Chronic Disease Management Flashcards
What is the normal value for HbA1c?
<42 mmol/L or <6%
What is the Diabetic value for HbA1c?
> 48 mmol/L or 6.5%
What is HbA1c?
a blood test to show us the average blood glucose level over the previous few months as the sugar sticks to you cells
What specific questions should be asked in diabetes PMHx?
Understanding of diabetes
Understanding of HbA1c
When diagnosed
Type
How well managed
Hx of CVD
macro and microvascular complications
kidney failure - raise hba1c
sickle cell/thallaseamia/blood loss - decreases hba1c
What are the benifits of lowering HbA1c?
Reduces risk of retinopathy, neuropathy, nephropathy, cataracts, heartfailure, amputation
What specific questions sould be included in the HxPC for diabetes?
HbA1c
How feeling
Recent infection/illness
Hospital admissions due to diabetes
Diabetes symptoms
Diabetes symptoms
Polyuria
Polydipsia
Weight loss
Vision changes
tingling feet
impotence
DHx questions for HbA1c
diabetes meds
other meds
when/how taking meds
side effects
are they monitoring glucose levels
are they managing
any med changes
when should metformin be taken?
with or after evening meal
SHx questions for HbA1C
ADLs
Diet - B12 deficiency can increase HbA1c
exercise
smoking
alcohol - can increase HbA1c
Advice for lowering HbA1c
Diet
Exercise
sick day rules - check BMs more, take meds, check ketones
Support - DAFNE and DAMOND, DNS
What is CRP?
non-specific acute inflammatory marker produced by liver
What is ESR?
RBCs more sticky due to increased fibrinogen - rises and falls slowly
What is INR?
Blood test to look at how well blood clots
increased = less clotty
decreased = more clotty
How should warfarin be taken?
same time every day preferably in the evening
DO NOT double dose
what questions to include in PMHx for INR?
why on warfarin?
do they get INR taken regularly?
what is INR normally like?
liver failure
bleeding disorders
what is the ideal INR?
2.5
what are symptoms of high INR?
headaches
severe stomach ache
increased bruising
prolongued bleeding
blood in urine
what are some symptoms of decreased INR?
sudden weakness/numbness/tingling in limbs
visual changes
inability to speak
new pain, swelling or redness in leg
new SOB or chest pain
questions to include in warfarin DHx
do you know how to take warfarin
Same time every day
when and how do you take it
missed any doses
double dosed
keeping up with meds?
any other medications - NSAIDs/Apirin increase, OCP/HRT decrease
Antibiotics
steroids
HxPC questions to ask about warfarin?
how are they feeling
recent illness
diarrhoea/vomiting
bloody/dark stools/vomit
high INR symptoms
Low INR symptoms
SHx questions to ask about warfarin
diet - leafy veg
binge drinking
smoking
treatment for high INR
vitamin K
blood components
decrease dose
Treatement for low INR
LMWH
increase dose
compression stockings
