Diagnosis Resources

When patients present with red lower legs, the cause is often assumed to be cellulitis or erysipelas. There are, however, several alternative conditions which mimic the clinical signs of cellulitis or erysipelas, which can lead to misdiagnosis. It is important that the cause is correctly diagnosed to prevent inappropriate prescribing of antibiotics. This article discusses the different potential causes of ‘red legs’, in addition to cellulitis and erysipelas, together with clinical signs and symptoms to enable general practice nurses (GPNs) to differentiate between them and implement appropriate treatments

Hayley Plimmer lost her 64-year old mother Catherine ‘aka Kay’ Christopher to liver cancer in 2017 following a late diagnosis. Hayley said:
My mother died of liver cancer five days after receiving her diagnosis and being told by
her consultant that there was nothing that could be done. It was a horribly shocking and traumatic experience for the whole family and we’re still reeling four years later. Looking back, there were some signs which we now know to have been symptoms of cancer but we had no idea at the time.

There are many different causes of liver disease and current estimates suggest that as many as one in 10 people have problems with their liver at some time in their life (Foundation for Liver Research, 2020). Perhaps most worrying is the fact that incidence of liver disease is increasing, with the number of deaths reported to have increased by 400% since 1970 (British Liver Trust, 2020). Most liver diseases are asymptomatic early on, frequently resulting in late diagnosis, potentially leading to a higher risk of poor outcomes. Many of the well-known liver diseases are preventable and this article, which covers fatty liver disease, hepatitis A, B and C and liver cancer, hopes to raise awareness of risk factors, recognition, causes and treatment of these conditions, and give general practice nurses (GPNs) and non-medical prescribers more confidence when caring for patients with these illnesses.

Migraine is a common debilitating headache condition that affects the quality of life of those affected. Migraine costs the NHS £150 million annually, with GP visits and prescriptions accounting for most of these costs. With access to neurologists and headache specialists limited in the UK, migraine is a condition GPs and general practice nurses (GPNs) are faced with on a daily basis. Therefore, it is vital that GPNs have good knowledge of migraines. They should be able to distinguish between common primary headaches, such as tension-type headaches (TTH), and migraines to avoid misdiagnosis and inform appropriate treatment, as well as to understand when acute or preventative treatments are required. As GPNs are limited in treatments they can provide for migraine, it is important that they recognise when to refer patients to a neurologist. This article explores how nurses within the general practice can effectively manage migraine patients to improve patient quality of life and alleviate pressures on an overstretched healthcare system.

Clinicians working within primary care services tend to do so in isolation and without direct access to investigative resources. This places emphasis on the clinician’s abilities to perform a focused clinical examination and employ sound clinical decision-making processes to reach a definitive diagnosis. This article looks at the case history of a patient presenting to a GP out-of-hours service with an acute, undifferentiated illness, and explores the decisionmaking processes used by the author, a trainee advanced nurse practitioner at the time, to support a working diagnosis and justify a clinically suitable management plan.

Lymphoedema is a debilitating condition that results in significant discomfort for patients and has no cure. However, with careful assessment and accurate diagnosis, appropriate treatment can relieve symptoms such as swelling and pain and improve patients’ quality of life. This article outlines the physiology of lymphoedema, before exploring the assessment and treatment measures, which include compression therapy to reduce oedema, skin care, manual manipulation of lymph fluid and exercise.

Prostate cancer is the most common cancer diagnosed in men in the United Kingdom (Cancer Research UK [CRUK], 2016). In 2013, there were 47,300 men diagnosed with prostate cancer. This amounts to 13% of all new cancers diagnosed in men. Furthermore, prostate cancer incidence has increased by 5% over the last ten years (CRUK, 2016). In 2014 there were 11,287 deaths due to prostate cancer, however 84% of men diagnosed with prostate cancer will survive 10 years or more (CRUK, 2016). This paper gives an overview of prostate cancer diagnosis and treatment and the role of general practice nurses (GPNs) in the care of men suspected of having prostate cancer and following treatment.

Chronic kidney disease (CKD) is an ongoing decline of renal function which may progress quite rapidly or develop slowly over many years. Due to the nature of the disease, it is linked to cardiovascular disease (CVD) and a host of symptoms, comorbidities, high mortality and reduced quality of life. The majority of CKD patients will be identified in primary care. Once diagnosed, patients are likely to become increasingly frequent attenders within general practice. It is therefore useful to have an overview of the disease process and the multifaceted care needs of this specific patient group. General practice nurses (GPNs) are vital members of the multidisciplinary team who are well􀀀placed to identify, monitor and provide ongoing support for patients with CKD.

Dementia is a progressive loss of the cognitive functions that are necessary for a person to live safely and independently. These include loss of memory, the ability to think logically and communicate effectively with others, and being able to care for yourself. In 2009 a national dementia strategy for England was launched in order to improve public and professional awareness, and to ensure high quality care at all stages, including early diagnosis and treatment (Department of Health [DH], 2009).

The strategy outlined a care pathway for people living with dementia and their families and carers from diagnosis through to end of life. This article will enable the reader to understand the importance of the dementia care pathway in supporting people to live well with dementia, to consider how the pathway is being developed and implemented in primary care and how general practice nurses (GPNs) can add  value within their professional role.