Chronic Condition Management

Question 1

HbA1c summary

Answer 1

1. Check understanding
2. Diabetes Hx taking
3. Current control of diabetes/coping
4. Factors influencing change
5. Lifestyle advice
6. Safety net
7. PMH
8. Monitor glucose regularly?
9. Injection sites?
10. Results: Normal (<42), Pre-diabetes (42-47), Diabetes (>48)

Question 2

HbA1c
1. Check understanding

Answer 2

Tell me what you already know

“Measure of how much sugar is stuck on your red blood cells. RBCs live for 3 months so it gives us an average of the last 3 months”

ICE

Question 3

HbA1c
2. Diabetes Hx taking

Answer 3

When were you diagnosed?
What type?
What were you symptoms pre-diagnosis?
PMH

Question 4

HbA1c
3. Current control of diabetes

Answer 4

Impact of the illness on patients life:
- Mood
- Ability to work
- Quality of sleep
- Social interactions
- Exercise

How do they control it currently? Adherence?
- Side effects: Metformin: nausea, abdo pain, diarrhoea, Insulin, Sulfonylureas, Gliptins

Any factors that influence compliance?

Any symptoms recently: polydipsia, polyuria, neuropathy, visual changes, hypos, BP control, foot care, ulcers, impotence, weight change

Question 5

HbA1c
4. Factors influencing change?

Answer 5

Diet, exercise, alcohol, smoking, stresses
Reason behind change?

Question 6

HbA1c
5. Lifestyle advice

Question 7

HbA1c
6. Safety net

Answer 7

DKA/Coma/Fainting - carry sugary drinks

Question 8

Peak flow
1. Check understanding

Answer 8

Tell me what you know

“Test to measure how well you can breath out air which we can assess your lung function with”

Question 9

Peak flow
2. HPC

Answer 9

How are you feeling?
Breathlessness - woken up at night?
Cough
Wheeze
Affecting mood, social life, work, exercise, sleep
Asthma attacks/hospital ad, control generally
Sx at diagnoses

Question 10

Peak flow
3. Drug Hx

Answer 10

Any changes?

Blue inhaler = reliever (acute)
Brown inhaler = preventer (daily)
Other steroids
B blockers (propranolol)

Adherence
Inhaler technique

Question 11

Peak flow
4. Social history

Answer 11

Smoking
Alcohol
Living
Travel
Pets
Work
Allergies

Question 12

Peak flow
5. Change

Answer 12

Allergies
Damp housing
New relationship/flatmate who smokes
Exercise

Question 13

INR
1. Check understanding

Answer 13

Tell me what you already know about INR/Warfarin
- Any concerns about being on warfarin?

Do you understand what warfarin is for/how it works?
- thins blood
- how is it relevant for condition? AF, hyper-viscosity
- INR monitors warfarin, measure of how long blood takes to clot. Usually 1, for you with increased risk of clotting is higher eg 2-3 so require frequent blood tests

ICE

Question 14

INR
3. Current warfarin use

Answer 14

How are you coping

How long have you been on warfarin
- PE/DVT (6 months)
- AF (lifelong)

How often do you take it

Do you ever miss a dose and if so, what do you do?

Question 15

Symptoms of high INR (increased bleeding risk/longer to clot)

Answer 15

Headache
Stomach ache
Bruising
Bleeding (gums, cuts)
Blood in urine
Bloody/dark stools
Increased menstrual bleeding

Question 16

Causes of increased INR

Answer 16

Recent illness

Change in medication
- aspirin
- NSAIDs
- St Johns Wort
- some antibiotics
- omeprazole etc.

Liver failure
Bleeding disorders
Decreased Vit K
Alcohol binge
Smoking

Too much warfarin - dosing

Question 17

High INR lifestyle advice

Answer 17

Max 1-2 drinks a day
Be careful brushing teeth?
Have INR measured regularly
Take meds properly
Don’t smoke
Keep amount of Vit K in diet regular

Question 18

High INR safety net

Answer 18

If you cut yourself and bleed for 5-10 minutes call for help
Sudden headache/back pain
Bruise easily don’t be worried

Question 19

Low INR = increased clotting risk

Answer 19

Symptoms
- sudden weakness in limb
- numbness, tingling
- new SOB, chest pain

Vitamin K!

Question 20

LFTs
Readings

Answer 20

ALT - liver cell damage
AST - alcohol
AST:ALT ratio - 2:1 = damage from alcoholic liver disease
GGT - liver damage from drugs + alcohol
Bilirubin - gallstones, haem cause
ALP - bile duct, biliary tract, low bilirubin = bone!

Question 21

LFTs
HPC

Answer 21

Oedema
Bloating
Stroke
Urine
Fever
Jaundice
Itching

Question 22

LFTs
SHx

Answer 22

Foreign travel
Tattoos
Unprotected sex
Alcohol
Obesity
Recreational drug use - IVDU?

Question 23

LFTs
CAGE questionnaire

Answer 23

C - Have you ever thought about cutting down?
A - Do you ever get annoyed at others who mention your drinking habits?
G - Do you ever feel guilty about how much you drink?
E - Eye-Opener have you ever woken up and needed a drink first thing to start your day?