Communication skills Flashcards
Foods containing vitamin K
Green fruit and veg
How does warfarin thin blood
It stops vitamin K activating clotting factors
High INR symptoms
Headache, stomache
Bleeding, bruising
Blood from everywhere
Drugs that increase INR
Overdosing
Aspirin, NSAIDs
Omeprazole, prednisolone, rifampicin
Conditions that increase INR
Liver failure, bleeding disorders
Social history things that increase INR
Decrease in vit K intake
Binge drinking
Smoking
How is an elevated INR treated
Vitamin K
Blood transfusion
How to keep INR stable
Have INR measured Take meds as directed Keep vitamin K stable Limit alcohol Dont smoke
How to decrease risk of bleeding
Avoid activities
Shave gently
Tell dentist etc youre on warfarin
When should you contact your doctor about your warfarin
Increased brusing
Bleeding increased
Darker stool
Blood in urine
Warfarin HPC which increases INR
Recent illness Fever N/V/D Pain or stress SE of warfarin
Warfarin DHx which increases INR
What is current dose?
Any missed dose?
Same time everyday?
Double dosing?
Other drugs which cause INR to go up
New medicines Stopped some? NSAIDs Aspirin Antibiotics Amiodarone Steroids
Warfarin SHx which increases INR
Major changes to diet?
Liver consumption?
Sudden change in vitamin K foods?
Cranberry juice?
Low INR symptoms
Sudden weakness Numbness or tingling Visual changes Slurred speech Pain, swelling, redness or heat in body parts SOB or chest pain
Causes of low INR
Supplements with vitamin K
High dietary intake
Oestrogens
Treatment of low INR
LMWH
Warfarin
What is warfarin
Anticoagulant, blocks enzyme which activates vitamin K. So means clotting factors arent produced
When should you take normal dose and when should you double dose when you forget
if you remember before midnight then you can take it
Warfarin interactions
Aspirin Ibuprofen Herbal medicines Alcohol Some food and drink Dietary changes
Can I go abroad on warfarin
If youre going to be away more than a month then you need it checked abroad
What should you do at the start of the warfarin history
- you are on warfarin, your INR is
- do you know what INR and warfarin is
- risks of high and low
- explain why they need to be on it
Warfarin PC questions
How are you feeling?
Infections or illnesses?
D and V?
Increased bleeding or bruising?
Warfarin DHx questions
Do you know how many times you are meant to be taking it?
How and when do you take?
Are you finding it ok?
Are you taking it everyday?
Warfarin DHx, other medications and side effects to ask about
Aspirin, NSAIDs, antibiotics, herbal.
Bleeding, bruising, blood from anywhere, headaches
Warfarin SHx questions
Diet
-leafy greens, kale, brocoli, green apples, pears. This can interact and reverse
Smoking
Alcohol
What is HbA1c
Glycated haemoglobin, gives the average blood glucose level over the previous two to three months
Normal HbA1c
less than 42mmol/mol or <6%
Prediabetes HbA1c
42-47mmol/mol or 6-6.4%
Diabetes HbA1c
48mmol/mol or >6.5%
Benefits of lowering HbA1c
Reduces risk of -retinopathy -neuropathy -diabetic nephropathy Less likely to -cataracts -heart failure -amputation
Management plan for lowering HbA1c
Dietary modifications
Physical activity
medications
Conditions which raise HbA1c
Kidney failure
Alcoholism
B12 deficiency
Conditions which reduce HbA1c
Blood loss
Sickle cell disease
Thalassaemia
Medications which increase HbA1c
Corticosteroids
Advice for someone on HbA1c monitoring
Be careful what you eat- aware of snacking
Stick to treatment plan- take meds as recommended
Be as active as possible
Sick day rules
Monitor BM
What should you say at the start of a HbA1c history
I understand you are.. I can see your HbA1c is When were you diagnosed What type Do you know what HbA1c is How well do you think its being manage Benefits of it being high or low
Diabetes PC questions
Howre you feeling Recent infections or illness (D or V) Hospital admissions for DKA Polyuria, polydipsia, weight loss, vision change, neuropathy, ED
Diabetes PMH
Cardiovascular, cerebrovascular, renal, visual complications or comorbiditis