Chronic disease management Flashcards
How do you start a chronic disease station?
‘I am aware you have a diagnosis of … and you have had some blood samples taken’
‘are you aware of these tests and how we use it?’
‘it looks like they are higher/lower than normal’
What is the structure of a chronic disease station?
- results
- PC
- DH - adherence
- Social history - stress/diet changes
- ICE
What is INR?
International normalised ratio - a measure of how likely blood is to clot
How do you interpret INR?
High INR - more likely to bleed
Low INR - more likely to clot
What are normal INR levels?
Normal patients 1
Patients on warfarin 2-3
What can cause a high INR (bleeding)?
Double dosing, NSAIDs, liver failure, antibiotics, binge drinking, smoking, aspirin, clopidogrel
What can cause a low INR (clotting)?
Poor compliance with warfarin, leafy green vegetables, cranberry/grapefruit, St John’s wort, rifampicin, HRT, COCP
What should you ask about warfarin compliance?
- do they take their meds as normal
- do they take it at the same time each day
- have they missed any doses
- have they taken any extra if they have missed a dose
- have they been started on any other meds/OTC
What is a peak flow?
How fast you can expel air from your lungs
What questions do you ask about asthma control?
- how has your asthma been recently?
- Any new symptoms - cough/SOB/chest pain/haemoptysis
- any recent infections
- any recent travel
- when did they last have their asthma assessed?
- have they been admitted to hospital for their asthma?
What does the blue inhaler do?
Blue = reliever - used for acute symptoms
What does the brown inhaler do?
Preventer - used daily
What questions would you ask about inhaler use?
- have you been needing to use your blue inhaler more?
- are you using the brown inhaler every day?
- Do you use a spacer with your inhaler?
- Can you explain how you use your inhaler?
What do you ask about in a social history with asthma?
- Smoking
- job changes
- damp/dust in the house
- pets
- impact of breathing on life
- ICE
What is HbA1c?
A measure of blood glucose control over the last 3 months by measuring the amount of sugar that is stuck to red blood cells
What are the normal and diabetic HbA1c levels?
Normal = <42
Pre-diabetes = 42-47
Diabetes = >48
What do you ask about in a HbA1c station?
- what type of diabetes?
- how long have they had it?
- how was it diagnosed?
- how do they think their management is?
- do they understand the benefits of having a low HbA1c?
What symptoms do you ask about in diabetes?
polyuria, polydipsia, weight changes, fatigue
vision changes, UTIs, erectile dysfunction
foot changes
What do you ask about medications on a HbA1c station?
- what are they taking for their diabetes?
- Do they miss doses/double up?
- are they on any steroids? (this can increase blood sugars)
What are LFTs?
Blood tests to measure the function of the liver and gallbladder
What symptoms do you ask about in an LFT station?
Abdo pain, bloating, jaundice (urine and stool changes), vomiting, bleeding, fever, weight loss, night sweats
What other things do you ask about in an LFT station?
recent foreign travel, IVDU, tattoos, blood products, dodgy food, unprotected sex, alcohol, smoking
What causes an acutely raised GGT?
alcoholic liver disease
What does a raised ALT mean?
liver issues
What does a raised ALP mean?
Biliary tree issues
What type of jaundice is it if there are stool and urine changes?
Post-hepatic/ obstructive jaundice
What are some causes of raised inflammatory markers?
- infections
- malignancy
- connective tissue disorders (rheumatoid)
- IBD
- burns
- Trauma
