Chronic disease control Flashcards
What is an INR
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 - sees how well your blood is clotting
The INR calculation is based on the ratio between the prothrombin times of the test and control samples.
What is the therapeutic range INR
2-3. Ideally 2.5 if on warfarin
In a healthy person, it should be 1.
It is higher in warfarin usage as the blood is more prone to clotting so we want it to take 2-3x as long to clot than their normal.
INR - results interpretation?
Varies according to age, meds, health problems
INR levels that are too low may mean you are at risk for dangerous blood clots.
INR levels that are too high may mean you are at risk for dangerous bleeding.
SHOULD BE 2-3 IF TAKING WARFARIN (value varies based on condition)
What do you need to ask a patient taking warfarin?
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
What can reduce the effect of warfarin?
Weight gain Diarrhoea Vomiting Starting smoking Increasing vitamin K intake
What can exaggerate the effect of warfarin?
Weight loss
Acute illness
Smoking cessation
What is a peak flow?
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.
Peak flow - results interpretation?
Normal score based on age, height and gender
Significant difference between scores (diurnal variation) - suggests poorly controlled
Average low score - airways are always narrowed
Questions to ask asthma patients (peak flow)?
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
What is spirometry?
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.
Spirometry - results interpretation?
FEV1 - depends on age, sex, height ethnicity
Obstructive - FEV1/FVC ratio <70%
Restrictive - FEV1/FVC ratio normal (both decrease by same amount)
Questions to ask - spirometry?
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
What is a HbA1c?
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.
HbA1c results interpretation?
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.
How and why to improve HbA1c results?
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
Questions to ask diabetic / prediabetic patients?
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?
What is a CRP?
C-reactive protein.
Inflammatory marker produced in liver, used to help in diagnosis of infections, autoimmune disorders and certain cancers.
What causes a raised CRP?
Trauma Infection eg pneumonia, TB Burns MI / VTE IBD Certain cancers Chronic inflammatory diseases eg SLE, vasculitis, RA
What is an ESR?
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
What can cause a raised ESR?
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
Inflammatory markers - what to ask patient?
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?
What are LFTs?
Liver function tests, do what it says on the tine - see how well the liver is working.
LFT interpretation?
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
LFTs - what to ask the patient
Liver symptoms Recent travel - tattoos Unprotected sex Alcohol - CAGE IVDU Diet
