If borderline, start with diet exercise (lifestyle changes) Review in 1-3 months; take 3 readings Diabetes 1 Continue diet exercise with Rx Continue diet exercise with Rx If still not controlled Use Health Workers manual for
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01
If borderline, start with diet + exercise (lifestyle changes)
Review in 1-3 months; take 3 readings Diabetes 1 Continue diet + exercise with Rx Continue diet + exercise with Rx If still not controlled Use Health Workers’ manual for reference<br>
02
Diabetes Diabetes – aim for good control Start Rx if:
Fasting blood sugar is constantly > 7mmol/L , OR
Random blood sugar is constantly > 11mmol/L
For good control of diabetes, aim for:
Fasting BSL of < 7.0 mmol/L, OR
Random BSL of <10.0 mmol/L
Readings of >10 indicate “poor control”
In addition to Rx
Do 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<br>
03
Start Rx
Hydrochorothiazide
(Esidrex 12.5mg/d) Hypertension 3 Lifestyle change
“SNAP” If borderline, start with diet + exercise (lifestyle change)
Review in 1 to 3months; take series of readings Lifestyle change “SNAP” Check compliance
Patient education “SNAP “ - smoking, nutrition, alcohol & physical activities<br>
04
Hypertension – aim for good control Consider medication if:
Systolic BP >140
Systolic BP >135 if they also have diabetes
Do risk assessment using risk chart to determine when to start Rx
For good control of hypertension, aim for:
Systolic BP of below 140
SBP of below 135, if patient also has diabetes
In 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 controlled
For a pregnant woman with high blood pressure, refer to hospital
If BP very high (SBP >200) or patient has symptoms, give nifedipine S/L, observe and refer.<br>
05
Cholesterol In all situations regardless of risk level, must do lifestyle changes<br>
06
Asthma and Chronic Obstructive Pulmonary Disease (COPD) 6 Attend to SOB and relieve symptoms If SOB settles:
Go home with Rx and follow up Steroids:
Prednisone 40mg x 3d
Or Hydrocortisone 100mg IV stat +/- If not improving:
- Admit and refer
- Discharge with long-term Rx Becotide 2 puffs BD daily +
Ventolin 2puffs as required Add antibiotics – if yellow sputum + fever. Give Amoxycilline or Doxicycline
Prevent 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<br>
07
Asthma and COPD Add Steroids if patient comes with:
Repeated attacks in recent weeks or past month
Poor response to ventolin nebuliser after 3-4 repeats
Dose
Prednisone 40mg stat, then 40mg daily x 3days
Hydrocortisone 100mg IV stat (if cannot swallow prednisone), followed by prednisone 40mg daily x 3days
If 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.<br>
