October
20
October
16
Asthma worksheet exercise with reflection (16-Oct-2022) KEC
October
15
Reflection on care, patient with dementia 16-Oct-2022 (KEC)
October
15
Certificate achievement on 14-Oct-2022 (KEC)
October
15
A learning opportunity about bullying at GP clinic on 14-Oct-2022.
The aim of this activity is to bring awareness to the student and educate them on how to manage and where to get help when they encounter bullying in the workplace.
I created a document which contains some useful information, which graphics, video clips and useful links, which I hope may help students to get more aware of bullying, how to address it and where to ask for help if needed.
[embeddoc url=”https://eportfolios.roehampton.ac.uk/chengw3/files/2022/10/Awareness-of-bullying-Anson-and-Jessica-14Oct2022-1.docx” download=”none” viewer=”google”]
October
13
Reflection on 13-Oct-2022, GP clinical settings placement
| What was the nature of the CPD activity and/or practice-related feedback and/or event or experience in your practice? |
| The duty assigned for this placement on the day is to make telephone calls to all registered patients, inviting them to have their annual seasonal flu vaccination.
|
| What did you learn from the CPD activity and/or feedback and/or event or experience in your practice? |
| Through making multiple phone calls to unfamiliar patients, I gained confidence in communicating with people of different ages and nationalities. Before making the call, I need to review their medical and appointment history. Try to understand their difficulties and present well-being of not having the flu jab as recommended. I also gained confidence in practising my critical thinking skills, e.g., if a patient recently confirmed with COVID, they may not be fully recovered, or someone has just gone through a surgical operation, definitely not a suitable and reasonable time to make those calls. Moreover, the task also allowed me to explain the importance and benefit of being vaccinated. Promoting and educating the community about prevention is the best way to help people avoid getting sick and stop spreading the transmission of diseases.
|
| How did you change or improve your practice as a result? |
| To become a better nurse, I must put what I have learnt into my future practice—always listening, communicating with empathy, educating and sharing my knowledge to promote public health. Understanding patients’ needs, acknowledging their concerns and addressing them accordingly and accurately. Make nursing diagnoses through evidence-based findings in past medical history and present complaints, signs and symptoms systemically and simultaneously. As to provide holistic patient-centred care.
|
| How is this relevant to the Code?
Select one or more themes: Prioritise people – Practise effectively – Preserve safety – Promote professionalism and trust |
| Preserve safety
Retrieving critical information from patients’ past medical history and appointment attendance history, listening and communicating proactively can reduce as far as possible any potential for harm associated with my practice.
|
October
4
Consultation and Learning session on 27-Sep-2022 GP Clinic (Recap)
General recap
Consultation session on 27-Sep-2022
Patient 1
Complaint: sore throat
OTC medication: paracetamol and ibuprofen
No sign of tonsil bacterial infection (no white spot)
No antibiotic offer
What I learnt:
A sore throat (Virus cause) can make it painful to swallow. A sore throat can also feel dry and scratchy. A sore throat can be a symptom of strep throat, the common cold, allergies, or other upper respiratory tract illnesses. Symptoms: cough, runny nose, etc.
A strep throat (bacteria cause), red and swollen tonsils, sometimes with white patches or streaks of pus. Antibiotics are needed to treat the infection and prevent rheumatic fever and other complications. Symptoms: Pain when swallowing, fever, red and swollen tonsils, sometimes with white patches or streaks of pus, tiny red spots on the roof of the mouth, and swollen lymph nodes in the front of the neck. May has a rash known as scarlet fever (also called scarlatina).
Patient 2
Compliant: abdominal pain
Complication: especially for children, must examine the testicle, abnormal like redness, discharge and swelling.
Diagnose: no physical unwell, suspect mental stress
Patient 3
Compliant: Rashes on and off (skin)
Diagnosis: hives
Medical term: dermatographia
Medication: menthol cream, antihistamines or steroid tablets.
The rash is usually itchy, sometimes feels like it’s stinging or burning, caused/triggered by allergy, high levels of histamine, and contact with chemicals.
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Recap Learning session on 27-Oct-2022
Raynaud’s disease
Raynaud’s affects blood circulation. When encountering cold, anxiety or stressed, fingers and toes may change colour.
Symptoms include: pain, numbness, pins and needles and difficulty moving the affected area. It can be treated by keeping warm.
Medication: nifedipine, help improve circulation, also used to treat high blood pressure.
Some people need to take this medicine every day. It could also be a sign of a more serious condition, such as rheumatoid arthritis or lupus.
Rheumatoid arthritis is a long-term condition that causes pain, swelling and stiffness in the joints. The condition usually affects the hands, feet and wrists.
Lupus is a long-term condition that causes joint pain, skin rashes and tiredness. There’s no cure, but symptoms can improve if treatment starts early. Symptoms: joint and muscle pain, extreme tiredness that will not go away no matter how much you rest, rashes – often over the nose and cheeks, inflammation of different parts of the body including the lungs, heart, liver, joints and kidneys. Usually, it needs blood tests regularly for anaemia and urine test to check for kidney problems.
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Orthostatic hypotension
It is also called postural hypotension — which is a form of low blood pressure that happens when standing after sitting or lying down. Orthostatic hypotension can cause dizziness or lightheadedness and possibly fainting.
Symptoms usually last less than a few minutes. Lightheadedness or dizziness upon standing, blurry vision, weakness, fainting (syncope), confusion.
Causes: when standing from a sitting or lying position, gravity causes blood to collect in the legs and belly. Blood pressure drops because there’s less blood flowing back to the heart (b.p. different 20Hmmg). Special cells (baroreceptors) near the heart and neck arteries sense this lower blood pressure. The baroreceptors send signals to the brain. This tells the heart to beat faster and pump more blood, which evens out blood pressure. These cells also narrow the blood vessels and increase blood pressure.
Other causes: dehydration, heart problems (e.g., extremely low heart rate (bradycardia), heart valve problems, heart attack and heart failure). Endocrine problems (e.g., thyroid conditions, adrenal insufficiency (Addison’s disease) and low blood sugar (hypoglycemia). Diabetes, which damage the nerves that help send signals that control blood pressure. Nervous system disorders (e.g., Parkinson’s disease, multiple system atrophy, Lewy body dementia, pure autonomic failure and amyloidosis). Eating meals, have low blood pressure after eating meals (postprandial hypotension). This condition is more common in older adults.
Risk factors: Age, medication (e.g., diuretics, alpha blockers, beta blockers, calcium channel blockers, angiotensin-converting enzyme (ACE) inhibitors and nitrates, certain antidepressants, certain antipsychotics, muscle relaxants, medications to treat erectile dysfunction and narcotics) and certain diseases (e.g., nervous system disorders, such as Parkinson’s disease, nerve damage (neuropathy), such as diabetes. Heat exposure, bed rest for too long, and alcohol.
Complications: high risk of fall, stroke due reduced blood supply to the brain, cardiovascular diseases (e.g., chest pain, heart failure or heart rhythm problems).
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Difference between acute and chronic conditions
Definition:
- Acute illnesses generally develop suddenly and last a short time, often only a few days or weeks.
- Chronic conditions develop slowly and may worsen over an extended period of time—months to years.
Causes:
- Acute conditions are often caused by a virus or an infection but can also be caused by an injury resulting from a fall or an automobile accident or by the misuse of drugs or medications.
- Chronic conditions are often caused by unhealthy behaviours that increase the risk of disease—poor nutrition, inadequate physical activity, overuse of alcohol, or smoking. Social, emotional, environmental, and genetic factors also play a role. As people age, they are more likely to develop one or more chronic conditions.
Symptoms:
- Acute diseases come on rapidly and are accompanied by distinct symptoms that require urgent or short-term care and get better once they are treated.
- Chronic conditions are slower to develop, may progress over time, and may have any number of warning signs or no signs at all. Common chronic conditions are arthritis, Alzheimer’s disease, diabetes, heart disease, high blood pressure, and chronic kidney disease. Unlike acute conditions, chronic health conditions cannot be cured—only controlled.
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Sickle cell disease
Sickle cell disease is the name for a group of inherited health conditions that affect the red blood cells. The most serious type is called sickle cell anaemia. It is a serious and lifelong health condition, treatment can help manage many of the symptoms.
Causes:
- unusually shaped red blood cells, they do not live as long as healthy blood cells and can block blood vessels.
- The gene that affects how red blood cells develop, both parents have the gene
- The child’s parents often will not have sickle cell disease themselves and they’re only carriers of the sickle cell trait
Symptoms:
- People born with sickle cell disease tend to have problems from early childhood, although some children have few symptoms and lead normal lives most of the time.
- painful episodes called sickle cell crises, which can be very severe and last up to a week
- an increased risk of serious infections
- anaemia (where red blood cells cannot carry enough oxygen around the body), which can cause tiredness and shortness of breath (SOB)
- delayed growth, strokes and lung problems.
Sickle cell disease is often detected during pregnancy or soon after birth. It is offered to all pregnant women in England to check if there’s a risk of a child being born with the condition, and all babies are offered screening as part of the neweborn blood spot test (heel prick test). Blood tests can also be carried out at any age to check for sickle cell disease or see if you’re a carrier of the gene that causes it.
Treatments:
People with sickle cell disease need treatment throughout their lives. This is usually delivered by different health professionals in a specialist sickle cell centre.
- self-care measures, such as by avoiding triggers and managing pain.
- drinking plenty of fluids and staying warm to prevent painful episodes
painkillers, such as paracetamol or ibuprofen (sometimes treatment with stronger painkillers in the hospital may be necessary)
- daily antibiotics and having regular vaccinations to reduce your chances of getting an infection
- hydroxycarbamide (hydroxyurea) to reduce symptoms
- regular blood transfusions if symptoms continue or get worse, or there are signs of damage caused by sickle cell disease
- an emergency blood transfusion if severe anaemia develops
- The only cure for sickle cell disease is a stem cell or bone marrow transplant, but they’re not done very often because of the risks involved.
Life expectancy:
- tends to be shorter than normal, but this can vary depending on the exact type of sickle cell disease.
- Carriers of sickle cell (sickle cell trait)
- someone who carries the gene that causes sickle cell disease but does not have sickle cell disease It’s also known as having the sickle cell trait.
- at risk of having a child with it if their partner is also a carrier.
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HPV
Human papillomavirus (HPV) is the name of a very common group of viruses. They do not cause any problems in most people, but some types can cause genital warts or cancer.
HPV affects the skin. There are more than 100 different types.
Symptoms
- It does not usually case any symptoms
- do not realise and do not have any problems.
- Sometimes the virus can cause painless growths or lumps around your vagina, penis or anus (genital warts).
Spread:
- HPV affect the mouth, throat or genital area. They’re easy to catch.
- Do not need to have penetrative sex.
- any skin-to-skin contact of the genital area
- vaginal, anal or oral sex
- sharing sex toys
Condition link to HPV:
- abnormal changes in the cells that can sometimes turn into cancer
- genital warts
- cervical cancer
- anal cancer
- penile cancer
- vulval cancer
- vaginal cancer
- head and neck cancer
Testing for human papillomavirus (HPV):
- HPV testing is part of cervical screening. A small sample of cells is taken from the cervix and tested for HPV.
- There’s no blood test for HPV.
- Screening is offered to all women and people with a cervix aged 25 to 64. It helps protect them against cervical cancer.
- Some sexual health clinics may offer anal screening to men with a higher risk of developing anal cancer, such as men who have sex with men.
How to protect yourself against human papillomavirus (HPV):
- Condoms can help protect you against HPV, but they do not cover all the skin around your genitals, so you’re not fully protected.
- HPV vaccine protects against the types of HPV that cause most cases of genital warts and cervical cancer, as well as some other cancers. It does not protect against all types of HPV.
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Abbreviations
LMP – Last menstrual period
SOB – Shortness of breath
PC – Presenting complaint
UPSI – Unprotected sexual Intercourse
HxPC – History of present complaint
RIF – Right iliac fossa pain (causes include appendicitis, gastrointestinal pathologies)
Abx – antibiotics
Fetal Position – a position in which you lie on your side with both legs and both arms bent and pulled up to your chest and with your head bowed forward.
Different position
October
3
Reflection on stress management (KEC Learning 03-Oct-2022)
Title: Reflection on stress management
Date: 3/Oct/2022
Introduction
The aim of this essay is a reflection on stress management. Potential stress triggers include academic, social, financial, medical, and environmental challenges. The level of stress tolerance varies depending on individual personality and life experience. Although stress cannot be avoided, understanding the causes, and poses of danger, helps better coping and manage stress more systemically and constructively.
Understanding stress and its cause
“Cortisol, the primary stress hormone, increases sugars (glucose) in the bloodstream, enhances your brain’s use of glucose and increases the availability of substances that repair tissues. Cortisol also curbs functions that would be nonessential or harmful in a fight-or-flight situation” (Mayo Clinic, 2018). Generally speaking, the disrupted natural changes in our built-in autoimmune system cause stress and protect us from threats or danger. In contrast, this flight-flight-freeze (FFF) response also benefits us to be more focused and helps us learn more effectively. Improve our performance until we reach our optimal level. It also protects our well-being physically and mentally.
Unmanaged stress and its dangers
Unable to cope and manage stress causes physically and mentally harm to us. Physical harm, e.g., anxieties, keep you awake during sleep and disrupt the quality of rest, affecting your skin and causing skin problems like acne, psoriasis, alopecia, eczema etc. Research studies also provided evidence-based proof that patients with chronic stress get sick more frequently and require a longer time for wound healing. Stress also activates our autoimmune system, which affects our brain to send out signals which causes increased secretion of adrenaline into the bloodstream and cause an increase in heart rate and blood pressure, posing damage to the heart. Additionally, it also simulates and affects hormone responses that cause gastrointestinal problems, e.g., heartburn, indigestion, nausea, vomiting, and diarrhoea.
Coping and managing stress
Based on the fact that stress cannot be avoided, and evidence-based harm caused related to accumulated and chronic stress developed, systemic and constructive coping and managing skills are essential for stress management. Doctors and health care professionals advised that consuming a regular healthy diet, e.g., fruits and vegetables, regularly exercising, and achieving at least seven and half hours of sleep daily, help reduce stress levels. Mentally prepare yourself, e.g., get well-organized your task based on your energy level, better time planning and managing tasks ahead, take a regular break between tasks, set a manageable goal, take things slowly and reward yourself with achievement, and avoid procrastination, which can also minimise stress. Develop hobbies and interests, e.g., listening to music, drawing, dancing, etc., and maintain a healthy social network, talk to someone, e.g., friends, family members, social workers, specialists, or GP, when feeling overwhelmed or stressed out of control. Lastly, acknowledge and accept that no one is perfect, forget yourself, face fear confidently, and try to attempt. Take these opportunities as a challenge to develop better coping and managing stress.
Summary
In conclusion, stress is not avoidable, but it is also not fearful if we understand that it is a natural cause of our autoimmune and hormone responses when we face uncertainty and things get overwhelming. Acknowledging the importance of keeping a work-life balance, regular exercise, acquiring quality sleep, and sharing feelings with others helps reduce anxiety and stress systemically and constructively.
Reference
Mayo Clinic, Healthy Lifestyle Stress Manage (2018). Available at: https://www.mayoclinic.org/healthy-lifestyle/stress-management/in-depth/stress/art-20046037#:~:text=Cortisol%2C%20the%20primary%20stress%20hormone,fight%2Dor%2Dflight%20situation(Accessed on 2nd Oct 2022)
October
3
A fundamental exercise (The eye – KEC placement 3-Oct-2022)
IPL Eye conditions (KEC IPL student led 3-Oct-2022)
Label the diagram-
- Cornea
- Anterior chamber
- Pupil
- Iris
- Scleral venous sinus
- Ciliary zonule (Suspensory Ligament)
- Lens
- Ciliary body
- Sclera
- Choroid
- Retina
- Macula lutea / Fovea centralis
- Optic nerve (artery and vein)
- Posterior segment (contains vitreous humor) the cint
- Blind spot
List the function of each of these structures
- Protect the structure inside the eye, contributing to the refractive power of the eye, and focusing light rays on the retina with minimum scatter and optical degradation.
- The anterior is filled with aqueous humour, which is a watery fluid that provides nourishment to the interior eye structure and helps to keep the eyeball inflated.
- it admits and regulates the flow of light to the retina. Which allows us to perceive images. It opens and closes to control the amount of light that is allowed to enter the eye.
- It controls your pupil and helps your eye see clearly. It constantly changes how dilated your pupil is without your control. That is called the pupillary light reflex.
- It also called the canal of Schlemm, is a circular channel in the eye that collects aqueous humor from the anterior chamber and delivers it into the bloodstream via the anterior ciliary veins.
- Key role in ocular function, centering the lens on the optical axis and transmitting the focus that molds its shape during accommodation.
- The main function is to transmit and focus the light onto the retina in order to create a clear image of observed objects at various distances. It is also the main structure of the accommodation reflex which is activated when the eye focuses on close objects
- The ciliary body is found behind the iris and includes the ring-shaped muscle that changes the shape of the lens when the eye focuses. It also makes clear fluid that fills the space between the cornea and the iris.
- The sclera functions as the supporting wall of the eyeball. It helps maintain the eyeball’s shape and protects it from injury. It is covered by conjunctiva, which is clear mucus membranes that lubricate (moisturise) the eye.
- The choroid supplies the outer retina with nutrients and maintains the temperature and volume of the eye.
- The retina is a layer of photoreceptors cells and glial cells with the eye that captures incoming photons and transmits them along the neuronal pathway as both electrical and chemical signals for the brain to perceive a visual picture.
- Part of the retina is responsible for the shape and detailed central vision (also called visual acuity). The macula lutea, also called the fovea, contains a very high concentration of cones. These are the light-sensitive cells in the retina that give detailed central vision.
- The optic nerves relay messages from your eyes to the brain to create visual images. It plays a crucial role in the ability to see. There are millions of nerve fibres that make up each optic nerve. (*damage to an optic nerve can lead to vision loss in one or both eyes.
- To protect the round shape of the ball.
Name 3 common eye conditions that would affect the outer eye and the treatment options…
- Refractive errors (include myopia (near-sightedness), hyperopia (farsightedness), astigmatism (distorted vision at all distances), and presbyopia)
Treatment option
- can be corrected by eyeglasses, contact lenses, or in some cases, surgery
- Cataract ( a clouding of the eye’s lens and is the leading cause of blindness worldwide)
Treatment option
- removal of cataract
- Retinal detachment (Natural ageing process, one or more holes on retain which allows fluid pass underneath, separated from the supporting and nourishing tissues underneath it.)
Treatment option
- Involves surgery. The eye doctor will seal the retinal holes and reattach the retina
Discuss 3 some activities of daily living that would be affected by blindness.
- Maintaining a safe environment – need time to familiarise the environment, unable to see hidden hazards, especially moving into a new environment.
- Eating and drinking – unable to cook, may familiarise by regular practice, but hard to ensure the quality and healthy of the food consumed.
- Woking and playing – may encounter difficulties in getting a sustainable job, unable to participate in certain sports activities.
Q1. Scenario one- Patient is 82 years old. She is blind and has lived alone for the last 8 years after her husband suddenly passed away. She had a fall yesterday and sustained a small wound to her arm, which the nurse is dressing 2 times a week. Lilly has a guide dog and has coped well at home prior to this. What considerations would you make for Lilly? What would you want to check, or what questions would you want to ask? Would you need to refer her to anyone?
Ans: What considerations would you make for Lilly?
Vision loss can affect her physical health by increasing her risk of falls and her quality of life, and it can also have a big impact on her mental health. Loss of vision is always linked to loneliness, social isolation, and feelings of worry, anxiety, and fear. Depression is common in people with vision loss.
Ans: What would you want to check or what questions would you want to ask?
Did Lily able to maintain a safe environment? Did she encounter difficulties in finding a job? How’re her activities of living affected due to visual impairment? Did she receive enough support? Did she able to access support from social services? Did she know where to get help and support if needed? Did she receive any information which helps her to cope and manage her disability?
Would you need to refer her to anyone?
Ans: refer to the social workers, inspect her living environment and remove any hidden hazards to minimise harm and hazard may cause. Refer her to the available social network group, so that she won’t feel isolated. Maintain socially active.
Q2. Scenario two- Rob is a plasterer- he has attended the GP surgery with a feeling of something in his eye. His vision is blurred, he is in 8/10 pain, his eye sclera is red, and his eye is watery.
What could have happened to Rob?
- Dirt gets into his eye.
- Chemical burn
List the first aid procedures for a chemical burn.
- Remove casualty from their working environment if possible.
- Put on protective gloves if they’re available. Hold the casualty’s eye under gently running water for at least 20 minutes and make sure the outside and inside of the eyelid are washed. Alternatively, flush the eye with 0.9% NS.
- Make sure the contaminated water does not splash the uninjured eye. (If the casualty is wearing contact lenses, ask them to remove them if they can.)
- Ask the casualty to hold a clean non-fluffy pad over the injured eye and put a bandage in place.
- Call 999 or 112. If you know what chemicals might have been involved in the accident, pass this information on to medical professionals.
When do we need to refer Rob on- what would prompt a referral?
If after washing or flushing the affected eye for more than 20 minutes, painfulness and condition remains unchanged or get worse. Should call 999. After being discharged from the hospital, Rob should be referred to an eye clinic or community nurse for a follow-up check-up.
October
2
History taking scenario and worksheet records (KEC on 30thSep)
Scenario worksheet
History taking scenario
The patient is 14 years old and is attending today with abdominal pain. The mother calls the GP surgery, concerned re pain.
Let’s take a history:
PC- abdominal pain
HXPC- – lasting 24 hours- hasn’t passed stools. She has been vomiting 4+ times and cannot keep down food. Feels hot.
SOCRATES U
Lower right-hand side of the abdomen- right iliac fossa
24 hours ago
No radiation
No alleviating factors
Constant pain
It makes it worse to lay flat- has to stay in the foetal position
Severity 8/10
She thinks she’s dying
PMH- nil
Surgical history- nil
Medications- nil
Allergies- nil
Family History- father has type two diabetes, the mother has hypertension
Social history- lives at home with mother, father and 3 siblings, attend school, no recent travel, up to date with imms. Lives in a house with no carers.
Would we want to ask about sexual history?
LMP- 2 weeks ago
No UPSI
What is our differential diagnosis?
What else might we want to know?
| Questions | Answer |
| Would we want to ask about sexual history?
|
NO. The reason is that patient mentioned No UPSI (Unprotected Sexual Intercourse) during history taking. |
| What is our differential diagnosis?
|
Right iliac fossa (RIF) pain may be an indication of appendicitis, and vomiting may be an indication of gastrointestinal inflammation. |
| What else might we want to know?
|
– Did Jenny eat anything special recently?
– Pass any urine? – Ask anything she would like to let me know? (safeguarding) – Did she encounter this before? – Feeling stressed, any lifestyle change? – Any food/medication allergies that we have to be aware of? |
Question worksheet
Q1. Why is history taking important?
Ans: Medical history is important because when GPs have more information about a patient’s medical history, health care professionals can deliver the most appropriate and effective treatment or support for their concerns. Genetic makeups, environments and lifestyle factors shared by family provide better insight into a medical condition the family may encounter. With the information collected, GPs can also understand patterns of the cause of the diseases or disorders and make a medical diagnosis more likely, which is particularly important in catching something harmful early.
Q2. Do you use any acronyms for history taking?
Ans: SOCRATES
Site (e.g., where, location, area, internal, external, etc.)
Onset (e.g., time of onset. sudden/gradual, etc.)
Character of pain (e.g., dull, sharp, crush, etc.)
Radiation of the pain (e.g., did the pain spread, at particularly sport, etc.)
Associations (e.g., symptoms associated with the pain, vomit, nausea, etc.)
Time course (e.g., any time pattern (morning/evening), duration, etc.)
Exacerbating/Relieving factors (e.g., what makes it worst / what makes it more comfortable.)
Severity (e.g., rate pain score 0 to 10, “zero” no pain, “10” severe pain.)
Top tip- 70% of the time, you will make a diagnosis based on the history taken alone.
Q3. How do you open a consultation?
Introduce myself, show empathy and confirm patient identity (e.g., DOF, Address, NHS no.). Observe any abnormalities (e.g., physical – severe external bleeding, disabilities, etc. Psychological and emotional distress, etc.)
Q4. A patient profile- What do you want to know that’s non-medical?
Ans: Any lifestyle change, allergy, disabilities, family medical history, and any family members who had presented similar symptoms. Any use of substances (e.g., alcohol, drugs).
Q5. How would you ask the patient for the chief complaint?
Ans: Ask an open question (e.g., what can I do for you? / What brings you here, how may I help you.) and allow the patient to express their concerns and needs. Active listening and with an open posture, acknowledge and ask for clarification if needed.
Q6. Do you want to ask open-ended, closed, or leading questions? Are these appropriate?
Ans: Most of the time, ask open-ended questions as medical diagnoses need to be evidence-based, collection of information and diagnosed with critical thinking skills. A closed question limits the information collected from the patient. However, it may be used sometimes, e.g., asking for any SOB – shortness of breath, cough, etc. Try to avoid the leading question, as they may mislead the patient and cause misdiagnoses.
Q7. What does SOCRATES stand for?
Ans: Site, Onset, Character of pain, Radiation of the pain, Associations, Time, Exacerbating/Relieving factors, Severity
Q8a. How would you determine the severity of the pain?
Ans: Plain scale “zero” to “10”. “Zero”, no pain and “10” sever pain.
Q8b. What about with a child?
Ans: Pain scales, behavioural (how the child behaves), physiological (how the child’s body responds) indicators assessment tools and the child’s pain history. Some tools are listed below:
- Visual analogue scales (Marked, indicate pain intensity by children)
- Numerical analogue scales (Marked, indicate pain intensity by children)
- Face Pain Scale (Visual)
- Drawings
- Faces, Legs, Activity, Cry, Consolability (FLACC) (behavioural indicators to assess pain
- Premature Infant Pain Profile (PIPP) Stevens B, Johnston C, Petryshen P, Taddio A. The premature infant pain profile: Development and initial validation. The Clinical Journal of Pain.1996;12(1):13-22.
- Non-Communicating Children’s Pain Checklist
- Obtain pain history from parents
Reference available at: https://www.mygp.com/why-is-medical-history-important/
Q9. Map out your history-taking process…
- Chief complaints / Presenting complaint (PC)
- SOCRATES
- History of presenting complaints (HxPC)
- Past Medical History
- Personal / Social History (e.g., sexual orientation, occupation, etc.)
- Family History
- Drug / Treatment History
Q10. Make a list of each system- what would you assess?
For example- Respiratory- SOB, Cough, Sputum production, Chest pain, Haemoptysis, Wheeze, sputum colour, and thickness time of when sputum is produced.
Ans:
- Integumentary System
- Condition of the skin (dry, wet, warm, cold)
- Temperature (Hypothermia/Hyperthermia)
- Speech (fluency, incomplete, confuse)
- Skeletal System
- Fracture (Open/close), posture abnormalities
- Muscular System
- Contract/extend difficulties
- Nervous System
- Voluntary/involuntary reflexes
- Endocrine System
- Sputum production (thickness, colour), any indication of infection
- Cardiovascular System
- Pulse Rate (Rapid, strong, weak, regular or irregular)
- Blood pressure (Hypotension/Hypertension)
- Circulation (capillary refill)
- Chest pain (crush, frequency, intensity, radiation), any indication of MI/cardio disease
- Lymphatic System
- Submandibular Nodes (any enlargement, infection indicator)
- Respiratory System
- Respiration Rate (SOB/hyperventilation)
- Airway (wheeze), any indication of bronchoconstriction, asthma
- Cough (Haemoptysis) indication of problems related to respiratory organs/tissues
- Digestive System
- Vomit or diarrhoea (GI tract infection)
- Urinary System
- Bowl/urinary retention
- Reproductive System
- Difficulty/Disability
Reflection
Q1. Reflection- Use the Gibbs cycle to reflect on a time when you have taken a history- would you change anything you did now?
Ans: Through the clinical session with the GP, I realised how important for taking an accurate and resourceful medical history from patients. The information collected allows medical professionals to have a broad insight into the patient’s conditions and provide support and help more effectively. Particularly factors like environment, genetics, lifestyle change, and history of present compliant are critical parts for supporting evidence-based diagnoses.
Now, I gained knowledge about how to take a medical history from the patient more effectively and systematically. I need to familiarise myself with using SOCRATES (Site, Onset, Character of pain, Radiation of the pain, Associations, Time, Exacerbating/Relieving factors, Severity) for documentation, address and provide personalised patient-centred care and support.
Q2.If you haven’t taken a history before map out a history for a patient attending with SOB- What questions would you ask?
Ans:
- When did the symptom start?
- Have you encountered this before?
- What makes you feel more comfortable? What makes it worse?
- Any history of the present complaint?
- Any associated discomfort/pain?
- Have you taken any medication before consultation?
- How frequently do you encounter SOB?
- Are you a smoker? Asthma? COPD?
- Are any family members shown with the same symptoms?
- Have you done a COVID test recently?
- Any difficulty in breathing?
Q3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3661386/
Read this article and make notes.
Essential skills required for medical history taking:
- empathetic communication
- systemic and skilled history taking enhance medical profession make an effective clinical decision
- history taking is usually developed from a chief complaint
- high-quality information gathering and empathy are essential for patient-centred care planning
- asking relevant open-ended questions, active listening to patient’s concerns, needs or demands.