Diagnosis Resources

Despite advances in knowledge, understanding, risk factors and treatment, cervical cancer continues to be a cause of death in women around the world. The disease is the fourth most frequent cancer type in women, with an estimated 342,000 deaths in 2020, with the majority of these (approximately 90%) occurring in low and middle-income countries (World Health Organization [WHO], 2022).

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 community nurses to differentiate
between them and implement appropriate treatments. Systemic antibiotics may not be the most appropriate management, and with the current focus on reducing antibiotic usage, community nurses need to be confident that they are prescribing them appropriately
and safely, and only when required.

This article, the first in a three-part series on Long Covid, provides a definition of post-Covid-19 syndrome and Long Covid. It highlights the considerations for diagnosis and an overview of the management of commonly reported symptoms through the experience of one of the 90 NHS England commissioned post Covid (Long Covid) assessment clinics, in addition to lived experiences of persons with Long Covid (PwLC). The next two articles in this series will look at the use of digital technology in Long Covid self-management and virtual group assessments.

This article describes the wound infection continuum in surgical, acute and chronic wounds. The phases are: contamination, colonisation, local infection and finally spreading and systemic infection. Clinicians need to be familiar with the signs and symptoms of local infection in order to put strategies in place to prevent a ‘full blown’ wound infection and to recognise how the signs and symptoms differ by wound type. The article looks at the
most recent guidance on wound infection management strategies, together with the identification and treatment of suspected biofilms and the two-week challenge, used in clinical practice to disrupt biofilms. Wound cleansing and the use of antimicrobial dressings
and topical antiseptics are also discussed.

Pneumonia is defined as an infection of the lung tissue in which the air sacs become filled with microorganisms, fluid and inflammatory cells, affecting the function of the lungs (National Institute for Health and Care Excellence [NICE], 2021a). The disease can affect anyone at any age and is a cause of morbidity mortality around the world, and particularly likely to result in poor outcomes in the elderly, babies and young children, and those with additional health problems (Htun et al, 2019). This article focuses on community-acquired pneumonia (CAP) in adults, and hopes to give nurses and non-medical prescribers an insight into the recognition, treatment and management of this disease in the adult population, with the aim of reducing hospital admissions and improving outcomes for those patients affected.

Faecal incontinence (FI), always has an underlying cause (Harari, 2009). It is defined as any involuntary loss of faeces that is a social or hygiene problem (National Institute for Health and Care Excellence [NICE], 2007).

Pneumonia has a huge impact upon the healthcare system in the UK and is not only associated with higher rates of hospital admissions than any other respiratory disease, but also carries a high risk of mortality. This article offers an overview of community-acquired pneumonia in adult patients, including the pathophysiology, common aetiologies, at-risk groups and pharmacological management. There is also a brief discussion on differential diagnoses and potential strategies to support clinical decision-making in the community.

Asthma is a common lung condition affecting many patients in the community. Nurses are pivotal in the diagnosis and management of people with both stable disease and during acute flare-ups. Asthma reviews offer opportunities to build therapeutic relationships and optimise treatment, helping patients to recognise and plan management of an asthma attack. On average, three people die of asthma every day in the UK - a stark statistic which should encourage nurses to be forever watchful of opportunities to regularly review the evidence base and produce patient-centred care. This article focuses on the management of chronic adult asthma, at diagnosis, management, and briefly touches on assessment of the acute exacerbation. They key differences between the asthma guidelines of the British Thoracic Society/Scottish Intercollegiate Guidelines Network (BTS/SIGN, 2016) and the National Institute for Health and Care Excellence (NICE, 2017) guidelines, which are currently in use in the UK, are presented for reader consideration. 

The community nurse may come across a range of wounds in the community setting, particularly with the rise in comorbidities such as diabetes and cardiovascular disease due to unhealthy lifestyles and an ageing population. Accurate assessment is the key to identifying the most appropriate wound treatment programme; one that will promote healing and/or relieve symptoms associated with chronic wound healing. Product choice is secondary to getting the assessment process right and accurate assessment and methodical documentation not only help protect against legal challenges, but also aim to reduce waste, dressing change frequency (and thereby nurse time), and patient discomfort. The community nurse should always seek to match their wound-healing knowledge with what they see in the wound bed and the patient’s history, which in turn will enable the nurse to make informed therapy choices and provide expert patient advice.

Community nurses will often encounter patients with psoriasis in their day-today work, and may be involved in delivering care directly or monitoring the condition. However, psoriasis has various presentations and knowledge of these variations is beneficial for all clinicians working in the community, particularly when it comes to understanding the range of treatments available. This article, the first in a series on psoriasis, will discuss the types of psoriasis that can be encountered, while future articles will examine the different treatment options that are currently available, focusing on the National Institute for Health and Care Excellence’s (NICE, 2016) treatment pathway for managing patients with psoriasis (see Figure 1). The series will focus on each of the steps in the pathway and how they relate to nurses working in the community.