If borderline, start with diet - PowerPoint Presentation

1. If borderline, start with diet + exercise (lifestyle changes)Review in 1-3 months; take 3 readingsRegular review + snapYESRegular review + snapYESIf controlledIf controlledYESYESAdd 5mg/dGlibenclamideStart Metformin low dose: 250mg/dIf not controlled with lifestyle changes:If controlledIf controlledEnsure complianceCounsel & reassessAdd Glibenclamide (daonil)Refer to hospital Check complianceCounsel & reassessIf still not controlledNONO                                   Diabetes1Continue diet + exercise with RxContinue diet + exercise with RxIf still not controlledUse Health Workers’ manual for referenceIncrease slowly up to a max of 2gm/dIncrease slowly up to 15mg/day maxNONO

2. Diabetes Diabetes – aim for good controlStart Rx if:Fasting blood sugar is constantly > 7mmol/L , ORRandom blood sugar is constantly > 11mmol/LFor good control of diabetes, aim for:Fasting BSL of < 7.0 mmol/L, ORRandom BSL of <10.0 mmol/LReadings of >10 indicate “poor control” In addition to RxDo a cardio-vascular risk assessment using the CVD risk chart.Explain to the patient what it means.Educate and counsel on lifestyle changes + compliance Follow up regularly and aim for good control Refer to hospital if not controlled Note: For a pregnant woman with diabetes, refer to hospital

3. Regular review“SNAP”YESYESStart RxHydrochorothiazide (Esidrex 12.5mg/d)Is BP under control?Increase 25mg/dIs BP under control?NOAdd Enalapril – 2.5mg/dSlowly increase up to a max of10mg bdIf still uncontrolled, referNO                                  Hypertension3Lifestyle change“SNAP”If borderline, start with diet + exercise (lifestyle change)Review in 1 to 3months; take series of readingsLifestyle change“SNAP” Check compliancePatient education“SNAP “ - smoking, nutrition, alcohol & physical activities

4. Hypertension – aim for good controlConsider medication if:Systolic BP >140 Systolic BP >135 if they also have diabetesDo risk assessment using risk chart to determine when to start RxFor good control of hypertension, aim for:Systolic BP of below 140SBP of below 135, if patient also has diabetesIn addition to Rx:Do a cardio-vascular risk assessment using the CVD risk chart.Explain to the patient what the colour means.Educate and counsel on lifestyle changes + compliance Follow up regularly and aim for good control Refer to hospital if not controlledFor a pregnant woman with high blood pressure, refer to hospitalIf BP very high (SBP >200) or patient has symptoms, give nifedipine S/L, observe and refer.

5. CholesterolIn all situations regardless of risk level, must do lifestyle changes

6. Prednisone 40mg daily for 3 days only+ inhalersVentolin NebuliserRepeat if neededevery 15-30min                                   Asthma and Chronic Obstructive Pulmonary Disease (COPD)6Attend to SOB and relieve symptoms If SOB settles:Go home with Rx and follow up Steroids:Prednisone 40mg x 3dOr Hydrocortisone 100mg IV stat+/-If not improving:- Admit and refer- Discharge with long-term RxBecotide 2 puffs BD daily +Ventolin 2puffs as requiredAdd antibiotics – if yellow sputum + fever. Give Amoxycilline or DoxicyclinePrevent recurrent attacks by avoiding all sources of smoke – cigarettes, tobacco, 2nd hand smoking, cooking fire, bush fire, allergens (peanuts, shellfish). This requires patient education.Discharge Rx

7. Asthma and COPDAdd Steroids if patient comes with:Repeated attacks in recent weeks or past monthPoor response to ventolin nebuliser after 3-4 repeatsDosePrednisone 40mg stat, then 40mg daily x 3daysHydrocortisone 100mg IV stat (if cannot swallow prednisone), followed by prednisone 40mg daily x 3daysIf patient not responding, admit to ward.If good response, observe and send home with good patient education on the 2 types of puffers.If there is no ventolin nebuliser, use ventolin puffers and spacers:Add 20 puffs into spacer and breath into mouth piece at normal breathing rate, in and out 20 times.