Chronic disease management Flashcards
what is a normal INR?
1 for normal people
2-3 for people on warfarin etc
How would you manage someone on warfarin
Regular blood tests, take at same time every day, do not double dose to catch up
How would you explain to a patient what warfarin and INR are
Warfarin is an anticoagulant and that means its job is to stop the blood from clotting too easily
INR is and the risks of it being high/low;
Provides information about someone’s bloods tendency to clot.
The higher the INR, the longer it takes the blood to clot and so the increased bleeding risk. The lower the INR, the thicker the blood so increased clotting risk.
Always double check if they know why they are taking their medication and clarify if otheriwise
What are some high INR symptoms
Always ask about infections and diarrhoea (plus ICE)
Any high INR symptoms?
Headache, severe stomach ache.
Increased bruising.
Prolonged bleeding after minor cuts/menstrual bleeding/gum bleeding.
Blood in urine.
Low INR symptoms
Sudden weakness/numbness/tingling in any limb, visual changes, inability to speak (stroke symptoms).
New pain, swelling, redness, heat in body parts or new SOB or chest pain (DVT/PE symptoms).
Social history questions for INR
Enquire about their diet, any changes either increase/decrease in vitamin K intake;
Foods containing vitamin K are green fruit/veg
Binge drinking and smoking can increase INR
Treating low INR
LMWH, warfarin.
Compression stockings if immobile.
Treating high INR
Vitamin K.
Blood components may be given during a transfusion to help stop bleeding.
If there is no clear explanation then the warfarin dose can be decreased and INR rechecked.
Advice to decrease risk of bleeding
Avoid activities that can cause bleeding/bruising.
Brush/shave gently.
Tell dentist and any other HCP that you take anticoagulants.
How would you explain and start an Hba1c station?
Check when the patient was diagnosed, if it’s T1/T2 and their understanding of their diabetes and HbA1c;
HbA1c shows us the average blood glucose level over the previous 2–3 months as the sugar sticks to cells in our blood.
How well do they think their diabetes is being managed plus the benefits of a low Hba1c
What sort of symptoms would you screen for Hba1c
Diabetes specific: Polyuria, polydipsia, weight loss, vision changes, tingling in feet, impotence (ED).
Otherwise:
Diarrhoea, vomiting, infection and illness
ANY HOSPITAL VISITS BECAUSE OF DIABETES
Social history for Hba1c
ADLs; How is your mood/sleep? Are home circumstances okay? Do you feel like your disease is affecting your ADLs. Diet; Adhering to dietary restrictions? Been on a recent diet/tried to lose weight? Exercise. Smoking + alcohol.
What advice could you give to someone who wants to lower their Hba1c
Diet and exercise but be careful about hypoglycaemia so chat with a doctor before you do that
‘sick day rules’ so check blood glucose more regularlty when ill
support is available- courses and diabetes nurses
How should patients be instructed to do their peak flow?
Take your peak flow before using the preventer inhaler.
Always use the same peak flow meter.
What is an obstructive lung disease?
Causes;
Reversible (asthma) and irreversible (COPD).
Bronchiectasis.
Inhaled foreign body, tumour.
Takes a long time to exhale (wheeze) so not much breathed out at 1 second but volumes not bad overall.
FEV1 < FVC
FEV1/FVC < 0.7 with FEV1 < 80% predicted.
Restrictive lung disease?
Usually diseases of the interstitium affecting chest wall movement and elasticity;
Scoliosis, kyphosis, ankylosing spondylitis.
Neuromuscular diseases like Guillain-Barré syndrome, myasthenia gravis.
Pulmonary fibrosis, sarcoidosis, asbestosis.
Due to restriction, lung volumes are small and most of breath is out in the first second.
How would you explain peak flow to a clueless patient
Peak flow test measures how fast you can breathe out so you can see how well your lungs are working.
Red flags for peak flow stuff
Wheeze is getting worse. Affecting ADL. Waking up at night with symptoms (SOB, cough). Using reliever inhaler more than usual. Hospital visits for asthma
Generic systemic peak flow questions
Infections, SOB, when is it better and worse, excaerbations
DH for peak flow station
How well do you think your condition is being controlled?
What medications do you take? Which inhalers do you use and how often?
Do you take any other medications (if on steroids then severe).
Any beta-blockers.
Check inhaler technique and check inhaler use has been assessed by the nurse.
Peak flow social history
Pets, travel, furniture, NEW JOB !!!!!, hayfever, alcohol and smoking
What advice would you give to someone with a crap peakflow
Stop smoking. Avoid precipitants. Vaccination (flu). Exercise. Eating. Support.
How would you explain CRP/ESR to a patient
It’s a marker of inflammation which tells us that there could be a flare up in your condition or new infection detected.
PC for an inflammation station?
PC –
How are they feeling?
Any recent illnesses/infections?
Drug history for an inflammation station
How well do you think your condition is being controlled?
What medications do you take? How often?
Any issues taking your mediation?
Do you take any other medications?
Advice to patient- inflammation
Stop smoking.
Advice on disease management if they’re non-compliant.
Causes of Raised CRP
Burns, trauma.
Infections (pneumonia, TB).
Chronic inflammatory diseases (SLE, vasculitis, RA).
MI, IBD, cancers.
What causes a raised ESR
Causes for raised ESR – Malignancy; Haematological; Multiple myeloma. Anaemia of acute/chronic disease combined with iron deficiency anaemia. Connective tissue disorders; SLE, RA. Polymyalgia rheumatica and temporal arteritis. Infections;
I have not done LFTs (flip)
This is not a flashcard but a disclaimer
