chronic management history questions Flashcards
what does INR stand for
international normalised ratio
what is the normal INR
1
what should INR be on warfarin
2-3 (2.5 = ideal)
what factors does vitamin K effect
10, 9, 7, 2
what is warfarin
a Vitamin K antagonist - blocks vit K epoxide reductase
What specifications for taking warfarin are there
take at the same time daily
don’t double dose to catch up
what overall questions should you ask in HxPC for INR station
any recent infections/illness
any diarrhoea/vomiting and if so is it bloody/dark
what are some symptoms to ask about with high INR
headache
severe stomach ache
increased bruising
prolonged bleeding after minor cuts/mentruation/gum bleeding
blood in urine
what are some common symptoms in low INR that should be specifically asked about
sudden weakness/numb/tingling in limb
visual changes
inability/slurred speech
new pain/swelling/redness/heat in body parts
new SOB or chest pain
PMHx specifically for INR Hx
liver failure
bleeding disorder
DHx specific questions in INR station
what medication do you take
how and when many time are you taking it
do you know how often you should be
have you missed a day - and did you double dose to compensate?
do you manage okay - if not, why?
any other meds - aspirin, NSAIDs, herbal, OCP/HRT
SHx for INR Hx
any diet change - green fruit/veg
alcohol - binge can increase INR
smoking - can increase INR
advice for INR
decrease chances of bleeding - avoid activities that could cause it
tell dentist and other HCPs you are on an anticoagulant
how to treat high INR
vit K
blood components via transfusion
decrease warfarin and recheck
treatment for low INR
LMWH
warfarin
compression stockings if immobile
what is HbA1C
the glycated Hb over 3 months
what is the normal HbA1C
normal = <42 mmol/L / <6%
what is pre-diabetes HbA1C
42-47 / 6-6.4%
what is diabetes HbA1C
> 48mmol/L / 6.5%
general questions to ask with diabetes chronic management
when was the patient diagnosed
Type 1/type 2
do you understand diabetes/HbA1C
how well do you think it is managed
what are the benefits of lowering you HbA1C
reduce risk of retinopathy, neuropathy, nephropathym HF, cataracts, amputation
questions to ask in HxPC in diabetes chronic management
how are you feeling
any recent illness/infection
any diarrhoea/vomiting
any recent hospital admissions - for hypos/DKA
any polyuria/polydipsia
vision changes
change in sensations - leg tingling/no feeling
weight change/loss
impotence/ED
specific past medical history questions in diabetes chronic management
any CVD/cerebrovascular/renal/visual complications
any co-morbidities
what may HbA1C be falsely raised in
kidney failure
chronic excess alcohol intake
bit B12 deficiency
what may HbA1C be falsely low in
acute/chronic blood loss
sickle cell disease
thalassaemia
drug history specific questions for diabetes chronic management
what medication do you take for your diabetes
how/when are you taking it
any side effects
do you find taking it okay - if not why?
do you struggle to keep up with dose + why?
are you altering injection site?
do you monitor your glucose levels
any other meds/changes
social history specific questions for diabetes chronic management
how is your mood/sleep
are home circumstances okay
do you feel like the disease is affecting your life?
adhere to diabetic diet/tried to lose weight
exercise?
smoking?
alcohol - if increase/decrease why?
advice to lower HbA1C
diet modification - aware of snacking and sugary foods + affect carbs have on HbA1C
physical activity - reg. exercise can help stop HbA1C increase - but check with doctor as some meds may induce hypos with exercise
sick day rules - check BM more regularly (4hr), keep taking meds even if you don’t feel like eating, contact diabetes team, check ketones
monito BM
ask for support - GP, diabetic nurse, online resource, training course
what are some rules for doing peak flow
take PF before using preventer inhaler
what does spirometry measure
functional lung volumes
causes of obstructive lung disease
reversible - asthma
irreversible - COPD
bronchiectasis
inhaled foreing body/tumour
describe FEV1 and FVC in obstructive lung diseases
takes a long time to breath out (wheeze) so not much is exhaled in 1 second but volume overall not bad
FEV1 < FVC
FEV1/FVC < 0.7 with FEV1 < 80% predicted
what are restrictive lung diseases caused by
disease of the interstitium, affecting chest wall movemtn and elasticity - like scoliosis, kyphosis, ankylosing spondlyitis, neuromuscular - GBS, MG
pulmonary fibrosis, sarcoidosis and asbestosis
describe FEV1 and FVC in restrictive lung diseases
due to restriction, lung volume small and most breath out in 1st second, therefore, FEV1/FVC >80% as FVC proportionally lower
introduction questions for an lung chronic management station
do you understand what is meant by PF and spirometry (PF = how fast your breath out to see how well lungs are working and S = measures lung function, specifcally amount and speed of air that can be inhaled and exhaled
HxPC in lung chronic management history
how are you feeling
any recent illness/infections
any SOB
anytime you notice condition is worse
redflags to ask about in a lung chronic management station
is your wheeze getting worse/not resolving
affecting ADL
wake up at night with Sx (SOB/cough)
using relief inhaler more than normal
Dhx in lung chronic management history - questions
how well do you think your condition is controlled
what meds do you take
which inhalers do you use and how often
any other meds
any beta-blockers
have you had technique and use of inhaler checked by a specialist
social history questions for lung chronic management
any pets - new?
recent travel (polluted?)
housing situation (damp)
hayfever
smoking
alcohol
how does your condition impact your life
advice for lung chronic disease management stations
stop smoking
avoid precipitants
vaccination (flu)
exercise
eating
support
what is CRP
a non-specific acute marker produced by the liver that increases during inflammation
what is CRP measured for
routinely measured to assess activity of autoimmune/inflammatory diseases
what are some examples of chronic conditions CRP can be used to monitor
RA
JIA
seronegative arthritis
crohns
vasculitis
pancreatitis
what can CRP be used to assist making a diagnosis of and monitoring infection
infective endocarditis
abscess post-op infection
response to ABx
what can CRP be used to differentiate between
inflammatory conditons
SLE vs RA
crohns vs UC
other causes for raised CRP
burns, trauma
infections - pneumonia, TB
chronic inflammatory diseases - SLE, RA, vascultitis
MI, IBD, cancers
causes for raised ESR
malignancy - lymphomas, carcinomas of colon/breast
haematological - multiple myeloma, anaemia of acute/chronic disease combined with Fe deficient
connective tissue disorders - SLE, RA, polymyalgia rheumatica and temporal arteritis
infections - TB, acute hepatitis, bacterial
HxPC questions for infection marker chronic management
do you know what ESR/CRP is … could be new infection or flare up of your condition
how are you feeling
any recent illness/infection
DHx questions for infection marker chronic management stations
how well do you think your condition is managed
what meds do you take and how often
any issues with taking them
any other meds/allergies
SHx questions for inflammatory markers
recent travel anywhere
smoking
alcohol
impact of condition on life
advice for raised inflammatory markers chronic management
stop smoking
disease management if non-compliant
what are some causes for low albumin
malnutrition (crohns/Uc/coeliacs)
kidney disease
liver disease (hepatitis, cirrhosis)
what are some causes for high albumin
severe infections
dehydration
chronic inflammatory disease
hepatitis
what is meant by globulins
total proteins
what does a high conjugated bilirubin indicate
liver/bile duct diseaseha
what does a high unconjugated bilirubin mean
Gilbert’s syndrome
haemolytic anaemia
what are liver enzymes raised in
chronic high alcohol excess
obesity (esp men)
smoking (esp women)
srug reaction
what does ALP indicate
bile duct obstruction stimulates ALP synthesis
increases in increased obstructive liver disease
non-hepatic origin like osteoblastic activity in Paget’s, osteomalacia, vit D deficient
what does GGT indicate
liver disease markers of drugs/alcohol (increase)
what does AST/ALT indicate
liver disease markers of drugs, toxins and viral (increase)
what does GGT + ALP indicate
biliary problems
what does AST + ALT indicate
hepatic problems
what does GGT + ALP risen > AST + ALT indicate
obstructive jaundice
question in intro of liver enzymes chronic management
do you know what LFTs are
HxPC questions for liver enzymes chronic management
how are you feeling
any recent illness/infection
PMHx for liver enzymes chronic management station
past gallstones
Crohn’s/UC
surgery in past if malabsorption may have had some bowel removed
DHx for liver enzymes chronic management stations
how well do you think your condition is controlled
what meds do you take and how often
any issues with your medication
do you take any other meds
social history for liver enzymes chronic management stations
recent travel
smoking
alcohol
recreational drug/toxins
diet
how does this impact your life
advice for liver enzymes chronic management station
stop smoking/acohol/drugs
diet advice
asdvice in disease management if non-compliant
