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
Diabetes DHx
How do you think its being controlled, do you think its going well
- recent changes
Diabetes compliance questions
How and when are you taking it?
How are you finding it? SE?
Injecting different sites?
Monitoring glucose?
Diabetes SHx
ADLs Diet Exercise Smoking Alcohol
How should you finish a diabtes history
Explain advantages of keeping it down. Mention support
- GP
- Diabetes nurses
- Online resources
- Training courses
Good BM for diabetes people
4-7mmol/mol
Peak flow is affected by
Age Sex Height Weight Inhalers
What is blue inhaler for
Reliever. Ventolin (salbutamol). Rescue from acute symptoms. SABA- stops bronchospasm
What is brown inhaler for
If youre having to use blue 3 times a week. Used everyday to prevent symptoms
Peak flow advice
Take your peak flow before preventer inhaler.
Always use same meter.
Peak flow red flags
Wheeze is getting worse
ADLs affected
Waking up at night with symptoms
Reliever inhaler more than usual
What does spirometry do
Measures functional lung volumes
Obstructive lung disease examples
Asthma COPD Bronchiectasis Inhaled foreign body Tumour
Describe obstructive spirometry
Takes a long time to breath out. FEV1/FVC <0.7
FEV1<80%
Restrictive lung disease examples
Kyphosis and scoliosis. AnkSpond. Neuromuscular
Fibrosis
Sarcoidosis
Asbestosis
Restrictive spriometry
Lower lung volumes.
FEV1/FVC >80%
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
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
How do you explain spirometry
It measures lung function, specifically the amount and speed of air that can be breathed in and out
Peak flow/spirometry HPC
Ask howre they feeling Illnesses or infections SOB PND Cough Wheeze
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?
Peak flow/spirometry DHx- exacerbations
Time when worse? Pets? Travel? Housing? Havfever?
Peak flow/spirometry SHx
Smoking
Alcohol
Impact of condition on life
Peak flow/ spirometry lifestyle advice
Smoking Avoid precipitants Vaccination Exercise Eating Support
What is CRP
Non specific marker
Produced by liver in the presence of inflammation
3 categories where CRP is measured
Autoimmune/ autoinflammatory conditions
Infection monitoring
Differentiation between inflammatory conditions
Causes of elevated CRP
Burns Trauma Infections Heart attack Chronic inflammatory conditions -lupus -vasculitis -RA IBD Ca
What is ESR
Distance erythrocytes settle in anticoagulated blood under gravity in an hour
Causes of high ESR categories
Malignancy
Haematologic
Connective tissue disorders
Infections
Cancers which raise ESR
Malignant lymphoma
Carcinomas of colon and breast
Haematologic causes of raised ESR
Multiple myeloma
Anaemia of chronic disease
Connective tissue disorders which cause raised ESR
SLE
RA
PMR
Temporal arteritis
Infections which cause raised ESR
TB
Acute hepatitis
Bacterial
What is low albumin
A sign of malnutrition and may occur when your body does not get or absorb enough nutrients.
Conditions which cause low albumin
Crohns, coeliac, kidney and liver disease
Conditions which cause high albumin
Severe infections, dehydration, chronic inflammatory diseases, hepatitis
What is the LFT- Globulins
Total proteins without albumin
What is ALP
Bile duct obstruction stimulates ALP synthesis
In what conditions is ALP raised
Obstructive liver disease, increased osteoblast activity (pagets, osteomalacia, vitamin D deficiency)
What is GGT
Liver disease marker, raised in drugs and alcohol
What are AST and ALT
Raised in any liver injury. Drugs, toxins, viral
What is high conjugated bilirubin suggestive of
Liver or bile duct disease
What is high unconjugated bilirubin suggestive of
Gilberts or haemolytic anaemia
When are liver enzymes increased
Chronic alcohol excess
Obesity
Smoking
Drug reaction
What are tumour markers
Substances found at higher than normal levels in the body fluid of some people with cancer
What are tumour markers used for
Guide treatment Monitor treatment Predict recovery Watch for recurrance Detect cancer in high risk
What are problems with tumour markers
Other conditions can increase levels
May be high in people without cancer
May vary with time
Normal CEA
<2.5 in non smoker <5 in smoker
Benign conditions that increase CEA
Smoking Infection IBD Pancreatitis Liver cirrhosis
When is CEA used
Mainly as a colorectal cancer marker. Raised CEA indicates progression or recurrence of cancer
Which conditions is CEA used in
Lung cancer
Breast cancer
Liver cancer
Colorectal cancer
Who is allowed a PSA
Anyone over 50 who has spoken about the advantages and disadvantages with a GP or nurse
What is PSA
Protein made by the prostate gland
When are PSA levels high
Men with prostate cancer
Prostatitis
BPH
Advantages of psa
Can help pick up prostate cancer before you have any symptoms
May detect a fast growing cancer at an early stage
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
How to start a PSA history
Check patient understanding of BPH and PSA
PSA HPC
Howre you feeling Urgency Incontinence Incomplete emptying Dysuria Haematuria Hesitancy Stream Terminal dribbling
PSA PMH
Enlarged prostate? UTI Surgery Catheterisation Trauma Inflammation DRE
PSA DHx
Compliance? Alfuzosin Doxazosin Tamsulosin -Finasteride
PSA SHx
ADL Smoking Alcohol Diet Exercise Sexual history (ejaculation increases it)
