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chronic management history questions Flashcards

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1
Q

what does INR stand for

A

international normalised ratio

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2
Q

what is the normal INR

A

1

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3
Q

what should INR be on warfarin

A

2-3 (2.5 = ideal)

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4
Q

what factors does vitamin K effect

A

10, 9, 7, 2

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5
Q

what is warfarin

A

a Vitamin K antagonist - blocks vit K epoxide reductase

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6
Q

What specifications for taking warfarin are there

A

take at the same time daily
don’t double dose to catch up

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7
Q

what overall questions should you ask in HxPC for INR station

A

any recent infections/illness
any diarrhoea/vomiting and if so is it bloody/dark

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8
Q

what are some symptoms to ask about with high INR

A

headache
severe stomach ache
increased bruising
prolonged bleeding after minor cuts/mentruation/gum bleeding
blood in urine

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9
Q

what are some common symptoms in low INR that should be specifically asked about

A

sudden weakness/numb/tingling in limb
visual changes
inability/slurred speech
new pain/swelling/redness/heat in body parts
new SOB or chest pain

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10
Q

PMHx specifically for INR Hx

A

liver failure
bleeding disorder

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11
Q

DHx specific questions in INR station

A

what medication do you take
how and when many time are you taking it
do you know how often you should be
have you missed a day - and did you double dose to compensate?
do you manage okay - if not, why?
any other meds - aspirin, NSAIDs, herbal, OCP/HRT

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12
Q

SHx for INR Hx

A

any diet change - green fruit/veg
alcohol - binge can increase INR
smoking - can increase INR

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13
Q

advice for INR

A

decrease chances of bleeding - avoid activities that could cause it
tell dentist and other HCPs you are on an anticoagulant

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14
Q

how to treat high INR

A

vit K
blood components via transfusion
decrease warfarin and recheck

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15
Q

treatment for low INR

A

LMWH
warfarin
compression stockings if immobile

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16
Q

what is HbA1C

A

the glycated Hb over 3 months

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17
Q

what is the normal HbA1C

A

normal = <42 mmol/L / <6%

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18
Q

what is pre-diabetes HbA1C

A

42-47 / 6-6.4%

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19
Q

what is diabetes HbA1C

A

> 48mmol/L / 6.5%

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20
Q

general questions to ask with diabetes chronic management

A

when was the patient diagnosed
Type 1/type 2
do you understand diabetes/HbA1C
how well do you think it is managed

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21
Q

what are the benefits of lowering you HbA1C

A

reduce risk of retinopathy, neuropathy, nephropathym HF, cataracts, amputation

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21
Q

questions to ask in HxPC in diabetes chronic management

A

how are you feeling
any recent illness/infection
any diarrhoea/vomiting
any recent hospital admissions - for hypos/DKA
any polyuria/polydipsia
vision changes
change in sensations - leg tingling/no feeling
weight change/loss
impotence/ED

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22
Q

specific past medical history questions in diabetes chronic management

A

any CVD/cerebrovascular/renal/visual complications
any co-morbidities

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22
Q

what may HbA1C be falsely raised in

A

kidney failure
chronic excess alcohol intake
bit B12 deficiency

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23
what may HbA1C be falsely low in
acute/chronic blood loss sickle cell disease thalassaemia
24
drug history specific questions for diabetes chronic management
what medication do you take for your diabetes how/when are you taking it any side effects do you find taking it okay - if not why? do you struggle to keep up with dose + why? are you altering injection site? do you monitor your glucose levels any other meds/changes
25
social history specific questions for diabetes chronic management
how is your mood/sleep are home circumstances okay do you feel like the disease is affecting your life? adhere to diabetic diet/tried to lose weight exercise? smoking? alcohol - if increase/decrease why?
26
advice to lower HbA1C
diet modification - aware of snacking and sugary foods + affect carbs have on HbA1C physical activity - reg. exercise can help stop HbA1C increase - but check with doctor as some meds may induce hypos with exercise sick day rules - check BM more regularly (4hr), keep taking meds even if you don't feel like eating, contact diabetes team, check ketones monito BM ask for support - GP, diabetic nurse, online resource, training course
27
what are some rules for doing peak flow
take PF before using preventer inhaler
28
what does spirometry measure
functional lung volumes
29
causes of obstructive lung disease
reversible - asthma irreversible - COPD bronchiectasis inhaled foreing body/tumour
30
describe FEV1 and FVC in obstructive lung diseases
takes a long time to breath out (wheeze) so not much is exhaled in 1 second but volume overall not bad FEV1 < FVC FEV1/FVC < 0.7 with FEV1 < 80% predicted
31
what are restrictive lung diseases caused by
disease of the interstitium, affecting chest wall movemtn and elasticity - like scoliosis, kyphosis, ankylosing spondlyitis, neuromuscular - GBS, MG pulmonary fibrosis, sarcoidosis and asbestosis
32
describe FEV1 and FVC in restrictive lung diseases
due to restriction, lung volume small and most breath out in 1st second, therefore, FEV1/FVC >80% as FVC proportionally lower
33
introduction questions for an lung chronic management station
do you understand what is meant by PF and spirometry (PF = how fast your breath out to see how well lungs are working and S = measures lung function, specifcally amount and speed of air that can be inhaled and exhaled
34
HxPC in lung chronic management history
how are you feeling any recent illness/infections any SOB anytime you notice condition is worse
35
redflags to ask about in a lung chronic management station
is your wheeze getting worse/not resolving affecting ADL wake up at night with Sx (SOB/cough) using relief inhaler more than normal
36
Dhx in lung chronic management history - questions
how well do you think your condition is controlled what meds do you take which inhalers do you use and how often any other meds any beta-blockers have you had technique and use of inhaler checked by a specialist
37
social history questions for lung chronic management
any pets - new? recent travel (polluted?) housing situation (damp) hayfever smoking alcohol how does your condition impact your life
38
advice for lung chronic disease management stations
stop smoking avoid precipitants vaccination (flu) exercise eating support
39
what is CRP
a non-specific acute marker produced by the liver that increases during inflammation
40
what is CRP measured for
routinely measured to assess activity of autoimmune/inflammatory diseases
41
what are some examples of chronic conditions CRP can be used to monitor
RA JIA seronegative arthritis crohns vasculitis pancreatitis
42
what can CRP be used to assist making a diagnosis of and monitoring infection
infective endocarditis abscess post-op infection response to ABx
43
what can CRP be used to differentiate between
inflammatory conditons SLE vs RA crohns vs UC
44
other causes for raised CRP
burns, trauma infections - pneumonia, TB chronic inflammatory diseases - SLE, RA, vascultitis MI, IBD, cancers
45
causes for raised ESR
malignancy - lymphomas, carcinomas of colon/breast haematological - multiple myeloma, anaemia of acute/chronic disease combined with Fe deficient connective tissue disorders - SLE, RA, polymyalgia rheumatica and temporal arteritis infections - TB, acute hepatitis, bacterial
46
HxPC questions for infection marker chronic management
do you know what ESR/CRP is ... could be new infection or flare up of your condition how are you feeling any recent illness/infection
47
DHx questions for infection marker chronic management stations
how well do you think your condition is managed what meds do you take and how often any issues with taking them any other meds/allergies
48
SHx questions for inflammatory markers
recent travel anywhere smoking alcohol impact of condition on life
49
advice for raised inflammatory markers chronic management
stop smoking disease management if non-compliant
50
what are some causes for low albumin
malnutrition (crohns/Uc/coeliacs) kidney disease liver disease (hepatitis, cirrhosis)
51
what are some causes for high albumin
severe infections dehydration chronic inflammatory disease hepatitis
52
what is meant by globulins
total proteins
53
what does a high conjugated bilirubin indicate
liver/bile duct diseaseha
54
what does a high unconjugated bilirubin mean
Gilbert's syndrome haemolytic anaemia
55
what are liver enzymes raised in
chronic high alcohol excess obesity (esp men) smoking (esp women) srug reaction
56
what does ALP indicate
bile duct obstruction stimulates ALP synthesis increases in increased obstructive liver disease non-hepatic origin like osteoblastic activity in Paget's, osteomalacia, vit D deficient
57
what does GGT indicate
liver disease markers of drugs/alcohol (increase)
58
what does AST/ALT indicate
liver disease markers of drugs, toxins and viral (increase)
59
what does GGT + ALP indicate
biliary problems
60
what does AST + ALT indicate
hepatic problems
61
what does GGT + ALP risen > AST + ALT indicate
obstructive jaundice
62
question in intro of liver enzymes chronic management
do you know what LFTs are
63
HxPC questions for liver enzymes chronic management
how are you feeling any recent illness/infection
64
PMHx for liver enzymes chronic management station
past gallstones Crohn's/UC surgery in past if malabsorption may have had some bowel removed
65
DHx for liver enzymes chronic management stations
how well do you think your condition is controlled what meds do you take and how often any issues with your medication do you take any other meds
66
social history for liver enzymes chronic management stations
recent travel smoking alcohol recreational drug/toxins diet how does this impact your life
67
advice for liver enzymes chronic management station
stop smoking/acohol/drugs diet advice asdvice in disease management if non-compliant

Phase 2b (16 decks)

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