Ask if he ever walked before?

Station 14 (Spacer Device) Councelling

A 4 years old child was diagnosed with asthma. All the meds have been explained. Talk to the mother and address her concerns regarding spacer device usage.

Are you the mother of (child mentioned in the task)?

How may I address you?

Introduce yourself

I am really sorry to hear how your child was diagnosed with asthma. Don’t worry, I understand your concerns (in case she shows any) but one of my colleagues will come and explain the meds (inhalers) to you and discuss in detail any concerns regarding them (incase the task doesn’t mention them as already been explained).

I am here to talk to you about this thing here we call as spacer device. It assists in giving the inhalers properly to kids, who can’t take them directly otherwise.

It’s either 2 plastic conical pieces joined together or just one cylindrical piece with a mouth piece and an end to attach the inhaler at. There is sometimes a pediatric mask attached at the mouth end as well, in order to assist the child in taking the medicine, as making a tight seal for them around the mouth piece is hard.

Just make sure before giving the inhalers, that you check its expiry date and shake it well. If it’s new, you should

release the first puff and fix it to the end of the spacer (which is made for the inhaler).

Don’t touch the mouth piece but ask the child to make a tight seal around the mouth piece by closing mouth over it properly or simply just fixing the mask if available, over his mouth and nose.

Each breathe he takes in and out, you’ll hear a click. 1 puff should be = to 20 clicking sounds. Give the puffs according to prescription.

Make sure an adult is always supervising and helping the child take his meds. Have you understood what I told you? Do you need to ask anything?

Mom: What if the child starts coughing?

Don’t worry. Just take it out of his mouth and let him cough. There’s a valve which only works one way so the medicine is still inside. It will still work when he places it in his mouth. Just make sure you start counting the clicking sounds from 1 again and make sure inhaler is intact.

Mom: When do I know the spacer isn’t working?

When you can’t hear the clicking sounds or it appears to be broken or stained.

Mom: How should I clean it?

The frequency of cleaning depends on usage so if you use it much, clean it once a week or otherwise, once in 2 to 4

weeks. Use luke warm water and a soft clean cloth to clean and dry it. There’s no need to use strong detergents.

Mom: What if my child is afraid to use it?

It comes with stickers on now but the child can put his fav stickers. Let him take it in his hands but make sure he doesn’t play with it like a toy.

Mom: How to explain a tight seal?

You don’t have to. Request a pediatric mask if it’s not already available from the GP. Fix it on the mouth piece.

When he starts breathing, you should still hear the clicking sound.

Mom: My child goes to day care!

Request a duplicate spacer and inhalers from your GP and give it to the day care staff or they can directly request us as

well since the child might need his meds at any time. They already have been trained to help kids in such situations.

Advice:

Always supervise. The patient has to be standing or sitting propped up and spacer device should be straight. Ask

mother to demonstrate all that you told her or you won’t pass. Child can rinse mouth after inhalers are taken.

Use one spacer for both inhalers and don’t have to wash it every time.

Station 15 (Foreign body ingestion)

A 2 years old child brought to the hospital by mom. The mom told you the baby had swallowed some foreign body. Please talk to mom and discuss your Mx and address the patient’s concerns.

Fx on Hx taking

What happened? Explore into the event!

He was playing about 4 hours ago. I was in the kitchen and I saw he started coughing and choking. Sometimes mentions him going blue for a while. I found my wallet around the little one. In the wallet there was a coin.

Was there anything else in the wallet like a button battery?

No.

As you told me, your little one swallowed a coin 4 hrs ago and since he stopped coughing straight away, it’s unlikely to be stuck in his wind pipe. It might be in his food pipe,

stomach or gut. We would do some investigations (X ray may be given) in order to check its location and if it’s still in the food pipe, we can take it out using a flexible tube with camera attached to it and we will give him some numbing agents and put him to a mild sleep in case that is required.

If the coin is in the stomach, there’s no need for

undergoing any of that since the coin is not sharp, poisonous and there’s little chance of it getting stuck anywhere when passed through the gut. What you should do is track your little one’s poo for next 48 hrs. (X-ray on the laptop showing coin in the stomach)

Warning advice

However if he starts to cry or you notice any pain in

tummy, any vomiting or no stool is passed or tummy feels distended, then immediately bring him back to the hospital.

General Advice

Please put your things in the safe box from now on. Kindly be more aware regarding child’s doings from now on and don’t leave him alone even when answering phones or opening doors.

Station 16 (Celiac Disease)

A 5 years old child was diagnosed with celiac disease. Talk to the dad and address his concerns.

Ask dad if he knows what’s going on? Disclose the disease and explain it.

It is a condition that causes inflammation in the lining of small intestine or small bowel. It is an autoimmune

disease. In autoimmune disease, your immune system (which helps you fight bugs and foreign bodies) produces some substances against your body. In this disease, the antibodies or substances are formed against a

substance called gluten which when ingested, leads to inflammation of the lining of small bowel.

Celiac disease can sometimes run in the families. People with this disease, should be put on gluten free diet. Foods containing gluten are wheat, barley and ray. Even a small amount of gluten can be dangerous and bring about many complications. This disease is more common in people who have conditions such as RA, DM and thyroid problems.

The main S/S of celiac disease are diarrhea, pale and bulky stools, smelly stools which are hard to flush and tummy pain.

Complications of Celiac disease:

1. Poor absorption (Deficiency of vitamins, Fe and