Chronic Disease Management

Question 1

Overall

Answer 1

1. Understanding- explain what score is and why they are taking what they do/ what it is being used to assess
2. Symptoms of different management
3. PMH- specific to score
4. Drug history- Adhering to medication
5. Social history- Diet changes, alcohol, exercise

Question 2

Drug history

Answer 2

“Do you know how many times you are meant to be taking ….?”
“How and when do you take it’’
“Have you missed any doses-if so, did you double the dose?’’
“Are you struggling with your current medication regime or is it okay?’’
“Any other/new medications – including over the counter

Question 3

Social history

Answer 3

Any changes in diet?
Alcohol
Smoking
Stress

Question 4

HbA1c

Answer 4

HbA1c shows us the average
blood glucose level over the
previous 2-3 months as the sugar
sticks to cells in our blood

We want it lower as it reduces the risk of retinopathy, neuropathy, diabetic nephropathy.

42 or lower is normal, 43-47 is prediabetic, over 48 is diabetic

What condition and understanding

Recent infections/illnesses (affecting insulin dose), DKA/hypoglycaemia admissions, symptoms: (polyuria, polydipsia, vision, changes in feet), diet, exercise

Drug history

Question 5

INR

Answer 5

INR is a ratio of prothrombin time- how long blood takes to clot. 1 is normal. On warfarin aim for 2-3- 2.5 is best.

Warfarin- used to treat DVT/PE/Stroke in AF/ Clots in prosthetic heart valves

INR symptoms- High bleed too easily (headache, stomachache, increased/easier bruising, prolonged bleeding after minor cuts/gums). Low- constant clotting- inability to speak/loss of tone/ pain/ redness/heat

Social- Diet- more vit K in green leafy veg.
Alcohol- Binge drinking increases INR, stopping alcohol INR decreases. Smoking causes INR to increase

Management- High INR- Vit K or Warfain dose decrease
Low- LMWH and warfarin, compression stockings, diet change

Question 6

Peak Flow

Answer 6

Measures how fast you can breathe out
so you can see how well your lungs are

DH- how well controlled is the asthma?

Social history- Pets? Recent travel? Housing (damp)? Hay fever? Smoking- patient or others i house? Alcohol? Smoking? Impact of condition

Question 7

Spirometery

Answer 7

Measures lung function, specifically the
volume and speed of air that can be
inhaled/exhaled

Question 8

Inflammatory markers

Answer 8

What causes a raised CRP? What causes a raised ESR?

Question 9

LFTs

Answer 9

Albumin –
Low;
Can be a sign of malnutrition (Crohn’s/UC, coeliac).
Kidney disease, liver disease (hepatitis, cirrhosis).
High;
Severe infections/dehydration, chronic inflammatory diseases, hepatitis.

Globulins –
Total proteins.

Bilirubin –
High conjugated = liver/bile duct disease.
High unconjugated = Gilbert’s or haemolytic anaemia.

Liver enzymes increase in –
Chronic high alcohol excess.
Obesity (especially in men).
Smoking (in women).
Drug reaction.

ALP –
Bile duct obstruction stimulates ALP synthesis;
Increase in obstructive liver disease.
Non-hepatic origin like increased osteoblastic activity in Paget’s, osteomalacia, vitamin D deficiency.

GGT –
Liver disease markers of drugs/alcohol (increases)

AST or ALT –
Liver disease markers of drugs, toxins, viral (increases).

GGT + ALP –
Biliary problems.

AST + ALT –
Hepatic problems.

GGT + ALP risen > AST + ALT –
Obstructive jaundice.