Chronic disease management

Question 1

what is a normal INR?

Answer 1

1 for normal people

2-3 for people on warfarin etc

Question 2

How would you manage someone on warfarin

Answer 2

Regular blood tests, take at same time every day, do not double dose to catch up

Question 3

How would you explain to a patient what warfarin and INR are

Answer 3

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

Question 4

What are some high INR symptoms

Answer 4

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.

Question 5

Low INR symptoms

Answer 5

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).

Question 6

Social history questions for INR

Answer 6

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

Question 7

Treating low INR

Answer 7

LMWH, warfarin.

Compression stockings if immobile.

Question 8

Treating high INR

Answer 8

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.

Question 9

Advice to decrease risk of bleeding

Answer 9

Avoid activities that can cause bleeding/bruising.
Brush/shave gently.
Tell dentist and any other HCP that you take anticoagulants.

Question 10

How would you explain and start an Hba1c station?

Answer 10

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

Question 11

What sort of symptoms would you screen for Hba1c

Answer 11

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

Question 12

Social history for Hba1c

Answer 12

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.

Question 13

What advice could you give to someone who wants to lower their Hba1c

Answer 13

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

Question 14

How should patients be instructed to do their peak flow?

Answer 14

Take your peak flow before using the preventer inhaler.

Always use the same peak flow meter.

Question 15

What is an obstructive lung disease?

Answer 15

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.

Question 16

Restrictive lung disease?

Answer 16

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.

Question 17

How would you explain peak flow to a clueless patient

Answer 17

Peak flow test measures how fast you can breathe out so you can see how well your lungs are working.

Question 18

Red flags for peak flow stuff

Answer 18

Wheeze is getting worse.
Affecting ADL.
Waking up at night with symptoms (SOB, cough).
Using reliever inhaler more than usual.
Hospital visits for asthma

Question 19

Generic systemic peak flow questions

Answer 19

Infections, SOB, when is it better and worse, excaerbations

Question 20

DH for peak flow station

Answer 20

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.

Question 21

Peak flow social history

Answer 21

Pets, travel, furniture, NEW JOB !!!!!, hayfever, alcohol and smoking

Question 22

What advice would you give to someone with a crap peakflow

Answer 22

Stop smoking.
Avoid precipitants.
Vaccination (flu).
Exercise.
Eating.
Support.

Question 23

How would you explain CRP/ESR to a patient

Answer 23

It’s a marker of inflammation which tells us that there could be a flare up in your condition or new infection detected.

Question 24

PC for an inflammation station?

Answer 24

PC –
How are they feeling?
Any recent illnesses/infections?

Question 25

Drug history for an inflammation station

Answer 25

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?

Question 26

Advice to patient- inflammation

Answer 26

Stop smoking.

Advice on disease management if they’re non-compliant.

Question 27

Causes of Raised CRP

Answer 27

Burns, trauma.
Infections (pneumonia, TB).
Chronic inflammatory diseases (SLE, vasculitis, RA).
MI, IBD, cancers.

Question 28

What causes a raised ESR

Answer 28

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;

Question 29

I have not done LFTs (flip)

Answer 29

This is not a flashcard but a disclaimer