CHRONIC DISEASE MANAGEMENT Flashcards
What are some key general questions to make sure you ask in any chronic disease management station
Confirm when they were diagnosed/had this problem established
Do you know what we are measuring is/why we have measured it? CHECK UNDERSTANDING
Ask about any new symptoms they are having, specific to the disease
Ask about their current adherence to their treatment regime (if relevant), and factors that can influence this, eg side effects of medication
How it is affecting their day to day life, physically and emotionally
How would you explain INR to a patient in patient-friendly language?
What is the normal range and what should it be for people on Warfarin?
- International normalized ratio: is a measure of how long it takes for your blood to clot - the longer the INR, the longer time it’ll take for your blood to clot.
normal INR is 1 and people on warfarin should aim for 2-3.
What is warfarin and when should it be taken?
- It is a vitamin K antagonist.
- It needs to be taken at the same time every day, regular blood tests need to be done. DO NOT DOUBLE DOSE
Why may people commonly be on Warfarin?
Commonly used to treat blood clots (DVT/PE/prevent stroke in AF).
What questions would you ask in a presenting complaint for an INR history?
Ask how they are feeling?
Any recent infections/illnesses?
Any diarrhoea/vomiting?
Bloody/dark stool or vomit.
What are symptoms you should ask for that could point to a patient having a high INR
Headache, severe stomach ache.
Increased bruising.
Prolonged bleeding after minor cuts/menstrual bleeding/gum bleeding after brushing teeth .
Blood in urine.
What are symptoms you should ask for that could point to a patient having a low INR
Any 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 things in a PMH can influence an INR
Liver failure (lack of clotting factors).
Bleeding disorders (haemophilia, factor 7 deficiency).
What things in a social history can cause an INR to increase? What comment should you make about such things?
Enquire about their diet, any changes either increase/decrease in vitamin K intake;
Foods containing vitamin K are green fruit/veg like broccoli, kale, celery, cucumber, green beans, green apples/grapes, pears, avocado.
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.
Binge drinking alcohol and smoking can cause INR to increase.
How can you treat a low INR
Treating low INR –
LMWH, warfarin.
Compression stockings if immobile.
How can you treat a high 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.
what extra things do you need to ask in an INR history
Weight change (weight gain can decrease INR)
Sleep
How long they’ve been taking warfarin
Establish Vitamin K intake, and why that has changed if relvevant
What specific things would you need to ask in a FRAX/osteoporosis related history
ask drug history
Specifically ask about Oral steroids
Ask PMH, Specificially about rheumatoid arthritis
Ask about conditions that are risks for
secondary osteoporosis (T1DM, Osteogenesis imperfecta, Hyperthyroidism, Premature menopause, (for female patients), malnutrition/malabsorption,
liver disease)
Any family HIstory of hip factures
Personal history of Fractures and nature - were they low impact?
What is a normal Hba1c
What is prediabetic and what is diabetic
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%
How can you explain what Hba1c is to a patient
HbA1c shows us the average blood glucose level over the previous 2–3 months as the sugar sticks to cells in our blood.
What general things do you need to establish in an Hba1c history
What type of DM
When were they diagnosed
Hows it affecting their life,
Any changes in exercise, diet, alchohol –> anything that can influence their hba1c
How well they feel their diabetes is being managed
Have they been recently ill at all
What things around medication do you need to estabslish in an Hba1c history
Adhereance to medication
Any side effects of medication (polyuria, Hypos, thrush around genitals)
Are they injecting insulin at the same site
What specific symptoms do you need to enquire about in a hba1 history
Polyuria and polydipsia
Vision/visual changes
Ask about neuropathy/tingling
Stress levels and mood
Sleep disturbance
Weight change, either gain or loss
Impotence
How would you explain Peak flow and spirometry to a patient
Peak flow test measures how fast you can breathe out so you can see how well your lungs are working.
Spirometry measures lung function, specifically the amount (volume) and the speed (flow) of air that can be inhaled/exhaled.
What things may be a presenting complaint in a patient with chronic asthma
What other general questions should you ask as part of a PC
Any recent illnesses/infections?
Any SOB?
Any hospital admissions due to asthma at all?
Is there any particular time you notice your condition worsens (winter etc).
Wheeze is getting worse.
Affecting ADL.
IF they are Waking up at night with symptoms (SOB, cough).
Using reliever inhaler more than usual.
What key things should you ask about in a drugs/allergy history in chronic asthma management
What medications do you take? Which inhalers do you use and how often?
Have the number of times you’ve needed to use an inhaler changed.
Do you take any other medications (if on steroids then severe).
Any beta-blockers.
Ask about inhaler technique and check inhaler use has been assessed by the nurse.
Do they use a spacer
Ask about allergies/hayfever, and any allergies in the family and excema
What key things should you ask about in a social history for chronic disease management of asthma
Any (new) pets?
Recent travel anywhere?
Particularly to places that are polluted.
Housing situation (damp)?
Hayfever.
Smoking? Alcohol?
are you exposed to any cigarette smoke
Any changes to job? what do you do?
Impact of condition on life.
How would you explain what CRP is to a patient
Substance produced by the liver and increases in the presence of inflammation.
Acute marker.
How would you explain what ESR is to a patient, and what is the key difference between ESR and CRP
Increased fibrinogen means RBCs stick together and so fall faster.
Raised ESR = rate of fall quicker.
ESR rises and falls slowly.
