Chronic Disease Assessment

Question 1

What does INR measure and what are the indications for abnormal readings?

Answer 1

International Normalised Ratio

• measures time blood takes to clot
• higher the number, longer the time

high readings could mean:

• too much anticoagulant medicine
• interaction w/ other medications such as NSAIDs or aspirin
• health conditions eg liver failure
• sudden decrease of Vit K in diet

management for high INR reading:

• adjustment of current anticoagulants
• Vit K
• blood components during blood transfusion

Question 2

How can patients prevent elevated INRs?

Answer 2

• regular check-ups/INR measurements
• adherence to medications
• eat same amount of Vit K in diet (leafy veg, broccoli, grapes)
• limit alcohol intake
• smoking cessation

Question 3

What does a reduced peak flow indicate and how can you explain it to patients?

Answer 3

• asthma is a respiratory illness, narrowing the airways
• peak flow relates to overall airflow the body produces - reduced peak flow means you can’t exhale as well as people without asthma
• peak flow is a precise measurement to monitor how your condition is at the moment and determining its severity
• can use the results to help you make changes in order to avoid development of further symptoms such as increased shortness of breath

Question 4

Explain what an HbA1c reading means to a patient and what can be done when it isn’t within the ideal range

Answer 4

It measures the product that’s made when sugar sticks to your red blood cells in your blood. The more that sticks to your blood means the more sugar floating around that the body can’t use properly, which can lead to complications

Ideal level for diabetics = 48mmol/mol or below

To lower your HbA1c:

• medication review and adherence
• diabetes education courses
• getting more active and losing weight if overweight
• balanced and healthy diet
• stop smoking

Question 5

Explain what elevated CRP means to a patient and what can be done to lower it/address any risk factors

Answer 5

Produced by the liver, in response to inflammation/swelling in the body. Many conditions can raise CRP levels.

To address risk factors:

• stop smoking
• lose weight if appropriate
• engage in more active lifestyle - aerobic exercise
• lower cholesterol levels in diet or with statins
• lower blood pressure
• ensure diabetes is managed well if appropriate

Question 6

What is ALT a useful marker of?

Answer 6

hepatocellular injury

Question 7

What is ALP a useful marker of?

Answer 7

indirect marker of cholestasis

Question 8

Why might someone’s GGT be raised?

Answer 8

• biliary epithelial damage and bile flow obstruction
• response to alcohol and drugs such as phenytoin
• in combo w/ raised ALP - highly suggestive of cholestasis

Question 9

What can cause an isolated rise in ALP?

Answer 9

• bony metastases/primary bone tumours
• Vit D deficiency
• recent bone fractures
• renal osteodystrophy

Question 10

What can cause an isolated rise in bilirubin?

Answer 10

• Gilbert’s syndrome (most common)

- haemolysis