NHS INTERVIEW PREPARATION WITH MNC ACADEMY- COMMONLY ASKED CLINICAL BASED TOPICS

Posted on 22th, May 24
NHS INTERVIEW PREPARATION WITH MNC ACADEMY- COMMONLY ASKED CLINICAL BASED TOPICS

MOST COMMONLY ASKED CLINICAL BASED TOPICS

1) SEPSIS

What is sepsis?

Sepsis is a serious complication of an infection.

Without quick treatment, sepsis can lead to multiple organ failure and death.

What causes a sepsis infection?

The immune system usually keeps an infection limited to one place. This is called a localised infection. To do this, the body produces white blood cells.

White blood cells travel to an infection site to destroy the germs causing the infection. This triggers tissue swelling, known as inflammation. This helps to fight the infection and prevent it from spreading.

However, an infection can spread to other parts of the body if the immune system is weak or an infection is severe.

Widespread inflammation can damage tissue and interfere with blood flow. When blood flow is interrupted, blood pressure can drop dangerously low. This stops oxygen from reaching the organs and tissues.

Sources of infection

Sepsis can be triggered by an infection in any part of the body. The most common sites of infection that lead to sepsis are the:

lungs
urinary tract
tummy (abdomen)
pelvis
However, sometimes the specific infection and source of sepsis can’t be identified.

Tests to diagnose sepsis

Sepsis is often diagnosed by testing your:

temperature
heart rate
breathing rate
blood
Other tests can help determine the type of infection, where it’s located and which parts of the body have been affected. These include:

urine or stool samples
a wound culture – where a small sample of tissue, skin or fluid is taken from the affected area for testing
respiratory secretion testing – taking a sample of saliva, phlegm or mucus
blood pressure tests
imaging studies – like an X-ray, ultrasound scan or computerised tomography (CT) scan
Who’s at risk of sepsis?

Anyone can develop sepsis after an injury or minor infection. However, some people are more vulnerable, including people who:

are very young
are very old
are pregnant
have had a urinary catheter fitted
have a long term health condition like diabetes
have recently had surgery
are genetically prone to infections
are already in hospital with a serious illness
have to stay in hospital for a long time
have wounds or injuries as a result of an accident
have a medical condition that weakens the immune system – like HIV or leukaemia
are receiving medical treatment that weakens the immune system – like chemotherapy or long-term steroids
are on mechanical ventilation – where a machine is used to help you breathe
Recovering from sepsis

Some people make a full recovery from sepsis fairly quickly. The amount of time it takes to fully recover from sepsis varies depending on:

the severity of the sepsis
the person’s overall health
how much time was spent in hospital
whether treatment was needed in an intensive care unit (ICU)
Long term effects of sepsis

Some people with sepsis will experience long-term physical and psychological problems. This is known as post-sepsis syndrome.

Symptoms of post-sepsis syndrome include:

feeling lethargic or excessively tired
muscle weakness
swollen limbs
joint pain
chest pain
breathlessness

Phone 999 immediately or go to A&E if:
You or someone else has symptoms like:

loss of consciousness
severe breathlessness
a high temperature (fever) or low body temperature
a change in mental state – like confusion or disorientation
slurred speech
cold, clammy and pale or mottled skin
a fast heartbeat
fast breathing
chills and shivering
severe muscle pain
feeling dizzy or faint
nausea and vomiting
diarrhoea

2) PRESSURE ULCER

About pressure ulcers

Pressure ulcers are an injury that breaks down the skin and underlying tissue. They are caused when an area of skin is placed under pressure.

They are sometimes known as “bedsores” or “pressure sores”.

Pressure ulcers can range in severity from patches of discoloured skin to open wounds that expose the underlying bone or muscle.

Read more about the symptoms of pressure ulcers.

How pressure ulcers develop

Pressure ulcers can develop when a large amount of pressure is applied to an area of skin over a short period of time. They can also occur when less pressure is applied over a longer period of time.

The extra pressure disrupts the flow of blood through the skin. Without a blood supply, the affected skin becomes starved of oxygen and nutrients, and begins to break down, leading to an ulcer forming.

Pressure ulcers tend to affect people with health conditions that make it difficult to move, especially those confined to lying in a bed or sitting for prolonged periods of time.

Conditions that affect the flow of blood through the body, such as type 2 diabetes, can also make a person more vulnerable to pressure ulcers.

Learn more about the causes of pressure ulcers.

Who is affected?

It’s estimated that just under half a million people in the UK will develop at least 1 pressure ulcer in any given year. This is usually people with an underlying health condition – for example, around 1 in 20 people who are admitted to hospital with a sudden illness will develop a pressure ulcer.

People over 70 years old are particularly vulnerable to pressure ulcers, as they are more likely to have mobility problems and ageing skin.

Treating and preventing pressure ulcers

Treatment for pressure ulcers includes the use of dressings, creams and gels designed to speed up the healing process and relieve pressure. Surgery is sometimes recommended for the most serious cases.

For some people, pressure ulcers are an inconvenience that require minor nursing care. For others, they can be serious and lead to life-threatening complications, such as blood poisoning or gangrene.

Read more about the complications of pressure ulcers.

Pressure ulcers can be unpleasant, upsetting and challenging to treat. Therefore, a range of techniques is used to prevent them developing in the first place. These include:

regularly changing a person’s position
using equipment to protect vulnerable parts of the body – such as specially designed mattresses and cushions
Read about treating pressure ulcers and preventing pressure ulcers for more information.

Unfortunately, even with the highest standards of care, it’s not always possible to prevent pressure ulcers in particularly vulnerable people.

Symptoms of pressure ulcers

The parts of the body most at risk of developing pressure ulcers are those that are not covered by a large amount of body fat and are in direct contact with a supporting surface, such as a bed or a wheelchair.

For example, if you are unable to get out of bed, you are at risk of developing pressure ulcers on your:

shoulders or shoulder blades
elbows
back of your head
rims of your ears
knees, ankles, heels or toes
spine
tail bone (the small bone at the bottom of your spine)
If you are a wheelchair user, you are at risk of developing pressure ulcers on:

your buttocks
the back of your arms and legs
the back of your hip bone
Severity of pressure ulcers

Healthcare professionals use several grading systems to describe the severity of pressure ulcers. The most common is the European Pressure Ulcer Advisory Panel (EPUAP) grading system. The higher the grade, the more severe the injury to the skin and underlying tissue.

Grade 1

A grade 1 pressure ulcer is the most superficial type of ulcer. The affected area of skin appears discoloured – it is red in white people, and purple or blue in people with darker-coloured skin. Grade 1 pressure ulcers do not turn white when pressure is placed on them. The skin remains intact, but it may hurt or itch. It may also feel either warm and spongy, or hard.

Grade 2

In grade 2 pressure ulcers, some of the outer surface of the skin (the epidermis) or the deeper layer of skin (the dermis) is damaged, leading to skin loss. The ulcer looks like an open wound or a blister.

Grade 3

In grade 3 pressure ulcers, skin loss occurs throughout the entire thickness of the skin. The underlying tissue is also damaged, although the underlying muscle and bone are not. The ulcer appears as a deep, cavity-like wound.

Grade 4

A grade 4 pressure ulcer is the most severe type of pressure ulcer. The skin is severely damaged and the surrounding tissue begins to die (tissue necrosis). The underlying muscles or bone may also be damaged.

People with grade 4 pressure ulcers have a high risk of developing a life-threatening infection.

Treating pressure ulcers

Treatment for pressure ulcers can vary, depending on the grade of the ulcer. Treatment options may include regularly changing your position, or using special mattresses and dressings to relieve pressure or protect the skin. In some cases, surgery may be needed.

Your care team

Pressure ulcers are a complex health problem arising from many interrelated factors. Therefore, your care may be provided by a team comprising different types of healthcare professionals. This type of team is sometimes known as a multidisciplinary team (MDT).

Your MDT may include:

a tissue viability nurse (a nurse who specialises in wound care and prevention)
a social worker
a physiotherpist
an occupational therapist
a dietitian
medical and surgical experts with experience in pressure ulcer management
Changing position

It’s important to avoid putting pressure on areas that are vulnerable to pressure ulcers or where pressure ulcers have already formed. Moving and regularly changing your position helps to prevent pressure ulcers developing and relieves the pressure on the ulcers that have developed.

After your risk assessment is completed, your care team will draw up a “repositioning timetable”, which states how often you need to be moved. For some people, this may be as often as once every 15 minutes. Others may need to be moved only once every 2 hours.

The risk assessment will also consider the most effective way of avoiding putting any vulnerable areas of skin under pressure whenever possible.

You may also be given training and advice about:

correct sitting and lying positions
how you can adjust your sitting and lying position
how often you need to move or be moved
how best to support your feet
how to maintain good posture
the special equipment you should use and how to use it
Mattresses and cushions

There are a range of special mattresses and cushions that can relieve pressure on vulnerable parts of the body. Your care team will discuss the types of mattresses and cushions most suitable for you.

Those thought to be at risk of developing pressure ulcers, or who have pre-existing grade 1 or 2 pressure ulcers, usually benefit from a specially designed foam mattress, which relieves the pressure on their body.

People with a grade 3 or 4 pressure ulcer will require a more sophisticated mattress or bed system. For example, there are mattresses that can be connected to a constant flow of air, which is automatically regulated to reduce pressure as and when required.

Dressings

Specially designed dressings and bandages can be used to protect pressure ulcers and speed up the healing process. Examples of these types of dressings include:

hydrocolloid dressings – these contain a special gel that encourages the growth of new skin cells in the ulcer, while keeping the surrounding healthy area of skin dry
alginate dressings – these are made from seaweed and contain sodium and calcium, which are known to speed up the healing process
Creams and ointments

Topical preparations, such as creams and ointments, can be used to help speed up the healing process and prevent further tissue damage.

Antibiotics

If you have a pressure ulcer, you will not routinely be prescribed antibiotics. These are usually only prescribed to treat an infected pressure ulcer and prevent the infection from spreading.

Antiseptic cream may also be applied directly to pressure ulcers to clear out any bacteria that may be present.

Nutrition

Certain dietary supplements, such as protein, zinc and vitamin C, have been shown to accelerate wound healing.

If your diet lacks these vitamins and minerals, your skin may be more vulnerable to developing pressure ulcers. As a result of this, you may be referred to a dietitian so that a suitable dietary plan can be drawn up for you.

Debridement

In some cases, it may be necessary to remove dead tissue from the ulcer to help stimulate the healing process. This procedure is known as debridement.

If there is a small amount of dead tissue, it may be possible to remove it using specially designed dressings and paste. Larger amounts of dead tissue may be removed using mechanical means. Some mechanical debridement techniques include:

cleansing and pressure irrigation – where dead tissue is removed using high-pressure water jets
ultrasound – dead tissue is removed using low-frequency energy waves
laser – dead tissue is removed using focused beams of light
surgical debridement – dead tissue is removed using surgical instruments, such as scalpels and forceps
A local anaesthetic will be used to numb the area of skin and tissue around the ulcer so that debridement does not cause any pain or discomfort.

Maggot therapy

Maggot therapy, also known as larvae therapy, is an alternative method of debridement. Maggots are ideal for debridement because they feed on dead and infected tissue without touching healthy tissue. They also help to fight infection by releasing substances that kill bacteria and stimulate the healing process.

During maggot therapy, the maggots are mixed into a wound dressing and the area is covered with gauze. After a few days, the dressing is taken off and the maggots are removed.

Many people may find the idea of maggot therapy off-putting, but research has found that it is often more effective than more traditional methods of debridement.

Surgery

It’s not always possible for a grade 3 or 4 pressure ulcer to heal. In such cases, surgery will be required to seal the wound and prevent any further tissue damage occurring.

Surgical treatment involves cleaning the wound and closing it by bringing together the edges of the wound (direct closure), or by using tissue moved from a nearby part of the body (flap reconstruction).

Pressure ulcer surgery can be challenging, especially because most people who have the procedure are already in a poor state of health. There is a risk of a large number of possible complications occurring after surgery, including:

infection
tissue death of the implanted flap
muscle weakness
blisters (small pockets of fluid that develop inside the skin)
recurrence of the pressure ulcers
blood poisoning
infection of the bone (osteomyelitis)
internal bleeding
abscesses (painful collections of pus that develop inside the body)
deep vein thrombosis (a blood clot that develops inside the veins of the leg)
Despite the risks, surgery is often a necessity to prevent life-threatening complications, such as blood poisoning and gangrene (the decay or death of living tissue).

Preventing pressure ulcers

As part of your treatment plan, your care team will discuss with you the best way to prevent pressure ulcers. This will be based on your individual circumstances.

However, you may find that the general advice outlined below is helpful.

Changing position

Making regular and frequent changes to your position is one of the most effective ways of preventing pressure ulcers. If a pressure ulcer has already developed, regularly changing position will help to avoid putting further pressure on it, and give the wound the best chance of healing.

As a general rule, wheelchair users will need to change their position at least once every 15 to 30 minutes. People who are confined to bed will need to change their position at least once every 2 hours.

Once you have developed a pressure ulcer, it’s important that you minimise or avoid putting any further pressure on it to give the wound the best chance of healing.

If you are unable to change position yourself, a carer or relative will need to assist you. For more information and advice about positional changes, read about treating pressure ulcers.

Nutrition

Eating a healthy, balanced diet that contains an adequate amount of protein and a good variety of vitamins and minerals can help prevent skin damage and speed up the healing process. You may be referred to a dietitian so that a dietary plan can be drawn up for you.

If you currently have a reduced appetite due to a pre-existing health condition, the following advice may be useful:

Try eating smaller meals throughout the day, rather than 2 or 3 larger meals. Set a timetable for when you should eat, rather than waiting until you feel hungry. This should ensure that you receive the necessary nutrition.
Avoid drinking large amounts of fluids just before you are about to eat, as this will make you feel fuller than you actually are.
If you find swallowing difficult, try drinking specially made nutritional drinks or puréed foods and soups.
If you are a vegetarian, it’s important to eat high-protein alternatives to meat. Cheese, yoghurt, peanut butter, custard, beans and nuts are all good sources of protein.
Read more information about healthy eating for more advice.

Checking your skin

If you have known risk factors for pressure ulcers, it’s important that you check your skin on a daily basis for any signs of pressure ulcers, such as discoloured areas of skin. This is particularly important if you have an underlying condition, such as nerve damage or diabetes, which may dampen or numb feelings of pain in certain parts of your body.

You can use a mirror to check the parts of your body that are difficult to see, such as your bottom and the heels of your feet. If you notice any damage, report it to your care team. If you are at home, contact your GP or community nurse. If you are in hospital or a nursing home, inform one of your nurses or carers.

Quit smoking

If you are a smoker, giving up is one of the most effective ways of preventing pressure ulcers. Smoking reduces the levels of oxygen in your blood. It also weakens your immune system, which increases your risk of developing pressure ulcers.

Read about quitting smoking for further information and advice about giving up smoking.

3) HYPERGLYCAEMIA OR HIGH BLOOD SUGAR

Hyperglycaemia (high blood sugar) can affect people with type 1 diabetes and type 2 diabetes, as well as pregnant women with gestational diabetes.

It can occasionally affect people who don’t have diabetes, but usually only people who are seriously ill, such as those who have recently had a stroke or heart attack, or have a severe infection.

Hyperglycaemia shouldn’t be confused with hypoglycaemia, which is when a person’s blood sugar level drops too low.

This information focuses on hyperglycaemia in people with diabetes.

Is hyperglycaemia serious?

The aim of diabetes treatment is to keep blood sugar levels as near to normal as possible. But if you have diabetes, no matter how careful you are, you’re likely to experience hyperglycaemia at some point.

It’s important to be able to recognise and treat hyperglycaemia, as it can lead to serious health problems if left untreated.

Occasional mild episodes aren’t usually a cause for concern and can be treated quite easily or may return to normal on their own. However, hyperglycaemia can be potentially dangerous if blood sugar levels become very high or stay high for long periods.

Very high blood sugar levels can cause life-threatening complications, such as:

diabetic ketoacidosis (DKA) – a condition caused by the body needing to break down fat as a source of energy, which can lead to a diabetic coma; this tends to affect people with type 1 diabetes
hyperosmolar hyperglycaemic state (HHS) – severe dehydration caused by the body trying to get rid of excess sugar; this tends to affect people with type 2 diabetes
Regularly having high blood sugar levels for long periods of time (over months or years) can result in permanent damage to parts of the body such as the eyes, nerves, kidneys and blood vessels.

If you experience hyperglycaemia regularly, speak to your doctor or diabetes care team. You may need to change your treatment or lifestyle to keep your blood sugar levels within a healthy range.

Symptoms of hyperglycaemia

Symptoms of hyperglycaemia in people with diabetes tend to develop slowly over a few days or weeks. In some cases, there may be no symptoms until the blood sugar level is very high.

Symptoms of hyperglycaemia include:

increased thirst and a dry mouth
needing to pee frequently
tiredness
blurred vision
unintentional weight loss
recurrent infections, such as thrush, bladder infections (cystitis) and skin infections
Symptoms of hyperglycaemia can also be due to undiagnosed diabetes, so see your GP if this applies to you. You can have a test to check for the condition.

What should my blood sugar level be?

When you’re first diagnosed with diabetes, your diabetes care team will usually tell you what your blood sugar level is and what you should aim to get it down to.

You may be advised to use a testing device to monitor your blood sugar level regularly at home, or you may have an appointment with a nurse or doctor every few months to see what your level is.

Target blood sugar levels differ for everyone, but generally speaking:

if you monitor yourself at home – a normal target is 4-7mmol/l before eating and under 8.5-9mmol/l two hours after a meal
if you’re tested every few months – a normal target is below 48mmol/mol (or 6.5% on the older measurement scale)
What causes high blood sugar?

A variety of things can trigger an increase in blood sugar level in people with diabetes, including:

stress
an illness, such as a cold
eating too much, such as snacking between meals
a lack of exercise
dehydration
missing a dose of your diabetes medication, or taking an incorrect dose
over-treating an episode of hypoglycaemia (low blood sugar)
taking certain medicines, such as steroid medication
Occasional episodes of hyperglycaemia can also occur in children and young adults during growth spurts.

Treating hyperglycaemia

If you’ve been diagnosed with diabetes and you have symptoms of hyperglycaemia, follow the advice your care team has given you to reduce your blood sugar level.

If you’re not sure what to do, contact your GP or care team.

You may be advised to:

change your diet – for example, you may be advised to avoid foods that cause your blood sugar levels to rise, such as cakes or sugary drinks
drink plenty of sugar-free fluids – this can help if you’re dehydrated
exercise more often – gentle, regular exercise such as walking can often lower your blood sugar level, particularly if it helps you lose weight
if you use insulin, adjust your dose – your care team can give you specific advice about how to do this
You may also be advised to monitor your blood sugar level more closely, or test your blood or urine for substances called ketones (associated with diabetic ketoacidosis).

Until your blood sugar level is back under control, watch out for additional symptoms that could be a sign of a more serious condition (see below).

When to get urgent medical attention

Contact your diabetes care team immediately if you have a high blood sugar level and experience the following symptoms:

feeling or being sick
abdominal (tummy) pain
rapid, deep breathing
signs of dehydration, such as a headache, dry skin and a weak, rapid heartbeat
difficulty staying awake
These symptoms could be a sign of diabetic ketoacidosis or a hyperosmolar hyperglycaemic state (see above) and you may need to be looked after in hospital.

How to prevent hyperglycaemia

There are simple ways to reduce your risk of severe or prolonged hyperglycaemia:

Be careful what you eat – be particularly aware of how snacking and eating sugary foods or carbohydrates can affect your blood sugar level.
Stick to your treatment plan – remember to take your insulin or other diabetes medications as recommended by your care team.
Be as active as possible – getting regular exercise can help stop your blood sugar level rising, but you should check with your doctor first if you’re taking diabetes medication, as some medicines can lead to hypoglycaemia if you exercise too much
Take extra care when you’re ill – your care team can provide you with some “sick day rules” that outline what you can do to keep your blood sugar level under control during an illness.
Monitor your blood sugar level – your care team may suggest using a device to check your level at home, so you can spot an increase early and take steps to stop it.

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