Metabolic Outcomes Flashcards
Effective approaches to prevent kidney injury including recognising the importance of hypovolaemia and nephrotoxic potential of drugs
- Avoid ACE Inhibitors, Angiotensin receptor blockers, Aminoglycosides, Diuretics and NSAIDs in patients at risk of an Acute Kidney Injury. Also avoid Metformin, Digoxin and Lithium; whilst it does not cause an AKI, it can be dangerous as they can cause toxicity
- Tight blood pressure and blood glucose control
- Ensure patients are well hydrated, i.e. use of fluid balance charts
- Continue regular observations (blood pressure, RR, O2 sats, temperature, HR) to a frequently according to NEWS Score
Impact of haemodialysis / peritoneal dialysis on physical and social well-being and psychological health
Haemodialysis
- Patients must travel for regular visits to their local dialysis centre or hospital for up to 4 hours 3-4 times a way, severely limiting their day-to-day schedules and planning of activities
- Has implications on travelling to other countries
- Patients must have an AV fistula, graft or central line. Risk of loss of access or line contamination
- Renal nurses will however manage your health during haemodialysis
Peritoneal Dialysis
- Patients are more flexible to do things such as travel and it is easier to go abroad on holidays with haemodialysis
- Very user-dependent, patients must feel empowered to change their filters / solutions / bags regularly
- Risk of hyperglycaemic episodes due to high sugar content on dialysis fluid
- Risk of bacterial peritonitis due to using the peritoneum as the membrane
Overall:
- Patients are likely to due of ischaemic heart disease whilst using dialysis
- Can severely impact mental health due to being limited by their treatments, patients may feel depressed and socially isolated. Can no longer perform activities they used to do
- Uncertainty with using dialysis; i.e. will it be forever? Will they have a transplant one day? When will they have it?
Matching of organs are based on what? Give details for each? Hyperacute rejection is mediated by what? Acute rejection is mediated by what? Chronic rejection is mediated by what?
ABO (AB = Universal acceptor, O = Universal donor)
HLA A, B, C, DR (If all 8 alleles match = great!)
MHC
Hyperacute: ABO
Acute: T cells
Chronic: Vascular changes
What is the time frame for an acute / chronic organ rejection?
Acute - within 6 months
Chronic - after 6 months
What is an Independent Assessor and what is their role?
Under the Human Tissue Act (2006) all donors and recipients are required to see an Independent Assessor (IA) trained / accredited by the Human Tissue Authority
Their role is to ensure:
- Donors are not being coerced
- Donors have capacity
- No reward is being sought
What are the arguements against a Financial Market of Blood (Titmuss, 1970)?
- Represses altruism
- Erodes sense of community
- Sanctions hospitals to market place rules
- Increases blood supply from poor
- Redistributes blood from poor to rich
- Commercialisation increases infection risk
How can donor rates be increased?
- Opt Out vs. Opt In system
- Have transplant co-ordinators in hospital
- Financial incentives
What is the PSA test? Is it specific or sensitive?
Prostate Specific Antigen, antigens released by epithelial cells of the prostate. Normal range less than 3 ng/ml. Low specificity and low sensitivity
Advantages of using PSA test?
- Can be used to pick up subclinical levels of Prostate Cancer
- Can be used for surveillance
Disadvantages of using PSA test?
- Low specificity / sensitivity
2. Increases likelihood of unnecessary medical intervention
Describe the diagnostic process for diabetes with reference to the WHO diagnostic criteria
Diabetes is diagnosed by a HbA1c >48 on one reading if symptomatic or two readings if asymptomatic, or a blood glucose >7 fasting or >11 random on one reading if symptomatic or two readings if asymptomatic
Describe the range of diabetic services in primary and secondary care
- GP (BP, lipid + glycaemic control, annual review)
- Diabetes specialist nurse clinics, HCAs (BP, bloods, weight)
- Podiatrist/chiropodist (diabetic foot care, neuropathy)
- Ophthalmologists (diabetic eye disease, renal physicians, gastroenterology (if gastroparesis)
- Endocrinologist (may advise in complex cases)
- Vascular medics, charities, district nurses (widens access)
- Dieticians (advise on correct diet in group classes)
Psychological and social impact of a diagnosis of Type 1 diabetes
- Change in their routine with eating, taking medications, checking glucose levels and attending appointments
- They may feel more restricted
- Grieving process: Denial, Anger, Bargaining, Depression, Acceptance
- May have a fear of hypos and hypers, won’t know what to expect or what to do until it happens to them
- Will feel alone and socially isolated
- During stress i.e. exam periods, glucose levels may be more erratic and difficult to control
How pituitary, adrenal and thyroid disease affects individuals
- Will require life-long medication
- Fertility issues, family planning
- Stigma due to appearance i.e. Exopthalmos
- Burden on family to recognise emergencies i.e. Addisonian crises
Underlying causes of weight gain and its increasing prevalence in western society
- Genetics: Children of obese parents more likely to be obese themselves
- “Instant” culture of ordering fast food such as McDonalds, take-aways and eating in restaurants instead of home-cooked meals
- Addition of sugar, additives, excessive salt and preservatives in food to promote shelf-life
- Aggressive advertisements / Media campaigns relating to food are always unhealthy food options instead of healthy ones
- Unhealthy foods can be addictive, feeding into the vicious cycle of consuming more and more
- Western diet promotes insulin resistance, leading to Type 2 Diabetes
- Certain medications, i.e. Steroids, Antipsychotics, Diabetic medication i.e. Sulfonylureas such as Gliclazide
