquid that is expelled just before a woman gives birth (this is referred to as the ‘waters breaking’). This fluid can aid the diagnosis of a range of chromosomal and genetic disorders, including Down’s syndrome and cystic fibrosis. It can also help to detect spina bifida.  

The test is usually performed at around sixteenth week of pregnancy. A needle attached to a syringe is inserted through the abdomen so that it just penetrates through the wall of the womb. A sample of fluid is then 

withdrawn. Ultrasound scanning is used to show the position of the needle, so that it can be kept away from the fetus. Amniocentesis carries a small risk of causing miscarriage.    

Antenatal screening tests:    

Amniocentesis for genetic disorder Down’s syndrome, spina bifida and sickle cell anaemia

Chorionic villus sampling for genetic disorder cystic fibrosis and muscular dystrophy and sickle  cell anaemia  

Blood tests for anaemia and blood groupings to include the rhesus factor.  

Amniotic fluid is the watery liquid surrounding the  foetus in the womb. The test is usually performed at  around sixteenth week of pregnancy. Before the  procedure an antiseptic solution will be used to clean  your abdomen to minimise infection. A needle attached  to a syringe is inserted through the abdomen so that it  just penetrates through the wall of the womb.  Ultrasound scanning is used to show the position of the  needle, so that it can be kept away from the fetus. A  syringe will then be used to remove a small sample of  the amniotic fluid. Amniocentesis carries a small risk of causing miscarriage.   

Down’s Syndrome ‐ A chromosomal condition that is acquired at conception, that  typically causes some level of learning disability and characteristic physical features  (reduced muscle tone, slant eyes etc).  

What is being looked for? - (To check for abnormalities in the chromosomes which may indicate genetic disorders  such as Down’s syndrome.)  Extra chromosomes on the 21st pair where there are  normally two.

Positive - The sample of amniotic fluid will be sent to a laboratory for analysis.   An extra copy of the 21st chromosomes (Trisomy 21) 

Spina‐Bifida ‐ Neural tube defect, which means that the tube of bone that normally  protects the spinal cord has not formed properly. In spina‐bifida, the vertebrae (bones  of the spine) have not grown enough to encircle the spinal cord fully, which is can  therefore be exposed to damage. Spina‐bifida is caused by a deficiency of the vitamin  folic acid before conception and first few months of pregnancy; there could also be a  genetic link as a factor.  

What is being looked for? - (To check for abnormalities which may indicate genetic disorders such as Spinabifida.)  AFP Test. Looks at the levels of the protein Alpha‐Fetoprotein (AFP) in  mothers’ blood and amniotic fluid.  

How positive  results are  recognised - High levels of AFP in the amniotic fluid or found in mothers’ blood. 

Sickle Cell Anaemia ‐ Sickle cell anaemia is a serious inherited blood disorder where the  red blood cells, which carry oxygen around the body, develop abnormally and look  crescent in shape. It is caused by a genetic mutation. 

What is being  looked for? - (To check for abnormalities which may indicate genetic disorders such as Sickle Cell  Anaemia.)  Abnormal shape of the red blood cells. 

How positive  results are  recognised - A high level of defective haemoglobin.    

Chorionic villus sampling (CVS) - involves taking a sample of cells from the tissue of the  placenta of a pregnant woman. The procedure is always carried out under the  continuous guidance of an ultrasound scan to ensure that nothing enters the amniotic  sac (the protective sac that cushions the baby with fluid as it grows) or touches the  baby. CVS can be carried out using two different methods:  transabdominal CVS   During transabdominal CVS, your abdomen is cleaned with antiseptic. You are given a  local anaesthetic injection. The sample is obtained by passing a needle through the  abdomen wall. The needle is guided towards the placenta using the image on the  ultrasound scan. Attached to the needle is a  syringe, which is used to extract a small sample  of chorionic villi. After the sample is removed,  the needle is taken out.    transcervical CVS   During transcervical CVS, a sample of the  chorionic villi are collected through your cervix  (the lower part or neck of the womb). First, your  ****** and cervix will be cleaned with  antiseptic. A thin tube or forceps (smooth metal  instruments that look like large tongs) are then  inserted through your ****** and cervix, and are guided toward the placenta using the  ultrasound scan.

Cystic Fibrosis ‐ A genetic disorder in which the lungs and digestive system become clogged with thick sticky mucus; symptoms: cough, lung & chest infections, poor weight gain. Cystic fibrosis is a genetic condition caused by a faulty gene (known as the CFTR gene). The CFTR gene normally creates a protein that moves salt and water out of a cell. 

What is being looked for? -Recessive gene Cystic fibrosis transmembrane conductance

regulator (CFTR) 

How positive results are recognised -Presence of the faulty CFTR gene 

Muscular Dystrophy ‐ Muscular dystrophy (MD) is a sex‐linked genetic condition characterised by progressive weakening of voluntary muscles that leads to death. It only affects boys. 

What is being looked for? - Mutation in a gene called myotonic dystrophy protein kinase, or DMPK 

How positive results are recognised - Shortage of dystrophin which causes muscle fibres to be damaged producing  high levels of creatine kinase (CK) 

Sickle Cell Anaemia ‐ Sickle cell anaemia is a serious inherited blood disorder where the red blood cells, which carry oxygen around the body, develop abnormally and look crescent in shape. It is caused by a genetic mutation. 

What is being looked for? - Abnormal shape of the red blood cells. 

How positive results are recognised - A high level of defective haemoglobin. 

Blood test usually involves taking a blood sample from a blood vessel in your arm. Blood samples from children are usually taken from the back of the hand. A tight band (tourniquet) is usually put around your upper arm. This squeezes the arm, temporarily slowing down the flow of blood out of the arm, and causing the vein to swell with blood. The doctor or nurse may need to clean the area with an antiseptic wipe. A needle attached to a syringe or to a special blood‐collecting container is pushed into the vein. The syringe is used to draw out a sample of your blood. You may feel a slight pricking sensation as the needle goes in, but it should not be painful. When the sample has been taken, the needle will be removed. Pressure is applied to the tiny break in the skin for a few minutes using a cotton‐wool pad to stop the bleeding and to prevent bruising. A plaster may then be put on the small wound to keep it clean and prevent infection. 

Blood tests for anaemia ‐ A condition where a lack of iron in the body leads to a reduction in the number of red blood cells.

What is being looked for? - Blood count for haemoglobin  

How positive results are recognised - Low levels of haemoglobin, few red blood cells, red blood cells may be smaller and paler than usual. 

Blood groupings for Rhesus Factor ‐ Rhesus disease is a condition where antibodies in a pregnant woman’s blood destroy her baby's blood cells. Rhesus disease only happens when the mother has rhesus‐negative blood (RhD negative) and the baby in her womb has rhesus‐positive blood (RhD positive). The mother must have also been previously sensitised to RhD‐positive blood. 

What is being looked for? - Blood test taken to determine which blood group mother is and whether her blood is RhD positive or negative. If mother is RhD negative, her blood will be checked for anti‐D antibodies 

How positive results are recognised - Presence of anti‐D antibodies. Means mother has become sensitised to RhD positive blood and developed an immune response. 

Infant and child screening tests: 

 Blood test for phenylketonuria (PKU) 

 Dental examination for caries 

 Eye tests for visual defects using a Snellen chart and behavioural response test for colour blindness 

 Hearing tests for deafness using audiograms and behavioural response tests  Physical examination for hip dislocation 

PKU ‐ Phenylketonuria (PKU) is a rare genetic condition that is present from birth. The body is unable to break down an enzyme called phenylalanine, which builds up in the blood and brain. 

How - Blood samples from children are usually taken from the back of the hand. The child's hand will be anaesthetised (numbed) with a special cream before the sample is taken. A tight band (tourniquet) is usually put around your upper arm/ forearm. This squeezes the arm, temporarily slowing down the flow of blood out of the arm, and causing the vein to swell with blood. This makes it easier for a blood sample to be taken. Before taking the sample, the doctor or nurse may need to clean the area with an antiseptic wipe. A needle attached to a syringe or to a special blood‐collecting container is pushed into the vein. The syringe is used to draw out a sample of your blood.  

What is being looked for - levels of phenylalanine will be measured. If levels are unusually high, a second blood sample will be taken to confirm the diagnosis. 

How positive results are recognised -If the second test confirms high phenylalanine levels, your baby will be referred to a doctor who specialises in treating cases of PKU. 

Dental Caries ‐ Tooth decay (dental caries) is caused by bacteria on the surface of the teeth that feed on sugar and produce acid waste. The bacteria live in a sticky coating of salvia and food remains called plaque, which collects on the surface and between the gaps between the teeth. The acid produced by the bacteria feeding on the plaque dissolves the enamel of the tooth surface, leaving small pits. More plaque collects in these pits, which can become enlarged into cavities in the dentine. This process of dissolving is called demineralisation. The cavities can eventually expose the tooth pulp, which leads to sensitivity or toothache. 

How test is  performed? - Examine your teeth, gums and mouth.  

What is being looked for - Dentist/dental hygienist will examine your mouth and teeth, probing your teeth with dental instruments to check for soft areas and they will be looking at dental X‐rays, which can show the extent of cavities and decay. 

How positive results are recognised - Presence of cavities in the tooth. 

How? -Red reflex ‐ Red reflex testing is vital for early detection of vision‐ and potentially life‐threatening abnormalities such as cataracts and glaucoma.  

The red reflex test involves using an instrument called an ophthalmoscope, which magnifies images and has a light at one end of it.  When light is shone into your baby's eyes, a red reflection should be seen as it is reflected back. If a white reflection is seen, it could be a sign of an eye condition such as cataracts. In this case, your baby will be referred to a specialist. 

What? - When light is shone into your baby's eyes, a red reflection should be seen as it is 

reflected back. 

How positive results are recognised - If a white reflection is seen, it could be a sign of an eye condition such as cataracts. 

How test is performed - Colour blindness ‐ One of the tests used to check for colour blindness is the Ishihara test. This involves looking at images that are made up of dots in two different colours. 

What is being looked for - If a child's colour vision is normal, they will be able to recognise a letter or number within the image. 

How positive results are recognised - A child who can't tell the difference between two colours won't be able to see the number or letter, which means that they may have a colour vision problem. 

How test is performed - Pupil reflex test ‐ The pupil reflex test involves shining a light into each of your baby’s eyes from a distance of 10cm to check the reflex of their pupils to light 

What is being looked for - Your baby’s pupils should automatically shrink in response to the brightness of the light. 

How positive results are recognised - If they don't, it suggests there is something affecting the reflex response of their pupils. 

How test is performed - Snellen Chart ‐ When your child can recognise or match letters, their vision is tested using charts that have rows of letters and numbers of decreasing sizes. Your child will be asked to read out or match the letters they can see from a specific distance. These charts are called Snellen or LogMAR charts and they test for visual acuity. The chart is placed 6 metres (20 feet) from the subject. The visual acuity is stated as a fraction: the distance from the chart 6 metres ‐ is the numerator; the distance at which a 'normal eye' would be able to read the last line that the patient is able to read is the denominator. For example, 6/6 vision signifies normal vision i.e. a patient can read a line of symbols at six metres that a person with 'normal visual acuity' would be able to read at six metres. 

What is being looked for - Visual acuity is being looked for (i.e. how sharp is your child’s vision). 

How positive results are recognised - Visual acuity can be determined by whether your child can read letters from a distance of 6m. If they have problems reading the small letters this may indicate short sightedness or poorer vision. 

How test is performed - Automated auditory brainstem response test (AABR) During an AABR test, three small sensors will be placed on your baby's head and neck. Soft headphones will be put over your baby’s ears and quiet clicking sounds will be played through them. A computer will then be used to analyse how well your baby’s ears respond to the sound. 

What is being looked for - During an AABR test, three small sensors will be placed on your baby's head and neck. Soft headphones will be put over your baby’s ears and quiet clicking sounds will be played through them. A computer will then be used to analyse how well your baby’s ears respond to the sound. 

Interpretation of Result - If the hearing system is working normally then the computer will report strong responses. If there is no strong response then the computer will report that a referral should be made. 

How test is performed - Automated otoacoustic emission test (AOAE) An AOAE test only takes a few minutes and can be carried out while your baby is asleep. A tiny earpiece will be placed in your baby's ear and quiet clicking sounds will be played through it.  

What is being looked for - If your baby's ear is working normally, reaction sounds (echoes) should be produced in a part of the ear known as the cochlea. A computer is used to record and analyse the reaction sounds. 

Interpreting the result - If the test records strong responses from the baby’s ear then they will not need any further tests. 

Developmental Dysplasia of the Hip ‐ Developmental dysplasia of the hip is a problem with the way that the hip joint develops. The ball and socket do not fit snugly together. 

What is being looked for - In DDH, there is an abnormality either in the shape of the head of the femur, the shape of the acetabulum, or the supporting structures around them. As a result, the acetabulum and femur are not in close contact. It may be a mild abnormality where there is some contact between them. This is called subluxation. It may be a severe abnormality where there is no contact between them and this is called dislocation. During an examination with the healthcare professional they will note how the baby holds its legs at rest. They will check to see if they are the same length and whether the natural thigh creases at the groin symmetrically.  The babies’ hips are gently manipulated to see if they are safely in joint by tests known as the Ortolani and Barlow Tests. The baby is laid on its back and the hips are moved gently outwards. ‘Clicky’ sounds can be entirely normal and are not usually important. 

How positive results are recognised - A distinctive ‘clunk’ (which is felt) suggests a possible abnormality and the joint may be classes as unstable.  It may be caused by the head of the thigh bone moving in and out of the socket. 

Adult screening tests: 

 Blood pressure for hypertension 

 Eye tests for glaucoma using tonometry and other visual defects include short‐sightedness and long‐sightedness 

 Smear test for cervical cancer 

 Mammography for breast cancer  

Mammography is the use of an X‐ray machine to look for signs of abnormalities (particularly cancer) in women’s breasts. The breast is pressed slightly flat between two plates and the photographic plate exposed to X‐rays. The resulting image is called a mammogram. 

 Physical examination for testicular cancer 

How test is performed - Using a sphygmomanometer – digital electronic (blood pressure) monitor. A cuff is placed around the upper arm and pressure exerted as cuff inflates, this tightens/stops pulse and restricts arterial blood flow (systolic reading). The pressure of heart beat is recorded during the deflation/loosening of the cuff and this takes the diastolic reading – pressure between beats.  

What is being looked for - Level of blood pressure  

How positive results are recognised - reading higher than 140/90 mm Hg 

How test is performed - Eye Tests for Glaucoma ‐ must include tonometry and normal eye test. Using a non‐contact tonometer, the optical assistant (or the optometrist) blows a few puffs of air at each of the eyes in turn. The air bounces back at the instrument, giving a measurement of the pressure inside each eye. Contact tonometer, A small amount of anaesthetic (painkilling medication) and dye is placed onto the transparent layer of tissue that covers the front of the eye (your cornea). A blue light from the head of the tonometer is held against your eye to measure the intraocular pressure. 

What is being looked for - Pressure in the eye. 

How positive results are recognised - Pressure reading exceeding 20 mmHg 

How test is performed - Clients read the Snellen chart through different strength lenses. The results for one eye often vary from those for the other, so each eye will be tested individually before both eyes are finally tested together. May indicate short‐ or long‐sight. 

What is being looked for - visual acuity 

How positive results are recognised - blurry vision when looking at faraway objects ‐ Myopia Vision is blurry when looking at objects up close ‐ hypermyopia 

Client Group - Women aged between 25 – 64 years old.

How test is performed - The client will be asked to undress from the waist down and lie on a couch. The doctor or nurse will gently put an instrument, called a speculum, into the vagina. This holds the walls of the vagina open so that the cervix can be seen. A small brush‐like instrument will be used gently to collect some cells from the surface of the cervix. The cell sample is then sent off to a laboratory for analysis. 

What is being looked for - Abnormal cell changes 

How positive results are recognised - Abnormal cell changes and/or HPV  

Client Group  - Women over 50, unless family history

How test is performed - Performed by a radiology technician, woman will undress to the waist and one breast at a time is placed upon the platform on the mammogram unit. The breast will be steadily compressed an x ray beam will pass through the breast the images taken are recorded this process will be repeated 3 more times. 2‐ 4 images are taken of each breast at different angles/one from above and one from side. The compression will even out the breast thickness and X‐ray results/mammogram will be viewed as images and examined by radiologist/radiographer. Results sent to patient/discussed with patient. 

What is being looked for - Mammography uses an x‐ray machine to look for abnormalities in a woman’s breast. 

How positive results are recognised - Small areas of calcium which may indicate changes to the breast tissue or lumps. 

Client Group  - Men aged between 15 – 49 years old 

How test is performed - Self‐examination by the client at home finds a lump. The GP may hold a small light or torch against the lump in the testicle to see whether light passes through it. GP may refer client to hospital for a scrotal ultrasound if they think lump is cancerous. 

What is being looked for - Changes/pain / lumps/ swelling in one or both testes. 

How positive results are recognised - Cancerous lumps tend to be solid, which means that light is unable to pass through them. 

Vaccines stimulating the immune system to produce antibodies (substances produced by the body to fight disease) without individuals actually becoming infected with the disease. Vaccines triggering the immune system to produce its own antibodies against disease, as though the body has been infected with it; this is called 'active immunity'. 

If the vaccinated person then comes into contact with the disease itself, their immune system will recognise it (memory cells) and immediately produce the antibodies needed to fight it.  

New‐born babies are already protected against several diseases, such as measles, mumps and rubella, because antibodies have passed into them from their mothers via the placenta; this is called ‘passive immunity’  

Passive immunity only lasts for a few weeks or months; in the case of measles, mumps and rubella, it may last up to one year (which is why the MMR jab is given to children just after their first birthday) 

If enough people in a community are vaccinated, it’s harder for a disease to pass between those who are not; this is called herd immunity when a vaccination programme is introduced, everyone in the population of a certain age or risk group is offered a specific vaccine to try to reduce disease. 

You need to understand that infants and children are immunised against: 

 Diphtheria 

 Pertussis (whooping cough) 

 Tetanus 

 Measles, mumps, rubella (triple MMR vaccine). 

Caused by - bacterial infection called Corynebacterium diphtheriae    

Mode of transmission of the disease - Spreads through respiratory droplets (by a cough or sneeze)/ droplets of their saliva enter another person’s mouth or nose of an infected person or someone who carries the bacteria. Diphtheria can also be spread by ingesting contaminated foods.  

Symptoms  High temperature/sore throat/breathing difficulties Causes foul smelling blood stained mucus, cough, difficulty swallowing 

Progression of the disease - Once infected toxins produced by the bacteria spread through bloodstream to other organs e.g. the heart causing damage (myocarditis). 

Risks of the disease to the person short term - High temperature/sore throat/breathing difficulties Causes foul smelling blood stained mucus, cough, difficulty swallowing 

Risks of the disease to the person long term - Can cause respiratory failure, paralysis of the diaphragm, bladder problems, damage to the heart and nervous system. 

Risk of having the vaccine, side‐effects - Common side effects: Pain, redness or swelling at injection site, Unusual crying, Fever, Loss of appetite, Restlessness 

Causes of the disease - Bacterial infection in the lungs and airways called Bordetella pertussis 

Mode of transmission of the disease - Spreads through respiratory droplets (by a cough or sneeze)/ droplets of their saliva enter another person’s mouth or nose of an infected person or someone who carries the bacteria.  

Symptoms - High temperature/runny nose/ vomiting (after coughing) cough makes a 'whooping' noise 

Progression of the disease - The condition causes a persistent dry/intense cough 

Risks of the disease to the person short term - High temperature/sore throat/breathing difficulties  

Risks of the disease to the person long term - Kidney failure, brain damage, if breathing difficulties prevent enough oxygen from getting to the brain, seizures, pneumonia 

Risk of having the vaccine, side‐effects - Common side effects: Pain, redness or swelling at injection site, irritability and headache, fever and loss of appetite 

Causes of the disease -  Bacterial infection caused by Clostridium tetani that lives in soil, house dust and manure 

Mode of transmission of the disease - The tetanus bacteria usually enter the body through a wound in the skin or a serious burn. Once inside, they multiply and release a powerful type of poison, known as a neurotoxin. 

Symptoms - high temperature/ muscle spasms and stiffness, spasms can cause difficulty swallowing, sweating, rapid heartbeat and high blood pressure 

Progression of the disease - The symptoms of tetanus usually develop within 4 to 21 days after infection with the Clostridium tetani bacteria (the incubation period). The average incubation period is about 10 days. The neurotoxin disrupts the normal workings of the nerves, causing symptoms such as stiffness and muscle spasms. 

Risks of the disease to the person short term - Stiffness in jaw muscles (lockjaw) that spreads from jaw to neck and limbs over 24 to 72 hours. 

Risks of the disease to the person long term - Can cause sudden cardiac death, pulmonary embolism (a blockage in the pulmonary artery, which is the blood vessel that carries blood from the heart to the lungs), pneumonia kidney failure, and death. 

Risk of having the vaccine, side‐effects - Common side effects: Pain, redness or swelling at injection site, Unusual crying and irritability, fever, loss of appetite, vomiting and diarrhoea. 

Caused by a Viral infection called paramyxovirus – very infectious and spreads easily. 

Mode of transmission of the disease - Contained in the millions of tiny droplets that come out of the nose and mouth when an infected person coughs or sneezes. Another person breathes in infected droplets or touches a surface that has been contaminated with the droplets then placing hands near their nose or mouth.  

Symptoms  cold‐like symptoms – such as a runny nose, watery eyes, swollen eyelids and sneezing, red eyes and sensitivity to light, high temperature (fever),  tiredness, irritability

Progression of disease & risks of the disease (short term) - After a few days a red‐brown spotty rash will appear usually starts behind the ears and the rest of the body. The spots are initially small but quickly get bigger and often join together. 

Risks of the disease to the person long term - Blindness, heart and nervous system problems, death 

Risk of having the vaccine, side‐effects - Common side effects: Pain, redness or swelling at injection site, Unusual crying, Fever, Loss of appetite, Restlessness 

Caused by: A contagious viral infection called paramyxoviruses  

Mode of transmission of the disease - Spreads like a cold/flu/ from close personal contact with someone who is infected with the virus, contaminated surfaces or by the droplets released  when someone infected coughs or sneezes.  

Symptoms  painful swellings at the side of the face/under the ears, hamster face appearance, headache, joint pain, fever 

Progression of disease & risks of the disease (short term) - When you get mumps, the virus moves from your respiratory tract (your nose, mouth and throat) into your parotid glands (saliva‐producing glands found either side of your face), where it begins to reproduce. This causes the glands to swell. The virus can also enter your cerebrospinal fluid (CSF), which is the fluid that surrounds and protects your brain and spine. Once the virus has entered the CSF, it can spread to other parts of your body, such as your brain, pancreas, testicles (in boys and men) and ovaries (in girls and women). 

Risks of the disease to the person long term - High temperature, swollen testicles, swollen ovaries, viral meningitis can occur if the mumps virus spreads into the outer protective layer of the brain, which is known as the meninges.  

Risk of having the vaccine, side‐effects - Hearing loss, encephalitis (infection of the brain) 

Caused by - viral infection caused by the rubella virus 

Mode of transmission of the disease - reads through respiratory droplets (by a cough or sneeze)/ droplets of their saliva enter another person’s mouth or nose of an infected person or someone who carries the virus.  

Symptoms  a red‐pink skin rash made up of small spots, swollen glands around the head and neck, a high temperature (fever),  cold‐like symptoms such as a cough and runny nose,  aching and painful joints (more common in adults), loss of appetite, tiredness, sore and red eyes. 

Complications of the disease - a pregnant woman catches rubella, the infection can be passed to her baby. This can result in problems such as miscarriage (the loss of the pregnancy during the first 23 weeks) and a range of birth defects known as congenital rubella syndrome (CRS). 

Risk of having the vaccine, side‐effects 

Common side effects: Pain, redness or swelling at injection site, Fever, Loss of appetite, Restlessness 

The following vaccinations are recommended for people of any age who travel to different countries which have specific health risks. Common examples include protection against: 

 Cholera 

 Hepatitis A 

Hepatitis B 

 Typhoid 

 Rabies 

Caused by A bacterial infection called Vibrio cholerae bacteria 

Mode of transmission of the disease - Drinking contaminated water/ ice using contaminated water, Food grown using contaminated water, raw fish/sea food caught in contaminated water, eating food prepared by someone contaminated with infection, Faeco‐oral route 

Symptoms Severe, watery diarrhoea, Feeling nauseous and being sick, Stomach cramps, Exhaustion, Muscle cramps 

Progression of disease - Usually main symptoms which develop few days after infection. In severe cases can develop in just a few hours. 

Risks of the disease (short term) - Diarrhoea, nausea and vomiting, can lead to dehydration 

Risk of the disease (long term)  - Without treatment, the combination of diarrhoea and vomiting can cause a person to quickly become dehydrated and go into shock (where there is a sudden massive drop in blood pressure). In the most severe cases, the condition can be fatal. 

Risk of having the vaccine, side‐effects -Common side effects: short‐term symptoms similar to a mild stomach upset, such as abdominal (tummy) pain, diarrhoea and nausea. Pain, redness or swelling at injection site, Fever, Loss of appetite, Restlessness 

Caused by a type of viral liver infection caused by the hepatitis A virus. 

Mode of transmission of the disease - Eating food contaminated by the stools of an infected person (Faeco‐oral route), eating/drinking food or contaminated by raw sewage. 

Symptoms  Mild fever, joint and muscle pain, feeling and being sick, diarrhoea, jaundice, itchy skin and swollen and tender liver 

Progression of disease - Symptoms usually clear up within two months, but can last up to six. 

Risks of the disease (short term) - Jaundice may develop, urine may be darker and stools pale in colour, itchy skin 

Risk of the disease (long term)  - Serious complications can occur in people with pre‐existing liver disease or the elderly 

Risk of having the vaccine, side‐effects - Common side effects: Pain, redness or swelling at injection site, Fever, Loss of appetite, Restlessness. 

Caused by a type of viral liver infection caused by the hepatitis B virus. 

Mode of transmission of the disease - Spread by infected blood and bodily fluids such as semen, vaginal secretions, saliva, open sores and breast milk. Injecting drugs and sharing needles with an infected person. 

Symptoms  flu‐like symptoms (such as tiredness, general aches and pains, headaches and fever), loss of appetite and weight loss, feeling sick, being sick, diarrhoea, jaundice 

Progression of disease - Many people do not realise that they have been infected with the virus because the symptoms may not develop immediately, or even at all. It takes 40 – 160 days for any symptoms to development after exposure to the virus. 

Risks of the disease (short term) - Flu‐like symptoms (such as tiredness, general aches and pains, headaches and fever), loss of appetite and weight loss, feeling sick, being sick, diarrhoea, jaundice. Often, symptoms occur 1‐6 months after exposure. 

Risk of the disease (long term)  - Development of chronic hepatitis B, Cirrhosis of the liver, liver cancer, immune system can attack the liver and cause damage (Fulminant Hepatitis B), death 

Risk of having the vaccine, side‐effects - Common side effects: Pain, redness or swelling at injection site, Fever, Loss of appetite, Restlessness 

Typhoid fever Caused by a Bacterial infection called Salmonella typhi. 

Mode of transmission of the disease - Faeco‐oral route – not washing hands after passing stools that contain the Salmonella typhi bacteria, ingested contaminated food, drank contaminated water, sewage contaminated with bacteria getting into water used for drinking/washing 

Symptoms  Fever/high temperature/39‐40 degrees Celsius, Abdominal pain, Constipation or diarrhoea, Vomiting, Dry cough, Dull headache, Severe mental confusion, Skin rash, Swollen abdomen, Slow heartbeat, Loss of appetite , Weight loss, Physical exhaustion e.g. fatigue, Rapid breathing, Psychotic mental state 

Progression of disease - The bacteria will then quickly multiply, triggering the initial symptoms such as a high temperature, stomach pain and constipation or diarrhoea. If the person is not treated, the bacteria can get into the bloodstream, which means they can spread to other areas of the body. The spread of bacteria out of the digestive system can cause the symptoms of typhoid fever to get worse during the weeks after infection. 

Risks of the disease (short term) - Fever/high temperature/39‐40 degrees Celsius, Abdominal pain, Constipation or diarrhoea, Vomiting, Dry cough, Dull headache.

Risk of the disease (long term)  - If the organs and tissue become damaged as a result of the infection, it can cause serious complications, such as internal bleeding or a section of the bowel splitting open. Can cause death. 

Risk of having the vaccine, side‐effects - Common side effects: Pain, redness or swelling at injection site, Fever, Loss of appetite, Restlessness 

Rabies is Caused by Rabies is a very serious viral infection that targets the brain and nervous system. 

Mode of transmission of the disease - You can catch rabies if you are bitten/scratched, or lick to skin or the eye by an infected animal and have not been vaccinated. 

Symptoms  tingling and itchiness of the infection, fever, irrational fear of water (hydrophobia) fear of drafts of air (aerophobia), aggressive behaviour 

Progression of disease -The incubation period is the time it takes for symptoms to develop after a person is infected with the virus. The incubation period for rabies is usually two to 12 weeks, although it can be as short as four days. It would be highly unusual for the incubation period to last for more than a year. The closer the site of infection is to your brain, the shorter the incubation period. For example, a bite to your face, head or neck will have a shorter incubation period than a bite to your arm or leg. 

The length of the incubation period is important, because it's the only period in which treatment can be successful. 

Risks of the disease (short term) - Fever, chills, extreme tiredness, problems sleeping, lack of appetite, headache, irritability, anxiety, sore throat, vomiting, pain and tingling sensation at infection site. These can last for two to 10 days before severe symptoms start. 

Risk of the disease (long term)  Advanced symptoms –furious rabies (characterised as episodes of odd hyperactive behaviour) Paralytic rabies (characterised by muscle weakness, loss of sensation and paralysis.  Person will fall into a coma and eventually die from heart or lung failure.  

Risk of having the vaccine, side‐effects - Common side effects: Pain, redness or swelling at injection site, Fever, muscle aches, a rash, vomiting 

Disease treatment aim to:  

 Cure the disease permanently – for example, eradicating a bacterial infection with antibiotics 

 Delay the progress of a disease that cannot be cured – for example, using drugs to inhibit the growth of an inoperable tumour.  

 Palliate the effects of the disease, especially to reduce pain and discomfort – for example, using analgesic drugs such as paracetamol to reduce pain  

 Reduce or remove the symptoms of disease – for example, using insulin to normalise metabolism in diabetes, or using antipsychotic drugs to reduce the symptoms of schizophrenia  

 Rebuild or repair damage to body tissues and structures – for example, facial reconstruction following an incident 

 Replace damaged or diseased body tissue and organs – for example, heart transplant and hip replacement  

Informal carers, such as parents with children who are ill, or adults looking after elderly or disabled relatives, can provide basic nursing care.  

Monitoring health – for example taking the patients temperature and watching for signs of improvement or deterioration.  

Supervising treatment – for example, making sure that medication is taken at the prescribed intervals as some patients, especially the very young or very old, are not able to manage their own medication.  

Maintaining hygiene – washing, bathing, toileting  

Providing nutrition  

 Providing social contract, support and stimulation – for example for young children or may become bored and depressed 

Hospital nursing involves some of the skills listed above, though usually at a higher level of sophistication.  

A greater range of monitoring equipment will be used – for example, to check blood pressure  Accurate record keeping  

Expertise in a range of treatment procedures compared to home nursing. E.g. a hospital nurse will be able to set up a intravenous drip  

Maintaining privacy and confidentiality  

Nurses also need:  Confidence and sensitivity, Skills in effective communication  , Ability to empathise with patients, The ability to empower patients, The ability to work as a team  

Drug Treatment is the use of a chemical substance that alters the function of one or more body organs or changes the process of disease. A drug is used for medical purposes is a substance that is administered to the patient in carefully controlled amounts, usually repeated and regularly. Drug treatment is used to do the following:  

 To make up for chemical imbalance in the body for examples to correct a deficiency disease 

 To help the body fight infectious disease agents such as bacteria 

 To relieve or palliate unpleasant symptoms 

 To recue pain  

Each drug normally has three names, i.e. a detailed descriptive chemical name, a shorter generic

name (official medical name) and a specific brand name chosen by the manufacturer. For example; Disprin (brand name), a drug used for pain relief. Its generic name is Aspirin and its chemical name is acetylsalicylic acid.  

Firstly according to chemical make‐up (for example, the drugs known as opioids are derived from opium poppies. One of these is morphine. Drugs that belong to the same family often have the similar effects on the body. The opioids are used as analgesics, i.e. to relieve pain).  

Secondly to the disorder treated (for example, antidepressant drugs are designed to improve mood in clinically depressed people). 

Thirdly by their specific effects on the body (for example, cardioselective beta‐blockers slow heart rate and reduce the force of contraction of heart muscle, resulting in reduced blood pressure.)  

You need to know the different methods of administering drugs, i.e. by mouth, injection, creams, suppositories or sprays should be known, and the reasons for administration in each case. The method chosen depends on factors such as the location of the organ at which the drug is targeted, the urgency with which the drug is needed, the required speed of release of the drug and the ability of the patient to swallow.  

The most common method of administering drugs is by mouth. In most cases the patient swallows a tablet, a capsule or liquid. The drug passes into the intestines, where some of it is absorbed into the blood stream. The results in the drug being transported to all parts of the body via the blood. This is an effective way of delivering antibiotics to treat bacterial infections. Some drugs are taken by mouth are designed to be realised over a period of several hours. This has the effect of avoiding a sudden, large dose entering the bloodstream and also of spreading the effect of the drug over a period of several hours, providing continuous relief from symptoms.  

Advantage - user friendly, enabling patients to administer the drug themselves.  

Disadvantage - Does not give immediate relief Some drugs are destroyed in the digestive system 

Some drugs are inhaled. The patient uses an inhaler, which delivers, a fine spray of the drug to the airways and lungs. This is an effective method of targeting drugs to the respiratory system, and is used to control the symptoms of asthma, emphysema and bronchitis.  

 Patients usually have to be taught how to use an inhaler, but otherwise this method of drug administration is easy and gives rapid relief of symptoms.  

Disadvantages - Benefits mainly restricted to the respiratory system 

Suppositories are bullet‐shaped blocks of gel that contain drugs. They are inserted into the ****** via the ****. The gel slowly dissolves and the drug is absorbed into the bloodstream via the wall of the ******.  

  The advantage of this method is that it can be used to administer drugs that would be destroyed by digestive action if they were swallowed. It can also be used with drugs that might cause inflammation in the stomach and with patients who cannot swallow.  

  A disadvantage of this method of delivery is that some patients find it unpleasant and undignified. This can be minimised if the patients administer it themselves.  

Disadvantages - Some discomfort and embarrassment 

Drugs can be injected directly into the body via a needle. Some drugs are injected subcutaneously, i.e. into the layer of fat just below the skin surfaces. Others injected into a vein (intravenously).  Other drugs are injected into a muscle (an intramuscular injection).  

Intravenous injections provide a rapid delivery of a drug to the body. This can be important in emergencies. For example an injection of adrenaline can save a person’s life in a case of cardiac arrest or anaphylactic shock. Intravenous administration allows continuous delivery at a precisely controlled rate when required in the form of a drip through a needle.   The flu jab is an example of an intramuscular injection. 

One advantage of injection is the ability to deliver the drug very quickly. Disadvantages include the slight discomfort caused by the needle and the fact that the method requires a practitioner. However people who require frequent injections, such as those with type 1 diabetes, often learn to inject themselves.   

Disadvantages - Some discomfort caused by needle Cannot usually be self‐administered 

Creams can be used to deliver drugs to one particular area. These are sometimes called topical creams. They are particularly useful for treating skin conditions such as tinea, including ring worm. However drugs in creams can also be used to penetrate some distance tissues below the skin – for example, anti‐inflammatory creams for minor muscle strains.  

Disadvantages - Slow action, Limited to tissues at or just below the skin surface 

Operative surgery involves incision and the inspection and removal of diseased tissues or organs and/or replacement or redirection of body channels and/or implantation of electronic or medical devices. 

Surgery uses a range of techniques in which body tissues are cut in order to:  

 Remove unhealthy tissue 

 Modify or rebuild damaged or diseased body structures 

 Bypass malfunctioning organs  

 Implant electronic or mechanical devices to improve body functions 

Surgical techniques rely on the fact that most healthy body tissues regenerate after damage. Once surgery is finished, the body’s self‐healing processes takes over.  

You need to understand the broad principles of transplant surgery including the need for aseptic techniques and general/local anaesthesia.  

Transplant surgery involves taking organs from a donor person and using them to replace diseased organs in a patient.  

  Organs and tissues that can be successfully transplanted include the heart, lungs, live, kidney, bone marrow and cornea.  

  A major problem with transplant surgery is that the patient’s immune system might attack the new organ. This called rejection. The risk of rejection is reduced by carefully matching the donor and recipient are closely related. This is why some people donate one of their kidneys to a relative suffering from kidney failure.  

  The risk of rejection can also be reduced by giving the patient corticosteroid and immunosuppressant drugs, although it may make patient more vulnerable to infections.  

Whenever incisions are made and body cavities opened, there is a risk of infection. For this reason operations are carried out in operating theatres in which aseptic conditions are maintained. Asepsis means the absence of infective agents (mainly bacteria and viruses). It is achieved in several ways:  Staff wash hands thoroughly beforehand  

 Wear sterilised gowns 

 Wear disposable gloves and masks 

 Operating theatre kept clean  

 Air entering theatre is filtered  

 Surgical instruments are sterilised using steam at high pressure in an autoclave 

 In some cases use disposable instruments  

 Patients skin and around the site is cleaned with antiseptic  

 Use anti‐bacterial hand washes between patients  

General anaesthetic is used in surgeries to put patients to sleep, immobilising them which prevents any feeling of pain and relaxes muscles. All anesthetics interrupt the passage of signals along the nerves. This means that any stimulation to the body doesn't get processed or recognised by the brain. General anaesthetic will be given to you by an anaesthetist (a specially trained doctor). It will either be given as a as liquid that's injected into your veins through a cannula or gas that you breathe in through a mask. Your anaesthetist will stay with you throughout the procedure. They will make sure you continue to receive the anaesthetic and you stay asleep, in a controlled state of unconsciousness. After the procedure, the anaesthetist will turn off the anaesthetic and you will gradually wake up.  

Local anaesthesia is also used during surgery. Local anaesthetic is a type of medication used to numb areas of the body during some types of surgery. Local anaesthetic causes a complete loss of pain sensation to a specific area of your body without making you lose consciousness. It works by blocking the nerves from the affected part of your body so that signals can't reach your brain. You will not be able to feel any pain during the procedure but you may still feel some pressure or movement. It only takes a few minutes to lose feeling in the area where local anaesthetic is given. Your doctor will make sure the area is fully numb before starting the procedure. It can take a few hours for local anaesthetic to wear off and for full feeling to return.

Local anaesthetic is also sometimes used for more major types of surgery, such as certain types of brain surgery. For example, it may be used when a brain tumour is located in the area of the brain that controls speech (the Broca's area). As the tumour is removed, the person will need to remain conscious so they can respond to the surgeon’s instructions. This helps the surgeon to minimise the risk of harming the person's speech during the procedure. 

An endoscopic surgery is a procedure where the inside of your body is examined using an endoscope. An endoscope is a long, thin, flexible tube that has a light source and a video camera at one end. Images of the inside of your body are relayed to a television screen. Endoscopes can be inserted into the body through a natural opening, such as the mouth and down the throat, or through the anus (via the bottom). Alternatively, an endoscope can be inserted through a small surgical cut made in the skin (known as keyhole surgery). 

An endoscopy is normally carried out while a person is conscious. It is not usually painful, but can be uncomfortable, so a local anaesthetic or sedative (medication that has a calming effect) may be given to help you relax. The endoscope is carefully inserted into your body.  

Advantage of this is that it minimises damage to surrounding tissues. It is sometimes also known as ‘keyhole surgery’.  

Microsurgery uses a range of specialised equipment to perform operations on very small structures in the body. This equipment includes a binocular microscope, through which the surgeon views the operation site, and small surgical instruments such as miniature scalpels and suturing (stitching) needles. Microsurgical techniques are used to operate on the eye and middle ear. They are also necessary during replantation, in which a severed finger or limb is re‐joined to the body. In this type of operation, many small structures, including blood vessels and nerves, have to be individually reconnected.  

A laser produces a beam of light that is intense enough to cut through tissues. The beam can be forced on a very small spot, enabling great precision to be used. Lasers can be used to remove skin blemishes, to correct some visual defects by removing tissue from the cornea and also to carry out surgery on the retina of the eye. Laser treatments can be carried out during outpatient visits and usually require local anaesthesia only.  

Radiotherapy is the treatment of cancer and other diseases using ionising radiation to destroy or slow down abnormal cell growth.  It is sometimes used on its own and sometimes in conjunction with surgical techniques. Radiotherapy can be administered from a machine outside the body which produces a beam of radiation, which is directed to the part of body to be treated. It can also be administered by introducing radioactive material into the body. 

The purpose of dialysis is to remove toxins and waste products (such as urea) from the blood in patients who kidneys have failed. It is not a cure – kidney failure is incurable, although kidney transplants are available with the right donor. There are two types haemodialysis and peritoneal dialysis.   

 Haemodialysis is the type of dialysis that most people are aware of. It involves inserting a needle, which is attached by a tube to a dialysis machine, into a blood vessel. Blood is transferred from your body into the machine, which filters out waste products and excess fluids. The filtered blood is then passed back into your body. Most people require three sessions a week, each lasting four hours. 

 

Peritoneal dialysis is a less well known type of dialysis, but it is becoming more common. It involves using the lining of the abdomen (the peritoneum) as a filter. Like the kidneys, the peritoneum contains thousands of tiny blood vessels, making it a useful filtering device. During peritoneal dialysis, a small flexible tube called a catheter is attached to an incision in your abdomen. A special fluid called dialysis fluid is pumped into the space surrounding your peritoneum (the peritoneal cavity). As blood moves through the peritoneum, waste products and excess fluid are moved from the blood and into the 

dialysis fluid. The dialysis fluid is then drained from the cavity. The process of peritoneal dialysis lasts about 30‐40 minutes and is usually repeated four times a day. Alternatively, you can run it overnight.   

Lithotripsy is used to break gallstones into small pieces, which can then move through the bile ducts to the intestines and thus be excreted. It can also be used to treat stones in the kidney and urinary tract. 

When broken up, these stones pass out with the urine.  

  The technique involves bombarding the stones with high‐intensity and high‐frequency (ultrasound) sound waves. The energy of the waves is absorbed by the stones and shatters them. A machine called a lithotripter produces the beam of sound waves via a liquid‐filled cushion placed near the organ containing the stones.  

Advantages 

- Avoids the need for surgery. It is less invasive than the surgical removal of stones. 

Disadvantages 

- It is not effective in preventing the stones from being formed, with gallstones recurring in many cases within a few years. 

You need to understand that individuals may be affected differently by a particular treatment and may wish to make other choices about treatment and quality of life.  

For some conditions, there are a number of treatments from which to choose. A practitioner might present a choice of treatments to a patient, with information about the advantages and disadvantages of each. In this case the patient can express a preference. Where possible patients should have the opportunity to give informed consent to suggested treatments. This means that the aims, procedures, benefits and risks of the treatment should be explained in terms they can understand.  

  Giving the patient opportunity for informed consent also implies that the patient can withhold consent and refuse treatment.  

  A patient who has thought about and agreed to treatment is more likely to feel confident about it and to cooperate with any guidelines for recovery, such as taking prescribed drugs or exercise.  

Appreciate the consequences of delayed treatment and understand that ethical issues are associated with the treatment of disease and dysfunction, e.g. where lifestyle choices relating to 

physical exercise, 

diet, alcohol consumption and smoking may reduce the effectiveness of treatment. 

The outcome of treatment can be influenced by a range of factors including:  

 Early diagnosis and treatment 

 Lifestyle choices – nutrition, exercise, alcohol and smoking  

 Age 

 Health of the immune system 

 Genotype 

Early diagnosis and treatment is must more likely to result in a cure. Diagnosis and treatment might be delayed in cases where the disease exhibits no symptoms at first or develops so slowly that patients do not notice changes in their condition. In other cases patients observe symptoms but delay seeking help, perhaps because of fear or embarrassment.  

Lifestyles choices can limit the effectiveness of treatment. For example a patient will ill‐health conditions associated with obesity might not follow advice to take more exercise or to eat a balanced diet. Excessive alcohol consumption is likely to reduce the effectiveness of treatments, especially for liver conditions. Smoking significantly reduces a person’s chances of recovering from respiratory conditions such as COPD (chronic obstructive pulmonary disease) or cardiovascular disease such as angina.  

Age can influence the outcome of treatment. Older people have a reduced capacity for tissue repair, usually take longer to react to treatment and make a less complete recovery.  

Patients’ immune system is another important factor. Some illnesses, including immunodeficiency diseases such as AIDS, impair the body’s immune system and make the patient more susceptible to infection. Some cancer treatments have a similar effect. Older people and young children have weaker immune systems than young people and other adults.   

A person’s genotype can have an effect on his or her ability to benefit from some treatments, because genetic variety can cause differences in body chemistry.  

Priority – who should be given treatment, availability of resources/ facilities/ low staffing issues/ funding cuts/ availability of equipment and drugs ‐ This in turn means that decisions have to be made as to which patients should have priority access to treatments.  

One factor that might be taken into account is the likely benefit of the treatment in terms of number of years good quality life provided. On the basis children and young people should have priority over older people.  

 This raises the ethical issue of whether or not it is right or justifiable to discriminate on the basis of age in providing health care. One ethical argument is that we should do what would create the greatest good (in this case, what would lead to the greatest benefit of life). Another argument is that all humans are equally deserving.  

Another issues that is by people by who illnesses are partly the result of lifestyle decisions they have made. It could be argued that people who smoke and develop respiratory and circulatory disorders are responsible for their own ill health and therefore should not receive priority treatment. Those people that smoke are likely to make greater demands on health services because they are more likely to become ill.