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Phase 2B > Chronic Disease Management > Flashcards

Chronic Disease Management Flashcards

1
Q

What is the normal value for HbA1c?

A

<42 mmol/L or <6%

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2
Q

What is the Diabetic value for HbA1c?

A

> 48 mmol/L or 6.5%

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3
Q

What is HbA1c?

A

a blood test to show us the average blood glucose level over the previous few months as the sugar sticks to you cells

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4
Q

What specific questions should be asked in diabetes PMHx?

A

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

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5
Q

What are the benifits of lowering HbA1c?

A

Reduces risk of retinopathy, neuropathy, nephropathy, cataracts, heartfailure, amputation

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6
Q

What specific questions sould be included in the HxPC for diabetes?

HbA1c

A

How feeling
Recent infection/illness
Hospital admissions due to diabetes
Diabetes symptoms

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7
Q

Diabetes symptoms

A

Polyuria
Polydipsia
Weight loss
Vision changes
tingling feet
impotence

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8
Q

DHx questions for HbA1c

A

diabetes meds
other meds
when/how taking meds
side effects
are they monitoring glucose levels
are they managing
any med changes

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9
Q

when should metformin be taken?

A

with or after evening meal

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10
Q

SHx questions for HbA1C

A

ADLs
Diet - B12 deficiency can increase HbA1c
exercise
smoking
alcohol - can increase HbA1c

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11
Q

Advice for lowering HbA1c

A

Diet
Exercise
sick day rules - check BMs more, take meds, check ketones
Support - DAFNE and DAMOND, DNS

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12
Q

What is CRP?

A

non-specific acute inflammatory marker produced by liver

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13
Q

What is ESR?

A

RBCs more sticky due to increased fibrinogen - rises and falls slowly

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14
Q

What is INR?

A

Blood test to look at how well blood clots
increased = less clotty
decreased = more clotty

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15
Q

How should warfarin be taken?

A

same time every day preferably in the evening
DO NOT double dose

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16
Q

what questions to include in PMHx for INR?

A

why on warfarin?
do they get INR taken regularly?
what is INR normally like?
liver failure
bleeding disorders

17
Q

what is the ideal INR?

A

2.5

18
Q

what are symptoms of high INR?

A

headaches
severe stomach ache
increased bruising
prolongued bleeding
blood in urine

19
Q

what are some symptoms of decreased INR?

A

sudden weakness/numbness/tingling in limbs
visual changes
inability to speak
new pain, swelling or redness in leg
new SOB or chest pain

20
Q

questions to include in warfarin DHx

A

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

21
Q

HxPC questions to ask about warfarin?

A

how are they feeling
recent illness
diarrhoea/vomiting
bloody/dark stools/vomit
high INR symptoms
Low INR symptoms

22
Q

SHx questions to ask about warfarin

A

diet - leafy veg
binge drinking
smoking

23
Q

treatment for high INR

A

vitamin K
blood components
decrease dose

24
Q

Treatement for low INR

A

LMWH
increase dose
compression stockings

25
Q

What can low albumin signify?

A

malnutrition - crohns/UC
kidney disease
liver disease

26
Q

what can high albumin signify?

A

severe infection
dehydration
chronic inflammatory disease
hepatitis

27
Q

what does high conjugated bilirubin suggest?

A

liver/bile duct disease

28
Q

what does high unconjugated bilirubin suggest?

A

gilberts disease or haemolytic anaemia

29
Q

What does deranged ALP suggest?

A

increased in obstructive liver disease and bile duct obstruction
can be non-hepatic - osteoblast activity

30
Q

what is GGT a marker for?

A

liver disease due to drugs/alcohol

31
Q

what is deranged AST or ALT a marker for?

A

liver disease due to drugs, toxins or viruses

32
Q

what is deranged GGT + ALP a sign of?

A

billiary problems

33
Q

what id deranged AST + ALT a marker for?

A

hepatic problems

34
Q

GGT + ALP > AST + ALP means…

A

Obstructive jaundice

35
Q

How often should asthmatics do a peak flow?

A

every day before taking preventer ihaler

36
Q

what is peak flow?

A

measures how fast you can breath out in one second to see how well your lungs are working

37
Q

SHx questions for peak flow

A

new pets
any travel
occupation
exercise
home situation
hay fecer
smoking
alcohol
ADLs

38
Q

DHx questions for peak flow

A

how well controlled
what medications
which inhalers and how often
other meds?
beta blockers
inhaler technique
asthma nurse?

Phase 2B (3 decks)

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