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Communication skills Flashcards

1
Q

Foods containing vitamin K

A

Green fruit and veg

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2
Q

How does warfarin thin blood

A

It stops vitamin K activating clotting factors

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3
Q

High INR symptoms

A

Headache, stomache
Bleeding, bruising
Blood from everywhere

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4
Q

Drugs that increase INR

A

Overdosing
Aspirin, NSAIDs
Omeprazole, prednisolone, rifampicin

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5
Q

Conditions that increase INR

A

Liver failure, bleeding disorders

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6
Q

Social history things that increase INR

A

Decrease in vit K intake
Binge drinking
Smoking

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7
Q

How is an elevated INR treated

A

Vitamin K

Blood transfusion

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8
Q

How to keep INR stable

A 
Have INR measured
Take meds as directed
Keep vitamin K stable
Limit alcohol
Dont smoke
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9
Q

How to decrease risk of bleeding

A

Avoid activities
Shave gently
Tell dentist etc youre on warfarin

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10
Q

When should you contact your doctor about your warfarin

A

Increased brusing
Bleeding increased
Darker stool
Blood in urine

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11
Q

Warfarin HPC which increases INR

A 
Recent illness
Fever
N/V/D
Pain or stress
SE of warfarin
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12
Q

Warfarin DHx which increases INR

A

What is current dose?
Any missed dose?
Same time everyday?
Double dosing?

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13
Q

Other drugs which cause INR to go up

A 
New medicines
Stopped some?
NSAIDs
Aspirin
Antibiotics
Amiodarone
Steroids
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14
Q

Warfarin SHx which increases INR

A

Major changes to diet?
Liver consumption?
Sudden change in vitamin K foods?
Cranberry juice?

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15
Q

Low INR symptoms

A 
Sudden weakness
Numbness or tingling
Visual changes
Slurred speech
Pain, swelling, redness or heat in body parts
SOB or chest pain
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16
Q

Causes of low INR

A

Supplements with vitamin K
High dietary intake
Oestrogens

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17
Q

Treatment of low INR

A

LMWH

Warfarin

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18
Q

What is warfarin

A

Anticoagulant, blocks enzyme which activates vitamin K. So means clotting factors arent produced

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19
Q

When should you take normal dose and when should you double dose when you forget

A

if you remember before midnight then you can take it

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20
Q

Warfarin interactions

A 
Aspirin
Ibuprofen
Herbal medicines
Alcohol
Some food and drink
Dietary changes
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21
Q

Can I go abroad on warfarin

A

If youre going to be away more than a month then you need it checked abroad

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22
Q

What should you do at the start of the warfarin history

A
  • 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
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23
Q

Warfarin PC questions

A

How are you feeling?
Infections or illnesses?
D and V?
Increased bleeding or bruising?

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24
Q

Warfarin DHx questions

A

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?

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25
Warfarin DHx, other medications and side effects to ask about
Aspirin, NSAIDs, antibiotics, herbal. | Bleeding, bruising, blood from anywhere, headaches
26
Warfarin SHx questions
Diet -leafy greens, kale, brocoli, green apples, pears. This can interact and reverse Smoking Alcohol
27
What is HbA1c
Glycated haemoglobin, gives the average blood glucose level over the previous two to three months
28
Normal HbA1c
less than 42mmol/mol or <6%
29
Prediabetes HbA1c
42-47mmol/mol or 6-6.4%
30
Diabetes HbA1c
48mmol/mol or >6.5%
31
Benefits of lowering HbA1c
``` Reduces risk of -retinopathy -neuropathy -diabetic nephropathy Less likely to -cataracts -heart failure -amputation ```
32
Management plan for lowering HbA1c
Dietary modifications Physical activity medications
33
Conditions which raise HbA1c
Kidney failure Alcoholism B12 deficiency
34
Conditions which reduce HbA1c
Blood loss Sickle cell disease Thalassaemia
35
Medications which increase HbA1c
Corticosteroids
36
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
37
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 ```
38
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 ```
39
Diabetes PMH
Cardiovascular, cerebrovascular, renal, visual complications or comorbiditis
40
Diabetes DHx
How do you think its being controlled, do you think its going well - recent changes
41
Diabetes compliance questions
How and when are you taking it? How are you finding it? SE? Injecting different sites? Monitoring glucose?
42
Diabetes SHx
``` ADLs Diet Exercise Smoking Alcohol ```
43
How should you finish a diabtes history
Explain advantages of keeping it down. Mention support - GP - Diabetes nurses - Online resources - Training courses
44
Good BM for diabetes people
4-7mmol/mol
45
Peak flow is affected by
``` Age Sex Height Weight Inhalers ```
46
What is blue inhaler for
Reliever. Ventolin (salbutamol). Rescue from acute symptoms. SABA- stops bronchospasm
47
What is brown inhaler for
If youre having to use blue 3 times a week. Used everyday to prevent symptoms
48
Peak flow advice
Take your peak flow before preventer inhaler. | Always use same meter.
49
Peak flow red flags
Wheeze is getting worse ADLs affected Waking up at night with symptoms Reliever inhaler more than usual
50
What does spirometry do
Measures functional lung volumes
51
Obstructive lung disease examples
``` Asthma COPD Bronchiectasis Inhaled foreign body Tumour ```
52
Describe obstructive spirometry
Takes a long time to breath out. FEV1/FVC <0.7 | FEV1<80%
53
Restrictive lung disease examples
Kyphosis and scoliosis. AnkSpond. Neuromuscular Fibrosis Sarcoidosis Asbestosis
54
Restrictive spriometry
Lower lung volumes. | FEV1/FVC >80%
55
What do you say at the start of a peak flow/spirometry
I understudand you are.. Your peak flow/ spirometry is.. Do you know what that is How well do you think your conditions is managed
56
How do you explain peak flow
The peak flow test measures how fast you can breath out, so you can see how well your lungs are working
57
How do you explain spirometry
It measures lung function, specifically the amount and speed of air that can be breathed in and out
58
Peak flow/spirometry HPC
``` Ask howre they feeling Illnesses or infections SOB PND Cough Wheeze ```
59
Peak flow/ spirometry DHx- control
How well is it being controlled? - taking meds - which inhalers - other meds - Beta blockers - inhaler technique been checked by nurse?
60
Peak flow/spirometry DHx- exacerbations
``` Time when worse? Pets? Travel? Housing? Havfever? ```
61
Peak flow/spirometry SHx
Smoking Alcohol Impact of condition on life
62
Peak flow/ spirometry lifestyle advice
``` Smoking Avoid precipitants Vaccination Exercise Eating Support ```
63
What is CRP
Non specific marker | Produced by liver in the presence of inflammation
64
3 categories where CRP is measured
Autoimmune/ autoinflammatory conditions Infection monitoring Differentiation between inflammatory conditions
65
Causes of elevated CRP
``` Burns Trauma Infections Heart attack Chronic inflammatory conditions -lupus -vasculitis -RA IBD Ca ```
66
What is ESR
Distance erythrocytes settle in anticoagulated blood under gravity in an hour
67
Causes of high ESR categories
Malignancy Haematologic Connective tissue disorders Infections
68
Cancers which raise ESR
Malignant lymphoma | Carcinomas of colon and breast
69
Haematologic causes of raised ESR
Multiple myeloma | Anaemia of chronic disease
70
Connective tissue disorders which cause raised ESR
SLE RA PMR Temporal arteritis
71
Infections which cause raised ESR
TB Acute hepatitis Bacterial
72
What is low albumin
A sign of malnutrition and may occur when your body does not get or absorb enough nutrients.
73
Conditions which cause low albumin
Crohns, coeliac, kidney and liver disease
74
Conditions which cause high albumin
Severe infections, dehydration, chronic inflammatory diseases, hepatitis
75
What is the LFT- Globulins
Total proteins without albumin
76
What is ALP
Bile duct obstruction stimulates ALP synthesis
77
In what conditions is ALP raised
Obstructive liver disease, increased osteoblast activity (pagets, osteomalacia, vitamin D deficiency)
78
What is GGT
Liver disease marker, raised in drugs and alcohol
79
What are AST and ALT
Raised in any liver injury. Drugs, toxins, viral
80
What is high conjugated bilirubin suggestive of
Liver or bile duct disease
81
What is high unconjugated bilirubin suggestive of
Gilberts or haemolytic anaemia
82
When are liver enzymes increased
Chronic alcohol excess Obesity Smoking Drug reaction
83
What are tumour markers
Substances found at higher than normal levels in the body fluid of some people with cancer
84
What are tumour markers used for
``` Guide treatment Monitor treatment Predict recovery Watch for recurrance Detect cancer in high risk ```
85
What are problems with tumour markers
Other conditions can increase levels May be high in people without cancer May vary with time
86
Normal CEA
<2.5 in non smoker <5 in smoker
87
Benign conditions that increase CEA
``` Smoking Infection IBD Pancreatitis Liver cirrhosis ```
88
When is CEA used
Mainly as a colorectal cancer marker. Raised CEA indicates progression or recurrence of cancer
89
Which conditions is CEA used in
Lung cancer Breast cancer Liver cancer Colorectal cancer
90
Who is allowed a PSA
Anyone over 50 who has spoken about the advantages and disadvantages with a GP or nurse
91
What is PSA
Protein made by the prostate gland
92
When are PSA levels high
Men with prostate cancer Prostatitis BPH
93
Advantages of psa
Can help pick up prostate cancer before you have any symptoms May detect a fast growing cancer at an early stage
94
Disadvantages of PSA
May not have cancer Can miss out cancer If raised you need a biopsy which has SE of pain, infection, blood in urine
95
How to start a PSA history
Check patient understanding of BPH and PSA
96
PSA HPC
``` Howre you feeling Urgency Incontinence Incomplete emptying Dysuria Haematuria Hesitancy Stream Terminal dribbling ```
97
PSA PMH
``` Enlarged prostate? UTI Surgery Catheterisation Trauma Inflammation DRE ```
98
PSA DHx
``` Compliance? Alfuzosin Doxazosin Tamsulosin -Finasteride ```
99
PSA SHx
``` ADL Smoking Alcohol Diet Exercise Sexual history (ejaculation increases it) ```

2b (28 decks)

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