Chronic disease control

Question 1

What is an INR

Answer 1

International Normalised Ratio

Blood test which is especially important if taking blood thinners, helps to check whether taking the right dose or needs to be changed

Question 2

INR - results interpretation?

Answer 2

Varies according to age, meds, health problems

Higher number, longer for blood to clot

SHOULD BE 2-3 IF TAKING WARFARIN (value varies based on condition)

Question 3

What do you need to ask a patient taking warfarin?

Answer 3

Why are they taking it?
How long?
Side effects?
Affect on life?
Adherent / missing doses?

Diet - vitamin K (leafy green veg, olive oils etc, if having more need to change the dose so important to tell us)
Alcohol intake

Question 4

What is a peak flow?

Answer 4

Blowing as hard as you can into small device called a peak flow meter.

Measures how quickly you can blow air out of your lungs.

Question 5

Peak flow - results interpretation?

Answer 5

Normal score based on age, height and gender

Significant difference between scores (diurnal variation) - suggests poorly controlled

Average low score - airways are always narrowed

Question 6

Questions to ask asthma patients (peak flow)?

Answer 6

Taking meds - how often need blue inhaler?
Inhaler technique, know which for what?
Seeing asthma nurse?
Triggers?
How is it affecting their life - work, activity, exercise etc
How do they feel at the moment?
Social
 - pets
 - smoking
 - change in housing etc

Question 7

What is spirometry?

Answer 7

Tests used to diagnose and monitor certain lung diseases.

Measures how much you can breathe out in one forced breath, and the maximal amount of air you can blow out.

Question 8

Spirometry - results interpretation?

Answer 8

FEV1 - depends on age, sex, height ethnicity

Obstructive - FEV1/FVC ratio <70%

Restrictive - FEV1/FVC ratio normal (both decrease by same amount)

Question 9

Questions to ask - spirometry?

Answer 9

Taking meds - inhalers, how often need rescue?
Inhaler technique, know which for what?
Any triggers or hospital admissions?
How is it affecting their life - work, activity, exercise etc
How do they feel at the moment?
Social
 - pets
 - smoking
 - change in housing etc

Question 10

What is a HbA1c?

Answer 10

Blood test to give an overall picture of how blood sugar levels have been over a period of 8-12 weeks - provides a useful gage of blood glucose control.

Question 11

HbA1c results interpretation?

Answer 11

Higher score = higher risk of developing diabetes

Below 42 = normal
42 - 47 = pre diabetes
48+ = diabetes

People with diabetes should aim to have HbA1c as close to 48 as possible.

Question 12

How and why to improve HbA1c results?

Answer 12

Reduce by healthy diet, taking medication, losing weight, exercising etc.

Improving my 1% can reduce risk of microvascular complications of diabetes by 25%, 43% less likely to require amputation

Question 13

Questions to ask diabetic / prediabetic patients?

Answer 13

When were they diagnosed?
How is it affecting their life?
Diet and exercise?
Alcohol
Smoking (increases risk microvascular complications)
Becoming tired - symptoms???
Compliance with meds - do they find it hard, SE’s?

Question 14

What is a CRP?

Answer 14

C-reactive protein.

Inflammatory marker produced in liver, used to help in diagnosis of infections, autoimmune disorders and certain cancers.

Question 15

What causes a raised CRP?

Answer 15

Trauma
Infection eg pneumonia, TB
Burns
MI / VTE
IBD
Certain cancers
Chronic inflammatory diseases eg SLE, vasculitis, RA

Question 16

What is an ESR?

Answer 16

Erythrocyte sedimentation rates, erythrocytes are a type of blood cell.

Helps in diagnosing things that can cause inflammation in the body eg infection, bloods problems, problems with connective tissue or some types of cancer

Question 17

What can cause a raised ESR?

Answer 17

Malignancy

• lymphoma
• carcinoma of breast or colon

Haemologic

• multiple myeloma
• anaemia of acute or chronic disease combined with Fe deficiency anaemia

Connective tissue disorders

• SLE
• RA
• polymyalgia rheumatica
• temporal arteritis

Infection

• TB
• acute hepatitis
• bacterial

Question 18

Inflammatory markers - what to ask patient?

Answer 18

Start by saying very none specific but are sensitive.

Are they smoking?
Medication compliance?
What symptoms are they having - how is this affecting their life?
Mobility - joints, when worse, ADLs?

Question 19

What are LFTs?

Answer 19

Liver function tests, do what it says on the tine - see how well the liver is working.

Question 20

LFT interpretation?

Answer 20

Reference rangers dependant on age, gender, health, ethnicity and unit of measurement.

General:
AST, ALT - liver health
ALP, GGT - biliary tree health
Bilirubin, albumin, PT - liver functioning

Specific:
ALT - hepatocellular injury
ALP - cholestasis, bone tumours or fractures
AST - alcohol
GGT - alcohol drugs, with raised ALP very suggestive cholestasis
AST/ALT ratio:
ALT>AST - chronic disease
AST>ALT - cirrhosis and acute alcoholic hepatitis

Question 21

LFTs - what to ask the patient

Answer 21

Liver symptoms
Recent travel - tattoos
Unprotected sex
Alcohol - CAGE
IVDU
Diet

Question 22

What are tumour markers?

Answer 22

Substances produced by cells in response to cancer and non-cancerous conditions.
Many different types, tumour dependent.
Most made by normal cells as well as cancer cells - higher levels in cancerous conditions.

Question 23

How and why are tumour markers investigated?

Answer 23

Taken from various bodily fluids, usually blood, sometimes urine.

Used to determine

• diagnosis, staging prognosis
• whether treatment is working
• whether there is recurrence

Question 24

Tumour markers - questions to ask patients?

Answer 24

SYMPTOMS OF CANCER!!
Weight loss, night sweats, fever.

Current medications and compliance
Impact on life
ICE
Support