risk scores and chronic disease mx Flashcards by Emily Fothergill

what are the 3 main important points in the chronic disease mx station?

data analysis: current control
impact of disease on work, mood, sleep, social interactions
adherence to tx regimen and factors effecting

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give the general questioning structure for the chronic disease station

we have these results which measure your X
youre results show X
do you know what this is and why we measured it
ask patient to establish why result is high/low
explain you will try and improve result
ask about sx
ask about current adherence (factors effecting: memory, SE, cost, didnt want to) and councel them
impact on home life
their concerns

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what is a normal INR?

1
if on warfarin 2-3

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what is warfarin?

vit K antagonist-> decreases factors 2,7,9, 10

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can a dose of warfarin be doubled to catch up?

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what qs are important in an INR/warfarin chronic disease station?

we have results measuring your INr
your INR is X which shows X
do you know what warfarin is-is an anticoagulant, stops blood clotting too easily
risks of high/low: higher INR=longer it takes to clot=increased risk bleeds. lower INR=thicker blood=increased clotting risk
why on warfarin-tx DVT, PE, prevent stroke in AF
sx: how feeling, infections, D+V (and blood), high INR (bruising, headace, stomach pain, blood in urine, prolonged bleeding after cuts/menstruation/gum bleeding), low INR (stroke, DVT)
PMH: liver failure, bleeding disorders, AF
drug hx: do you know how many times meant to be taking warfarin, how and when, do you miss doses, do you double doses, any issues. other meds=st johns wort, aspirin, nsaids, OCP/HRT, abx
diet: vit k-green veg, alcohol

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what advice is given for INR control

avoid activities causing bruising/bleeding, brish/shave gently, tell HCP you take anticoag
if elevated: VIt K, if no explanation warfarin dose reduced
if low: LMWH, warfarin, compression stockings
DOACs generally preferred unless liver dysfunction or renal impairment, or over 120kg

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what is a normal HbA1c?

42mmol/L or <6%
pre-diabetes: 42-47
diabetes>48

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what important qs are asked for HbA1c hx

when were you tiagnosed, T1 or 2
HbA1c-acurate blood sugar over 2-3m, how well do you think your diabetes is being managed
benefits of reducing: decreased risk eye problems, losign sensation in hands and feet or kidney problmes
how are you feeling, recent infections, any DKA/hypos, sx diabetes
PMH: CVD, cerebrovascular, retinal, renal
medication: what, when, SE, struggling, monitoring leve;s, injection technique
socisl: mood, sleep, home, effects of disease, deit, exercise, smoking and alcohol

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what can falsely raise or lower HbA1c?

increase: kidney failure, excess alcohol, vit B12 deficienct
deecrease: acute/chronic blood loss, sickle cell disease, thalassaemia

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advice for HbA1c

dietary modifications: sugar, carbs and blood level
regular exercise-check with Dr to avoid hypos
take care when ill-check blood glucose more regularly, contact team
support: GP, diabeteic nurse, online, training courses

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what does diurnal variation in peak flow suggest?

poorly controlled asthma

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how can spirometry be interpreted?

obstruvtive: FEV1/FVC<70%, FEV1<80%
restritive: FEV1/FVC normal

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what is important to ask in a peak flow/spirometry station?

peak flow measures how fast you can breathe out to see how well your lungs are working
spirometry measures lung function: amount and speed of air that can be inhaled/exhaled
how feeling, recent infection, sob, time notice worsening e.g. winter. red flags=wheeze getting worse, affecting ADL, waking up at night, using reliever more
how well do yuou think being controlled, medications, inhalers and how often, other meds, BB, inhaler technique assessed
any new pets, recent trave, damp housing, hayfever, smoking and alohol, impact on life

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what advice is given at a peak flow/spirometry station?

stop smokong, avoid precipitating factors, vaccination, eating, exercise, support

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what are the causes of obstructive lung disease?

asthma, COPD, bronchiectasis, inhaled forgein body, tumour

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what are the casues of restrictive lung disease?

scoliosis, kyphosis, ankylosing spondylitis
guillain barre, myasthenia gravis, pulmonary fibrosus, sarcoidosis, asbestos

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what inflammatory markers may be assessed

CRP and ESR

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what qs are asked for inflammatory markers?

marker of inflammation, tell if flare up or new infection
how feeling, recent illnesses, sx
how well condition controlled, medcations, how often adherehce
recent travel, smoking, alcohol, impact on life

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what advice is given for inflammatory markers?

stop smoking
disease mx and compliance
try and reduce result
any concerns

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what is CRP and causees raise?

released by liver
acute and non specific
AI or inflammatory: JIA, RA, seronegative arthtitis, crohns, vasculitis, polyarteritis nodosa, pancreatitis
burns, trauma, infection, chronic inflammatory disease, MI, IBD, cancer

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what is ESR and used for monitoring?

increased fibrinogen and CRP causes raised ESR
rises and falls slowly
temporal arteritis, systemic arteritis, polymyalgia rheumatica

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what are liver function tests used for?

help diagnose and monitor liver disease and damage, levels of proteins and enzymes in blood

what increases liver enzymes?

chronic high alcohol, obesits, smoking, drug rxn

what are ALT and AST?

liver hepatic enzymes markers of drugs, toxins and viral infections indicate liver damage

what is ALP?

enzyme in liver and bone marker for damage to biliary tree and bone disease bile duct obstruction stimulates ALP synthesis gall stones, primar biliary sclerosis, primary sclerosing cholangitis hyperparathyroidism, osteomalacia, pagets

what is GGT?

alcoholic liver disease

what does increased ALP and GGT indicate?

cholestasis

what does increased ALP and ALT indicate?

cholestatic pattern

what does increased ALT and ALP indicate?

hepatocellular pattern

if increased AST and ALT same amount?

hepatic problems

increased ALT>AST?

chronic liver disrase

increased Ast>ALT?

cirrhosis and acute alcoholic hepatitis

what does GGT and ALP increased >AST and ALT?

obstructive jaundice

what is albumin?

produced in liver, indication synthetic function low=liver damage-IBD, cronhs, hepatitis, cirrhosis high-infection, dehydration, chronic inflammatory disease, hepatitis

what are globulins in liver?

total proteins

what is important to ask in LFTs?

how feeling, recent illnessses prev gallstones, UC, crohns, surgery how well managing, medication,s how often issues travel, smoking, alcohol, recreational drugs, toxins, deit, impact on life ICE

advice for LFTs?

stop smoking/alcohol/drugs diet disease mx and compliance

what are tumour markers?

produced by cancer cells or the body in response tells if tx working, recurrenece, diagnosis, staging, prognosis found in blood, urine, stools, tumours

what qs are asked for tumour markers?

how feeling, recent illnesses sx: fatigue, wt loss, change in bowel or bladder, lump, sking canges, cough, swallowing, indigestion, muscles and joint aches, fevers, bleeding and bruising how well being controlled, medication or tx, how often, issues impact on life, concerns, support

how is diabetes risk score interpreted?

low: 0-6, 1% increased: 7-15, 1 in 35 moderate: 16-25, 10% high: 25-47, 25%

what qs are asked in diabetes risk assessment?

age gender: M ethnicity relative with diabetes waist measurement ht and wt for BMI HTN sx: polyuria, polydipsia, fatigue, thrush, wt loss

what advice is given for diabetes risk?

lifestyle-8wk regular meals, portion size, decrease fat/sugar food and exercise diarry exercise 150 min/wk wt loss

what is the QRISK2 score?

risk of developing CVD next 10y aged 35-74 <10%=low, 10-20%=moderate >20%=high

what qs are asked for QRISK2?

age sex ethnicity BMI CKD stage 4/5 AF RA DM HTN tx first degree relative <60 with angina or MI smoking cholesterol/HDL ratio BP

how is QRISK2 mx?

<10%: lifestyle, smoking, exercise, deit, wt loss >10%:lifestyle, tx comorbidities, lipid modification

what is the CHa2Ds2VaSc score?

risk stroke with AF

how is CHa2DS2VaSc calculated

CCF HTN age (>75, 65-75) DM stroke or TUA vascular disease female

how is CHADSVASC mx?

0=no anticoag 1=consider , maybe aspirin 2+required DOAC, warfarin if on anticoag: modifiable RF=HASBLED=HTN, renal/liver, labile INR, NSAIDs/antiplatelets, alcohol lifestyle warfarin: INR check, teratogenic, increased bleeding risk, diet DOAC: non-reveersible, CI renal impairment and hx GI bleed

what is the FRAX score?

10 yr probability osteoporotic fracture in spine, hip, shoulder, wrist 40-90

what qs are asked for FRAX>

age sex wt ht femoral neck BMD RA secondary osteoporosis: kidney failure, cushings, coeliac, MS, hyperparathyroid, hyperthyroid, DM, prev fracture drug: glucocorticoids, lithium, barbiturates parental hip fracture smoker alcohol >3 units/d

how is FRAX mx?

low=<10%, reassess 5r: lifestyle-wt bearing exercise, no smoking or alocohol, calcium and vit D diet, shoes with good grip intermediate: 10-20%: DEXA scan and tx bisphosponate if<2.5 high risk: DEXA and modify RF

what is the Well's score?

for DVT

what is asked for Wells'

paralysis or immobilisation of leg localised tenderness along deep venous system entire leg swollen calf swelling >10cm compared to other leg pitting oedema in sx leg collateral superficial veins bedridden >3d or major surgery in 12w active cancer within 6m prev DVT aldernative diagnosis more likelt -2 long haul flighrs, smoking, HRT/OCP

how is wells score mx?

0=unlikelt 1-2=moderate-17% =>3 likely D-dimer if unlikely, unreliable USS dopler PE=CTPA tx: LMWH, warfarin or DOAC, compression stockings, find cause, diet, exercsie, smoking