Responding to Symptoms - Respiratory System

  • Created by: LBCW0502
  • Created on: 12-11-18 21:03
Outline the RTS consultation framework
Scene setting, information gathering, problem identification, actions and solutions, closing, consultation behaviours
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What general advice can pharmacists give to patients?
Non-drug and healthy lifestyle advice (self-care) and signposting
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What is a cough?
Reflex action to clear airway, usually mild and self-limiting. An acute cough can last for up to 3 weeks. Sub acute 3-8 weeks and chronic is more than 8 weeks
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What are the two types of cough?
Productive (chesty, phlegm/colour) and non-productive (dry/tickly, no phlegm)
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What are the conditions to eliminate with a cough?
Acute cough (croup, postnasal drip, allergy related), chronic (bronchitis, asthma), productive (heart failure, TB, pneumonia, lung cancer), non-productive (lung abscess, GORD), medicines ADRs (ACE inhibitors, NSAIDs, beta blockers)
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What are the key questions to ask about a cough (application of RTS framework)?
Sputum colour, nature of sputum, location/duration/onset, periodicity, age, medications, smoking history. (Refer if there is chest pain, recurring cough, more than 3 weeks, pain on inspiration, high temperature, SOB etc.)
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What are the treatments for a cough?
Expectorants, suppressants/antitussives, demulcents, antihistamines, analgesics (don't use antibiotics) - patients with diabetes are a caution. Codeine linctus for people aged 18+
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What are the treatments for children with a cough?
Colds resolve in 5-7 days, plenty of fluids, paracetamol or ibuprofen for fever/pain, nasal decongestants (vapour rubs/steam), warm fluids, honey and lemon (honey cannot be given to child under the age of 1)
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What is a common cold?
Acute, mild self-limiting catarrhal syndrome. Resolves 7-10 days, up to 3 weeks, direct/droplet transmission. Caused by 5 types of viruses
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What are the symptoms of the common cold?
Inflammation (nose, pharynx), nasal discharge, nasal obstruction, cough, sore throat, headache, fever
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What are the conditions to eliminate for a common cold?
Influenza, rhinitis, acute sinusitis, otitis media (refer to table in lecture notes comparing flu, cold and allergy symptoms)
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What are the key questions to ask about the common cold (application of RTS framework)?
Onset, nature and other symptoms e.g. ear pain, headache made worse by sneezing (refer if ear pain in middle ear, high fever, SOB, rash - could be meningitis)
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What are the treatments for the common cold (symptomatic relief)?
Analgesia (paracetamol/ibuprofen/aspirin), antihistamines, decongestants (sympathomimetic), topicals, steam, menthol, saline nasal drops, vitamin C, zinc (no antibiotics) - non drug advice - reassurance, fluids, smoking cessation, signposting (NHS)
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What are the cautions with treatments for the common cold?
Combination products, paracetamol maximum doses, pregnancy and breast feeding
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What are the treatments for flu?
Similar to those for the common cold (don't use antibiotics). Refer if patient is severely vomiting, drowsy, confused, stick neck - suspected pneumonia (elderly), signposting
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Describe features of flu vaccines
Inactivated, nasal flu vaccine. For children, elderly. For those with asthma, heart disease, kidney disease, liver disease, neurological disease, diabetes, weak immune system - can get flu jab in local pharmacy
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What are the symptoms of sinuitis?
Sinus pain, inflammation (bacterial/viral), headache, fever, referred pain (toothache) - refer if >7 days, treatment failure, infection, rebound congestion. Cautions - CVD, hypertension, hyperthyroid, diabetes and MAOI
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What are the treatments for sinusitis?
Decongestants, saline drops, steam, menthol, antibiotics (if infection). Children, <3 months (saline drops, nasal aspiration), 6-12 years (decongestants for 5 days maximum) - see table comparing symptoms of cold, allergy and sinusitis
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What are the symptoms of a sore throat?
Acute discomfort in pharynx, self-limiting (7 days), can accompany sinusitis/cough/headache. Viral 70-90%. Symptoms - fever, tenderness, severe pain, viral/bacterial
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What are the conditions to eliminate for a sore throat?
Bacterial, glandular fever, herpes simplex, mouth ulcers, trauma related to sore throat, medicines ADRs, duration >2 weeks, dysphagia, GORD
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What are the key questions to ask about a sore throat?
Duration >14 days, age, other symptoms e.g. white plaques, ulcers etc.
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What are the treatments for a sore throat?
Local anaesthetics, local antiseptics, anti-inflammatories, demulcents, analgesia, warm salt water to gargle, antibiotics (if bacterial), formulations - spray, lozenges, mouthwash (Boots - sore throat scheme)
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Describe features of allergic rhinitis
Inflammation of nasal lining caused by allergens. Symptoms - rhinorrhoea, nasal congestion, sneezing, nasal itch, ocular (allergic conjunctivitis), pollen count/type. Types - seasonal, perennial (many causes) - genetic link to asthma/eczema
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What are the key questions to ask for hay fever (application of RTS framework)?
Timing, history, adverse effects on quality of life, other symptoms, previous treatment/effectiveness, personal preference of formulations, triggers (pollen) - refer if rebound congestion, nasal obstruction, unilateral discharge (children)
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What are the treatments for hay fever?
Antihistamines (1st/2nd generation), topicals (corticosteroids). Mast cell stabilisers for intraocular. Avoid for MAOIs, glaucoma, pregnancy, athletes (anaphylaxis - Epipens)
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Describe features of allergic rhinitis in the NICE guidelines
Antihistamine (1st line treatment), self care (avoid allergen, stay indoors, avoid house dust mite, animals etc), use intranasal corticosteroid. Allergy screening. Patients carrying 2 Epipens (back-up, better to have expired one than nothing at all)
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Other cards in this set

Card 2

Front

What general advice can pharmacists give to patients?

Back

Non-drug and healthy lifestyle advice (self-care) and signposting

Card 3

Front

What is a cough?

Back

Preview of the front of card 3

Card 4

Front

What are the two types of cough?

Back

Preview of the front of card 4

Card 5

Front

What are the conditions to eliminate with a cough?

Back

Preview of the front of card 5
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