Varicose Veins: Causes, Symptoms, Diagnosis, and Treatment of Chronic Venous Insufficiency- Varicose veins are more common in women than in men, and are linked with heredity.Other related factors are pregnancy, obesity, menopause, aging, prolonged standing, leg injury, abdominal straining, and crossing legs at the knees or ankles. Less commonly, but not exceptionally, varicose veins can be due to other causes, as post phlebitic obstruction and/or incontinence, venous and arteriovenous malformations.
Random tips for completing the history assessment during the patient interview.
Apologize immediately when wait has been long. Sit down, don’t look at watch or act hurried.
Balance of empathy, listening, and structure.
Active listening, documenting during the interview.
Sit down, lean forward, state: “The nurse mentioned that you’re having this problem. Tell me the story.” Actively listen while giving patient one minute to speak.
“I’m sorry that I have to do this, but I have to make notes while we’re talking so that future providers know…”
Patients are the best experts on the terms of their own culture—ask them about it. Variations include ethnicity, economic status, religion, age and gender.
If history is not taken well, data may be skewed or incomplete.
Don’t make assumptions about patients, such as “I’m sure you’re not a smoker.”
Be sure to ask patient if it is okay to speak with family member in room. Focus on patient, not family member. Be sure to have family member leave room temporarily at some point.
Warn patient when you’re about to ask of sensitive questions.
“That’s big news” is not negative or positive, it allows patient to process big information such as pregnancy, cancer. No value is attached to the event/diagnosis/etc.
Don’t talk about your self. Don’t try to relate with life events such as deaths, etc.
Take time for self-reflection. What are you anxious about?
Review chart before going in room, establish if you have seen patient before.
Don’t introduce yourself and shake hands if you’ve met this patient before.
Be aware of how you dress; be professional.
Be aware of “failure of the therapeutic relationship.” Litigious, threatening, noncompliant people are examples of patients to avoid involvement with.
Avoid marginalizing patient based on narcotics, drug use, etc, etc.
If you must document on electronic record, have the patient sit next to you and explain “I must carefully document everything we discuss so that during future visits, we’re able to identify changes to body systems over time.”
Place patient in front of wall to bounce sound off of—increases hearing.
Do not sit directly in front of patient as it is confrontational.
Have blankets in exam room if it is a cold environment.
During the interview, you are completing a ROS; sometimes you have several complaints that are uncovered when the visit lasts for only 30 minutes. To help address symptoms, use:
7 attributes of a symptom: location, quality, quantity or severity, timing, setting, remitting/exacerbating factors, and associated manifestation’s.
One way to differentiate viral from bacterial illness is to obtain CBC with differential. If the lymphocyte count is elevated, the organism is likely viral.
Rights: People have a right to health and health care.
Balance: Health of the population should be balanced with the health of individuals.
Comprehensiveness: Ease suffering, minimize disability, prevent disease, promote health.
Cooperation: Essential among patients, providers, and the system.
Improvement: Serious responsibility
Safety: Do no harm to patient or self.
Openness: Being open, honest, trustworthy is vital in health care. Don’t keep errors to yourself, may result in poor outcomes. (Lido & epi in Rocephin IM accident).
Must confront patient regarding sexual advances/jokes. Don’t assume that it’s okay, because a problem may come up again in the future.
Reflect on your own behavior.
…as long as it gives you dimes and a nickel on the way out” –Physician guest speaker at SJCME.
Xylocaine with epi has been shown in studies to be nearly as safe as plain xylocaine… however, my instructor strongly urges us not to use it unless absolutely necessary due to the risk of necrosis, especially on fingertips and toes. 2% lidocaine is perfect for adults, no more than 1% for children. A tourniquet can be left on for approx 10 minutes or less to suppress bleeding in lieu of epi. Too much xylocaine can be toxic– 3mL is generally sufficient. This is VERY important in children!
Pig feet are an awesome learning tool for suturing. 6.0 thread is just about the tiniest needle imaginable and should be reserved for areas such as the face. Your sutures should be spaced apart by approximating the distance from the former suture by 1/2 the width of your previous sutures.
Punch biopsies look like you literally used a hole puncher… but you don’t. It’s this very unsophisticated (yet effective) looking tool that you twist into the skin (using local anesthetic). You need just the tiniest amount of subcutaneous fat (very tiny) for the pathologist to estimate wound depth. Any deeper and you’re going to have increased bleeding that may require stitching. The wound is closed with silver nitrate. If it requires suturing, you have to adjust the wound to make elliptical shape for closure.
If you have MDConsult, 5 Minute Consult, Ferri’s advisor, etc be sure to check their sites for instructional videos. I know 5 minute consult has excellent ones to review procedures Practice, practice, practice.
I learned much more in class and will add as I go along… for now, I’m spending my vacation in Maine with my nose in textbooks!
I just got back from Colorado. It was beautiful! It was a short business trip, courtesy of Family Heritage. We snuck away from the group with a few friends for half a day to visit Mt. Evans. It’s a 14,000 ft mountain that you can literally drive up. It’s a 30 minute drive from ground to top. It was 101 in Denver, and 50 degrees on the top of the mountain! It was amazing! Beautiful sights! Of course, I was doing pathophysiology and pharmacology during his meetings and any chance I got. We just returned home a few days ago and then I’m off to Maine in 2 days! Busy, busy.
Pathophysiology is nearly done… I’m just a few critical thinking questions away. Hallelujah!! I’ve never been so excited to move on to the next course I found a preceptor and hope to start this September for clinicals. I just have a few MAJOR, CRAZY goals to hit to make that happen! Pharmacology is underway, and health assessment will be started when I travel to Maine this week. I’m doing a workshop for suturing, I&Ds, x-ray interpretation, etc. I’m such a nerd… I’m more excited about a edu-vacation than I was when I went to Colorado without any forced learning I think it’s nice sometimes to just have a break away from work, other people having fun, and feeling like you’re letting your loved ones down because you’re buried in a book! In Maine… I won’t have to excuse myself for studying :) And what better place to celebrate with a few drinks for finishing pathophysiology?
I’m back on hiatus for another 2 weeks. Other students… feel free to let us know how your program is going & any helpful hints that you’ve found! When I’m back from Maine, I hope to share a lot of what I’ve learned in the skills workshop and health assessment!!