Long-term conditions: asthma in children.
Respiratory tract infections, such as rhinovirus, can trigger asthma symptoms and lead to asthma exacerbations, which can constitute a medical emergency. Emergency admission data for asthma exacerbation in children reflect the dates of the return-to-school calendar, when children become more exposed to infection. While general practice nurses (GPNs) have recognised this pattern of asthma exacerbation in children for some time, there has been a lack of evidence around the factors that cause such alterations to patients’ airway pathophysiology. Unfortunately, avoiding exposure to viral respiratory infections is impossible, therefore this article examines how optimum asthma management is vital in reducing the impact of infection on the patient’s airways.
Long-term conditions: compression therapy and venous leg ulceration.
Compression therapy is the recommended treatment for the prevention and management of venous leg ulceration and lymphatic insufficiency (Scottish Intercollegiate Guidelines Network [SIGN], 2010; Harding et al, 2015; Wounds UK, 2016). Various methods of delivering compression are used in the UK, including bandaging, hosiery and Velcro® wraps. Selecting the correct device can be challenging for clinicians. This article explores the different compression systems available to help general practice nurses (GPNs) make appropriate choices for their patients, i.e. an option which is acceptable to the patient and can be applied safely and proficiently.
Long-term conditions: skin care
Skin conditions are commonly seen by nurses in primary care. Not only do they have a significant impact on patient health and quality of life, they also have implications for healthcare resources, requiring long-term regular treatment. This article provides an overview of the anatomy and physiology of healthy skin, as well as outlining its primary functions. Managing common skin conditions such as psoriasis and atopic eczema is also discussed, alongside the various preparations that can help general practice nurses (GPNs) to maintain the patient’s skin integrity. A guide to the use of skin care treatments such as emollients, with particular emphasis on quantities and application technique, is also given.
A considerable proportion of general practice nurse (GPN) visits are for patients with venous leg ulcers (Guest et al, 2015). However, clinicians’ skills and knowledge in managing these cases vary (Wounds UK, 2016), due to the increase in comorbidities and complexities of venous ulcer presentation (Newton, 2010). This article explores accurate venous leg ulcer assessment through analysing the best evidence available. Prevalence, as well as wound, holistic and Doppler assessment are covered to provide a detailed assessment plan that can be used to ensure evidence-based patient care. Management will not be discussed in detail, but appropriate techniques will be considered with compression therapy being referred to as the gold-standard treatment for venous ulceration (National Institute for Health and Care Excellence [NICE], 2016).
Breathing is a normal vital function which is spontaneous, regular, quiet and effortless and reflects the way that the respiratory system functions. Breathing pattern disorders or dysfunctional breathing, historically known as hyperventilation syndrome, are chronic abnormal respiratory patterns in relation to the efficiency of breathing, often resulting in dyspnoea and other non-respiratory symptoms (Clifton-Smith and Rowley, 2011). It is not a disease process, but alterations in breathing patterns that interfere with normal respiratory processes. Breathing pattern disorders can occur with an absence of disease or co-exist with many diseases such as chronic obstructive pulmonary disease (COPD), asthma, or heart disease, and in some cases, can mimic cardiac symptoms.
There has been an increase in non-cancer-related cases of lymphoedema across the UK and there is a need to raise awareness of this chronic non-curable condition (Williams, 2003; Keen, 2008). Lymphoedema can be effectively managed in primary care; however, frontline clinicians should have an understanding of the difference between lymphoedema and other lower limb conditions, especially with regards to lower limb lymphoedema. There are also gaps in knowledge around the practice of managing poorly drained interstitial fluid, which need to be addressed. However, for management to be effective, a patient-centred approach needs to be established with patients directing their care. As the management of lymphoedema involves patients doing exercises, it impacts on their day-to-day lives. Slight modifications, such as personal massage to improve lymphatic drainage, skin care to improve skin texture and theraband exercises to aid mobility, may need to be considered as part of the management process and, as the medical model on its own is not effective in managing this condition, patients may need to be referred to a team of specialist practitioners.
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