Chronic disease management

Question 1

How do you start a chronic disease station?

Answer 1

‘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’

Question 2

What is the structure of a chronic disease station?

Answer 2

• results
• PC
• DH - adherence
• Social history - stress/diet changes
• ICE

Question 3

What is INR?

Answer 3

International normalised ratio - a measure of how likely blood is to clot

Question 4

How do you interpret INR?

Answer 4

High INR - more likely to bleed
Low INR - more likely to clot

Question 5

What are normal INR levels?

Answer 5

Normal patients 1
Patients on warfarin 2-3

Question 6

What can cause a high INR (bleeding)?

Answer 6

Double dosing, NSAIDs, liver failure, antibiotics, binge drinking, smoking, aspirin, clopidogrel

Question 7

What can cause a low INR (clotting)?

Answer 7

Poor compliance with warfarin, leafy green vegetables, cranberry/grapefruit, St John’s wort, rifampicin, HRT, COCP

Question 8

What should you ask about warfarin compliance?

Answer 8

• 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

Question 9

What is a peak flow?

Answer 9

How fast you can expel air from your lungs

Question 10

What questions do you ask about asthma control?

Answer 10

• 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?

Question 11

What does the blue inhaler do?

Answer 11

Blue = reliever - used for acute symptoms

Question 12

What does the brown inhaler do?

Answer 12

Preventer - used daily

Question 13

What questions would you ask about inhaler use?

Answer 13

• 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?

Question 14

What do you ask about in a social history with asthma?

Answer 14

• Smoking
• job changes
• damp/dust in the house
• pets
• impact of breathing on life
• ICE

Question 15

What is HbA1c?

Answer 15

A measure of blood glucose control over the last 3 months by measuring the amount of sugar that is stuck to red blood cells

Question 16

What are the normal and diabetic HbA1c levels?

Answer 16

Normal = <42
Pre-diabetes = 42-47
Diabetes = >48

Question 17

What do you ask about in a HbA1c station?

Answer 17

• 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?

Question 18

What symptoms do you ask about in diabetes?

Answer 18

polyuria, polydipsia, weight changes, fatigue
vision changes, UTIs, erectile dysfunction
foot changes

Question 19

What do you ask about medications on a HbA1c station?

Answer 19

• what are they taking for their diabetes?
• Do they miss doses/double up?
• are they on any steroids? (this can increase blood sugars)

Question 20

What are LFTs?

Answer 20

Blood tests to measure the function of the liver and gallbladder

Question 21

What symptoms do you ask about in an LFT station?

Answer 21

Abdo pain, bloating, jaundice (urine and stool changes), vomiting, bleeding, fever, weight loss, night sweats

Question 22

What other things do you ask about in an LFT station?

Answer 22

recent foreign travel, IVDU, tattoos, blood products, dodgy food, unprotected sex, alcohol, smoking

Question 23

What causes an acutely raised GGT?

Answer 23

alcoholic liver disease

Question 24

What does a raised ALT mean?

Answer 24

liver issues

Question 25

What does a raised ALP mean?

Answer 25

Biliary tree issues

Question 26

What type of jaundice is it if there are stool and urine changes?

Answer 26

Post-hepatic/ obstructive jaundice

Question 27

What are some causes of raised inflammatory markers?

Answer 27

• infections
• malignancy
• connective tissue disorders (rheumatoid)
• IBD
• burns
• Trauma