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40 Cards in this Set
- Front
- Back
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What is chronic disease ? |
Chronic disease is a long-term condition that can be treatable but not cured |
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What are the chracterstic of chroinc illness |
1. Gradual onset 2. Compromised life quality 3. Most common cause of premature death 4. More common with older people 5. More common in those lower socioeconomic group 6. Many are preventable |
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Having 2 or more conditions co-occuring at the same time is called? |
Co-morbidity |
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Top 4 major chronic illnesses in Ireland are? |
Cancer CVD COPD Diabetes |
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Case: a 68 year old man presenting Exercise intolerance Unable to walk without becoming breathless Chronic productive cough Feels wheezy at times Frequent chest infections 3 courses of antibiotics Smokes 40 cigarettes per day for 45 years |
COPD |
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What are the Key questions in shortness of breath |
1. When did it start? 2.do you get short in breath at rest or when moving? 3. How far do you move or walk before you get short of breath? 4. Do you get short breath lying down flat on bed at night ? |
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What causes COPD ? |
Mainly somoking Others: Air pollution Occupational exposure Gentics |
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What are the symptoms for COPD? |
Shortness in breath Chronic cough Wheeze Overtime COPD can affect the heart and cause right sided heart failure also known as " COR PULMONALE " |
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What is exacrbations ? |
It is the acute worsening in COPD patients in their symptoms. Also happens for CVD |
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Signs of COPD are ? |
Tripod position Accessory muscle use Pursed lip breathing Barrell chest ( large ribcage) Use of oxygen Tar staining ( on the nails - sign of smoking ) Blue lips Wheeze |
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How can you diagnose a patient with COPD ? |
Take history Examination Test: main test is spirometry which is a machine can measure the airflow out of your lungs ( how quickly they can get the air out of the lings in 1 second) Chest X ray |
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How to manage COPD ? |
There are 4 ways to manage COPD: 1. Non-pharmacological 2. Pharmacological 3. Surgery 4. Manage co-morbidities |
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What can we do in terms of non- pharacoligical menagment ? |
Education and self-management Smoking cessation Pulmonary rehabilitation COPD outreach programs |
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What do pharmacological management have? |
Inhalers Nebulizer Steroids Antibiotics Long term oxygen thereby Vaccinations |
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What does surgery involve in managing COPD |
It can involve Bullectomy Lung volume reduction surgery Transplant |
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Manage co-morbidity? |
Lung cancer Depression Obstructive sleep apnea Cardiovascular disease Gastroesophageal reflux disease Osteoporosis |
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Case 2 : 48 male presenting increasingly thirsty Passing urine very frequently ( 15 times a day ) Tired all the time Recently noted some unintentional weight loss Due to his work his diet is mainly fast food |
Diabetes |
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What is diabetes mellitus ? |
It is a disease that is caused by the lack or insufficiency of insulin which in turn leads to excess sugar in the blood |
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What is hyperglycemia? |
It is excess sugar in the blood. |
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Why we need insulin? |
Insulin is a hormone made by the beta cells of the pancreas The cells in the body need sugar ( glucose) for energy. HOWEVER, the cell allows glucose to enter the cell and be used by insulin. |
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What are the types of diabetes ? |
Type 1 : less common, only 5-10% of diabetes mellitus. The pancreas fails to produce enough insulin due to destruction of beta cells. This leads to a situation where you have no insulin. It is usually caused by autoimmune reaction. Where the body attacks itself Type 2: more common 90% of diabetes mellitus.. Starts off when the body developing a resistance to insulin and then eventually you can also get failure of beta cells Risks: increased weight and certain medications |
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What are the symptoms of diabetes? |
Polyuria ( frequent urination ) Polydipsia (Always thirsty ) Fatigue Weight loss Infections Particular fungi e.g. the skin or vaginal fungal Blurred vision Increase appetite Poor healing |
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How to diagnose? |
Blood sugar levels Hba1 c blood test ( average sugar level over a period of 3 months |
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Risks of diabetes ? |
Patient on Dialysis ( غسيل الكلى) Diabetic retinopathy Stroke |
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What are the effects of diabetes? |
Eyes ( diabetic retinopathy- range from decrease in vision to blindenss) Cardivascular ( increase your risk of strok, heart disease, peripheral vascular disesse) Kidneys ( diabetic nerphropaty- damage to the kidenys) Nerves (diabetic neuropathy - tingling/ pins and needle or even a compelte loss of sensation This can lead to injury of the feet in particular without a patient knowing |
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How to manage diabetes? |
Non-pharamacogical: Education Diabetes team involvement. Lifestyle ( diet and exercise ) Pharmacological Insulin * all type 1need insulin, some type 2 need insulin. Oral hypoglycemic agents |
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What a heart failure? |
The heart is not pumping correctly. With heart failure, the heart is weakened and cannot supply cells with enough blood to the cells. Due to the decrease pumping, there is also leads to a " congetion of blood in the veins. |
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Like COPD, patients with heart failure can be stable for a long time, but period of acute worseing. What is this called ? |
Congetive cardiac failure exacerbation |
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How dose a real heart functions? |
The heart has 4 chambers: Two upper chambers called- atria Two lower chambers called- ventrtical The right atrium brings oxygen depleted blood from the body. This blood travels to the right ventricle and out into the lungs where it becomes oxygenated. Oxygen rich blood travels back into the heart via the left atrium, then to the left venticle, and is pumper out the rest of the body |
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What causes the heart to fail? |
1. Too little oxygen getting to the heart itself.( coronary artery disease) 2. Problem with the muscle - myocarditis- inflammation in the muscle, -cardiomyopathy- hypetrophic cardiomyopathy ( HCM). Dilated cardiomyopathy- can happen in alcoholism. -restrictive cardiomyopathy- when there is too much build up of something in the heart muscle leading for stiffness ex: hemochronmotosis ( too much iron build up in the heart.
3. Problem with the valves - too tight or too flappy 4. Abnormal rhythms Atrial fibration 5. Congeital diseases |
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So in short what causes the heart to fail? |
1. Problems with valves 2.problems with the blood supply to the heart itself 3. Problems with the heart rhythm 4. Problems with the heart muscle ( myocardium ) |
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What are the signs of heart failure ? |
Patients may look short of breath Tachcardia ( fast heart rate ) Swelling of the neck veins ( increase jugular venous pressure ) Crepitations on lungs examination ( fluid in the lungs ) Ascites * abdominal swelling * Peripheral oedema ( leg swelling ) |
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The diagnose of heart failure rely on what ? |
Electrocardiogram ( ECG ) Blood test CXR ECHOCARDIOGRAM: like ultral sound to see the pumping function of the heart and also look at the valves |
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How we can manage CVD ? |
Find and treat the cause Non pharmacklogical: Education Diet Exercise Pharmacological: Diuretics ( to remove excess water) Beta blockers Angiotensin blockers Surgery ( valve replacement and heart transplant ) |
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Case 4: 82 year old found wordering on the streat late at night. She started to get forgetfull. And things are gotting progressively worse . |
Dementia. |
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What is dementia ? |
It is not a specific disease. Its an over all term that describes a group of symptoms associated with a decline in memory or other thinking skills severe enough to reduce a person's ability to preform everyday activities. People have diffeculty with: memory Planning things Emotions Perception It is chronic and progressive The main type is Alzheimer's disease |
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Sympotoms of dementia |
Memory loss Diffeculty planning things Emotions liability diffeculty reading peoples faces Perceptin |
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Social history is really important for dementia. What kind of questions you can ask ? |
Where do you live? Are you living along? Do you have help? Is there someone taking care of you? Can you drive Can you do the shopping and pay for shopping ? |
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Diagnosis rely on what for dementia? |
History Examination Cogbitive test Rule out things Collateral history in the case of not having good answers from the patients |
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How do you manage dementia? |
Non pharamcomogical support for patients and family Education Exercise Cognative training Pharamacological : many but non of them cure dementia |
