Chronic disease management Flashcards
What is INR? What does a high INR mean?
- 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.
What is the normal INR? What INR value should those on warfarin aim for? Why may some people have a high INR but not be on warfarin?
- Normal INR is 1
- Those on warfarin should aim for 2–3 (2.5 as an ideal). Warfarin increased blood clotting time.
- People with an INR higher than the normal range who are not taking warfarin may have a medical condition.
What is warfarin? Why are patients usually given warfarin?
- Vitamin K antagonist (blocks vitamin K epoxide reductase) leading to decrease in factors 2, 7, 9 and 10 - ‘Warfarin is an anticoagulant which means its job is to stop the blood from clotting too easily’.
- Regular blood tests, take at same time every day, DO NOT DOUBLE DOSE to CATCH UP.
- Commonly used to treat blood clots (DVT/PE/prevent stroke in AF).
What are some high INR symptoms?
- Headache, severe stomach ache.
- Increased bruising.
- Prolonged bleeding after minor cuts/menstrual bleeding/gum bleeding.
- Blood in urine.
What are some 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).
What can cause the INR to increase/decrease?
Increase: taking too much anticoagulant medication, alcohol, diarrhoea + vomiting
Decrease: vitamin K, e.g. green fruit + vegetables. It’s not necessary to avoid these foods but it’s important to keep the amount of vitamin K consistent if you’re on warfarin.
What advice can we give to those with a raised INR?
- Avoid activities that can cause bleeding/bruising.
- Brush/shave gently.
- Tell dentist and any other HCP that you take anticoagulants.
How do we treat an elevated 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.
How do we treat a low INR?
- LMWH, warfarin.
- Compression stockings if immobile.
What does HbA1c show (patient explanation)?
HbA1c shows us the average blood glucose level over the previous 2–3 months as the sugar sticks to cells in our blood.
What are the normal, pre-diabetes and diabetic levels for HbA1c?
- Normal is <42mmol/L or <6.0%.
- Pre-diabetes is 42 < mmol/L ≤ 47 or 6–6.4%.
- Diabetes is ≥48mmol/L or 6.5%.
What can HbA1c be falsely raised in?
- Kidney failure.
- Chronic excessive alcohol intake.
- Vitamin B12 deficiency.
What can HbA1c be falsely decreased in?
- Acute/chronic blood loss.
- Sickle cell disease.
- Thalassaemia.
What is the advice for lowering HbA1c?
- Dietary modifications: awareness of snacking and sugary foods/carbs affecting the blood sugar level.
- Physical activity: getting regular exercise can help stop blood sugar levels rising. Check with doctor first because some diabetes medicines can lead to hypoglycaemia if you exercise too much.
- Take extra care when ill: “sick day rules” check blood sugar more regularly (4h), keep taking diabetes medications even if you don’t feel like eating, contact diabetes team, check ketones.
- Monitor blood sugar level - so you can spot an increase early and take steps to prevent it.
- Support available: GP, diabetes nurses, online resources, training courses.
What are peak flow and spirometry?
- Peak flow: “The peak flow test measures how fast you can breathe out, so you can see how well your lungs are working.” Take your peak flow before using the preventer inhaler. Always use the same peak flow meter.
- Spirometry: “It measures lung function, specifically the amount (volume) and/or speed (flow) of air that can be inhaled and exhaled.”
