Assessment Resources

The purpose of this article is not to discuss the pathophysiology of pain in detail, but to focus on the clinical importance of assessing and managing leg ulcer pain. Effective pain management is crucial for improving patient comfort, promoting wound healing and improving overall quality of life. The article explores how to assess pain, including the importance of understanding a patient’s pain experience, use of pain scales, and distinguishing between different types of pain. It also discusses pharmacological approaches to pain relief and offers suggestions as to how healthcare professionals can minimise pain during dressing changes, a frequent source of distress for patients with leg ulcers.

Despite advances in wound care, treatment of lower limb ulceration remains suboptimal, with poor outcomes often attributed to inadequate diagnosis, failure to follow evidence-based practice, and variations in care delivery. These shortcomings result in delayed healing, reduced quality of life (QoL), and a significant economic burden on healthcare systems. Compression therapy is the recommended treatment for venous ulcers and ulcers with mixed aetiology, however there are some individuals who may not respond to compression alone or who are unsuitable due to arterial status. Recent advances in adjunctive therapies, such as the geko® device, offer promising results for these patients. This muscle pump activation (MPA) device activates the calf and foot muscle pumps, increasing venous, arterial and microvascular blood flow. This article examines the impact of leg ulceration on healthcare services and patient outcomes, while exploring the potential of the geko® device to improve healing rates and reduce associated costs.

Childhood constipation is a common and often distressing condition affecting both the child and their family. It is frequently encountered in primary care settings and, if not managed effectively, can lead to significant physical and psychological morbidity. Effective management hinges on a comprehensive approach that encompasses assessment, diagnosis, treatment, and understanding the psychological impacts. This article covers the critical aspects of assessing and diagnosing childhood constipation, including abdominal examination, recognising red flags and differential diagnoses, further investigations, and the psychological implications of the condition. It also delves into the causal reasons for childhood constipation, its effects on the child’s well-being, parental frustrations due to poor management, and treatment options available.

The mental health of children and young people (CYP) has markedly declined in recent years, a trend significantly accelerated by the Covid-19 pandemic. Accessing support for mental health issues is highly variable with long waiting lists for specialist child and adolescent mental health services (CAMHS) and inconsistent provision of mental health support in schools and educational institutions, meaning that supply does not meet demand. There is a gap in support for CYP who need a greater level of support than is currently available in education settings, but do not require specialist mental health
treatment (King’s Fund, 2024). Mental health issues may manifest as primary complaints in primary care settings or may be discovered incidentally during the evaluation of related physical or social problems. Consequently, it is imperative for general practice nurses (GPNs) to be able to recognise and accurately assess mental health issues that present to them. They should also be equipped to offer appropriate signposting, advice and guidance, as well as to facilitate necessary escalation or referral to specialist services when required. This article, the first in our series on CYP and mental health, focuses on history-taking and initial assessment.

Due to its diverse manifestations, Lyme disease (caused by the bacterium Borrelia burgdorferi) can present as a diagnostic challenge. This article will help practitioners to recognise Lyme disease in all its formats, ensure that historytaking and assessment are appropriate, and to consider other differentials while considering Lyme disease as the most likely diagnosis. Additionally, clinicians need to be able to manage the presentation appropriately using up-to-date guidelines. There will also be some discussion about the sequelae of Lyme disease — treated or untreated — and the impact of global warming on arthropod disease generally, including Lyme disease.

The population is ageing and so we are seeing an increase in the prevalence and incidence of age-related conditions, such as frailty and dementia. These two conditions can often go ‘hand in hand’, making it important to ensure appropriate recognition, assessment and then management of each when experienced together. This paper uses a case study approach to illustrate and discuss the issues.

For many nurses working in general practice, chronic obstructive pulmonary disease (COPD) is a familiar condition. From carrying out annual reviews to supporting people living with the symptoms of cough, phlegm, breathlessness and managing their effect on day-to-day living, most general practice nurses (GPNs) will have some experience of supporting people living with COPD. Increasingly, though, GPNs are having to consider comorbidities as part of the review, as for many people living with COPD, this will be just one of the long-term conditions they have already been diagnosed with or of which they will be at risk. In this article, the relationship between COPD and other long-term conditions will be highlighted, along with recommendations about how to identify and manage comorbidities in order to holistically optimise outcomes.

Moisture-associated skin damage (MASD) is an umbrella term to describe the trauma that occurs when there is prolonged exposure to moisture. Incontinence-associated dermatitis (IAD) is an MASD condition caused by urinary and/or faecal incontinence. It often causes significant pain and has a negative impact on an individual’s quality of life. Prompt diagnosis of IAD is key to successful management, but the early symptoms of erythema and redness may not be obvious in those with a dark skin tone. Delays in assessment and treatment mean that maceration, infection and the development of pressure ulcers become more of a risk. This is compounded by the lack of education and awareness of the significance of skin tone in relation to wound care. This article is based on published research, together with the practical experience of healthcare professionals at the Complex Wound Clinic (CWC) in North West London. The aim is to highlight the importance of considering skin tone when managing IAD. This can be achieved by using a validated skin tone assessment tool which shows a range of six skin tones. The importance of skin tone is a critical subject as the latest 2021 Census data shows that in England and Wales, 18% belong to a black, Asian, mixed or other ethnic group (Gov.UK, 2021 Census data).

Hidradenitis suppurativa (HS) is a chronic long-term condition that occurs mostly in intertriginous areas of the skin. Unfortunately, HS is often not recognised and is poorly managed in clinical practice. Early detection and referral to an appropriate service such as dermatology is essential to reduce the long-term impact of the disease. Treatment is
multifactorial and includes management of associated comorbidities and lifestyle factors, such as obesity and smoking, medication, surgical intervention and managing depression and anxiety. This article explores the assessment and management options for general practice nurses (GPNs) to consider when presented with a patient with HS.

Pilonidal sSinus disease (PSD) is a debilitating inflammatory disorder of the skin that is more common in young males. The cause of PSD is not fully understood but contributed to loose hair and debris driven deep into the skin within the natal cleft leading to prolonged inflammation and formation of ‘pits’ which fill with hair and debris. Symptoms range
from mild discomfort to severe sinus development, which may result in pain, infection and multiple surgical procedures and has a significant impact on an individual’s quality of life