Assessment Resources

This article explores why we should adapt assessment of leg ulceration to be more mindful of the presence of lymphoedema. If clinicians can change the assessment process and begin to treat leg ucleration with a lymphatic component differently to venous oedema, this, in turn, can potentially reduce complications such as toe, foot and knee oedema. The introduction of simple changes in documentation and additional training can lead to improved outcomes for patients as well as potential cost savings for healthcare providers.

Eczema, also known as dermatitis, is a very common skin condition. There are several different types of eczema, affecting people throughout their lifespan. General practice nurses (GPNs) will see children and adults with eczema regularly and they are well placed to assess, manage and support them. Eczema is a chronic conditon and can have devasting effects on quality of life and mental health. GPNs can play an important role in supporting patients with eczema and their families in understanding how to self-manage this long-term conditon and help with coping strategies. This article outlines eczema as a long-term condition and provides practical advice for GPNs on assessment and treatment in primary care. Psychological effects and intervention and referral guidelines for eczema are also discussed.

This article is the second in a two-part series on respiratory assessment. The first article looked at the importance of taking a patient history as part of assessment. This article goes on to address the various stages and techniques involved in physical assessment. It will give an overview of the process, looking at inspection, palpation, percussion and auscultation, and provides insight to technique. Integrating the physical assessment outcome with information gained from history-taking is also discussed. Using all of the gathered information and vital signs enables clinicians to process and decide on the patient’s problems. While this two-part series provides an overview of the assessment process, further in-depth training is essential for safe and effective patient outcomes.

This article discusses the assessment and management of vitamin B12 deficiency. The author examines the causes of this condition, such as pernicious anaemia, and the different methods that can be used to manage it, for example vitamin B12 supplements, diet and medication review. Primary care nurses are frequently responsible for ordering blood tests and managing B12 deficiency. However, there is a lack of consistency in the management of the condition, partly because there are a number of different blood tests that can be performed, not all of which are available in every hospital laboratory.

Highly exuding wounds can affect people of all ages, often causing distress, anxiety and social isolation. Managing these challenging wounds can also represent a significant cost to the NHS. This article looks at exudate and the difference between normal and excessive exudate and examines the causes of a high volume of exudate and its effect on the patient. Exudate assessment is an important part of holistic assessment, which is also explored in the article. Strategies GPNs can employ to manage exudate, including wound dressings and other devices, are then discussed.

Exudate is produced as part of the inflammatory phase of wound healing and assists the healing process by providing essential nutrients to the wound, promoting moist wound healing and naturally debriding the wound bed. However, exudate can also be detrimental to the healing process and managing excessive exudate in clinical practice is often challenging. The key to managing exudate is accurate assessment and identifying the underlying cause of excessive production. Accurate diagnosis and assessment will assist general practice nurses (GPNs) in selecting appropriate treatment options and strategies that can help in managing exudate efficiently. This article discusses what exudate is and its function in wound healing. It also explores the causes of excessive exudate production and what GPNs can do to manage high volumes to prevent skin damage and improve patient quality of life.

When undertaking patient assessment, including assessment of the respiratory system, it is important that general practice nurses (GPNs) use all their senses. Expensive equipment and multiple investigations are useful when assessing a patient’s respiratory function, but the initial assessment can often be undertaken using the senses — hearing, sight and touch — as well as basic equipment, such as a stethoscope. This article, the first part of a two-part series on respiratory assessment, looks at history-taking. The information given should be used as an adjunct to any face-toface teaching of respiratory assessment skills and may provide the novice nurse with an idea of what to expect when undertaking an advanced clinical skills course. The second article in this two-part series will focus on the physical aspects of respiratory assessment.

Nutrition is an important modifiable factor for patients with chronic obstructive pulmonary disease (COPD). Being overweight brings breathing difficulties and being malnourished leads to poorer outcomes. Maintaining a healthy weight and a nutritious diet is a central part of COPD management. This article equips general practice nurses (GPNs) and patients with the tools needed to assess and promote a healthy weight and diet while living with COPD. It explains the reasons for malnutrition and how these can be avoided. Helping people improve their diet as well as the role of oral nutritional supplements (ONS) are explored, and specific issues, such as vitamin D deficiency, are discussed.

Acne vulgaris is a common dermatological condition, with most adolescents experiencing ‘spots’ at some point. For most people, these will resolve by the time they are in their 20s. However, approximately 15% of people in the UK will seek treatment for persistent acne that does not resolve with the use of over-the-counter preparations. This equates to over three million visits per year in the UK to primary care clinicians, such as general practice nurses (GPNs), who are well-placed to support patients. This article outlines the types of lesions that patients can present with, provides guidance on effective skin care, and discusses the topical and oral therapies that may be prescribed and their side-effects. The authors also look at the optimal referral of patients for secondary care assessment, as well as signposting nurses to assessment tools that focus on the psychological, as well as the physical, signs of acne. The psychological effect of having a visible, albeit common, skin condition should not be underestimated.

There is a variability and inconsistency in how GPs carry out cancer care reviews (Meiklejohn et al, 2016). Many people report feeling abandoned after treatment finishes (Scottish Cancer Experience Survey 2015/16). This article looks at an evaluation undertaken by NHS Lanarkshire as part of the Macmillan Transforming Care after Treatment (TCAT) programme to ascertain the acceptability and feasibility of general practice nurses (GPNs) taking on the role of delivering cancer care reviews using a Macmillan Holistic Needs Assessment Tool. After Macmillan cancer training, 10 GPNs invited people with a new diagnosis to a cancer care review. A concerns checklist was sent to the patients before the review. Four hundred people were invited, with 250 accepting the offer. People reported that the time afforded by the GPN was valued and they saw them as a point of contact in the future. Fatigue, pain and worry were the top three concerns raised. It was concluded that, with training, GPNs can offer quality-assured cancer care reviews and therefore shift some of the workload from GPs.