Counsel mum of the child who suffers with asthma about how to use the spacer. In GMC exam, Patient is a 5 years old child.
Good morning I am Dr X...
Ask Mum: “How is your little one doing? I have come through notes that your little one is suffering from asthma…
She says: Yes
Say: I am very sorry to hear that. I am here to introducing a device called spacer. Have you ever heard about it?
She says: No
“I am here to talk you about it. If you have any question, stop me whenever you want.” Hold the spacer in your hand and say: “Actually it is a device which contains of two ends one is called the mouthpiece and the other end is called inhaler adaptor.show the mum that end. “Do you have the medication with you?” “Do you know how many puffs you have to give?” Tip: If she doesn’t know prescription, don’t tell her on your own. I am giving you example, once you get your prescription you will find it out. If any question, come back to us we will describe it to you.
Three spacers are present on the table in GMC shown below,pick up the blue one and then demonstrate it.
Demonstration how to use spacer and Inhaler;
1. Remove the protective cap from the puffer.
2. Shake the puffer and fix it firmly into the end of the spacer.
3. Make sure you little one hold the spacer horizontally, and make a tight seal with his mouth. 4. Press the puffer once to release a dose of the medicine into the spacer. Do not remove the puffer.
5. Allow your little one to breath in and out in the spacer for 5 to 7 times, then remove the spacer from the mouth of your child.if you have to repeat another puff repeat after 30 seconds.
6.“Can you please demonstrate it for me?” give the spacer to her
8. Blue capped inhaler is a reliever, a bronchodilator that may cause racing of the heart for example, palpitation.
9. Brown capped inhaler is a steroid; it is a preventer. Therefore your little one must rinse out her/his mouth after each use to prevent the growth of any bugs in the mouth called oral thrush.
10. If another puff is needed, wait for 30 seconds. How to care for your spacer
“Take the spacer to bits and wash it in warm water DO NOT RINSE. Do not scrub its inside to prevent any scratches, and allow dripping dry. Do not rub dry.
It should be cleaned at least once a week and more depending on frequently of use. It needs to be replaced when there is obvious breakage, any staining inside.
Ask: Does little one go to school? If yes, the school nurse should have a spacer too.
11.sometime the mum asks if my child start coughing what should i do.tell her to remove the spacer from his face and allow your child to cough.once setteled repeat the dose because the medication you have given earlier is wasted.
12.sometime she ask what should i do if my child dont like spacer.tell her that you can make it attractive by putting cartoons pictures.
REMEMBER THE YELLOW ONE
Note: New guideline says thay in 5 year old child use spacer with mouthpiece to administer the inhaler. -5 year old child can understand your instruction plus some portion of drug is wasted while giving drug through facemask.
-So,pick up the blue aerochamber with mouthpiece and tell the mother to ask your child to make a tight seal around the mouthpiece and breath in and out for 5 to 7 time.
Never try to disassemble it. just demonstrate as it is
Blue one is for elder children above 5 years. Yellow one between 18 months to 5 years and orange one for up to children under 18 months.
Never disassemble the facemask from spacer. Tell her to wash with warm soapy water.
DYSPHAGIA;
DDS FOR DYSPHAGIA
1-ESOPHAGEAL CANCER 2-CARDIA ACHLASIA
3-STRICTURES SEC TO CORROSIVE...4-GORD 5-MYESTHENIA GRAVIS 6-SCLERODERMA 7-OESOPHAGITIS 8-GLOBUS HYSTERICUS 9-BULBAR PALSY 10-PHARYNGEAL POUCH 11-OESOPHAGEAL SPASM 12-SEC TO ENLARGED GOITOR
HX TAKING;
SWALLOWING: “What about your swallowing, any difficulty?”YES - Course: “Is it getting worse? (Progressive)”
- Duration: “Does it come and go? (Intermittent)”
- Quality: “Is it difficult to swallow liquids (Neuromuscular & mechanical) or solids (Mechanical)?… Do you feel a lump in your throat?”
- Timing: “Do you feel the difficulty immediately at the beginning of swallowing (Oropharyngeal) or does food stop in your chest a few seconds later (Esophageal)?.. Is it followed by vomiting?.. Choking or cough?..”
-Screen for:
Thyroid: “Does the heat or cold bother you more than you think it bothers other people?.. How?..”
Scleroderma: “Any skin tightness on your face or hands?”
CNS: “Do you have Headaches?…... Do you feel lightheadedness? Do you feel any pins & needles sensations? .. Where?..
Associated symtoms: -Wt loss -Anorexia -Fever -Night sweats -Nausea/vomiting -Heartburn
-Change in bowel habit -Malena+PR bleeding -Jaundice SYMPTOMS OF ANEMIA: -Tirdness+weakness -Palpitation -SOB IMPRTANT TO ASK: SOCIAL HX: -Smoking - Alcohol
-Lifestyle....eat fatty,spicy pickled food+beetlenut chew -Recreational drug
-Travel -Housing -Employment
Rest of the history same as for other GIT hx.
DX IN EXAM= CA OESOPHAGUS INVESTIGATIONS
-Blood test
-Barium swallow(special xray)