PATIENT COUNSELLING POINTS FOR CHRONIC DISEASES.pptx

HYPERTENSION
DIABETES
ASTHAMA
TUBERCULOSIS
COPD
AIDS

1. PATIENT COUNSELLING POINTS FOR CHRONIC DISEASES/DISORDERS BY: LIPANJALI BADHEI KIMSR, KEONJHAR

2. CONTENT HYPERTENSION DIABETES ASTHMA TUBERCULOSIS CHRONIC OBSTRUCTIVE PULMONARY DISEASE AIDS

3. Counselling of the selected chronic diseases Patient counselling related to drug administration, drug interactions and handling of drugs is the duty of pharmacists. Examples of patient counselling for some well-known chronic diseases and some drugs are given below: HYPERTENSION It is the clinical condition, in which more blood pressure observed in the blood vessels which leads to hemorrhagic and other disease condition. Educate the patient on Lifestyle modifications to include: Weight loss, if they are overweight Decrease salt intake (sodium) Decrease alcohol intake Increase physical activity Stress reduction Stop smoking Certain diets (e.g. DASH) that are high in fruits & vegetables and low-fat dairy products may be as effective as monotherapy with one antihypertensive drug.

4. Activity helps to lower blood pressure (BP) and can help to maintain a healthy weight. Mostly, all need at least 60 minutes of physical activity each day. Patients may be taught how to check labels to find low-sodium or no-salt-added foods. Healthcare providers will tell how much sodium and potassium are safe to have in a day. A regular sleep routine can prevent high. Check his or her BP at home, directed him or her sit and rest for 5 minutes before taking the BP. Extend his or her arm and support it on a flat surface. The arm should be at heart level. You may be asked them to check BP more than 1 time each day. We should keep a record of the BP readings and bring it to follow-up visits. Health conditions such as kidney disease or diabetes can increase the hypertension. The healthcare provider may recommend tests for difficulties sleep apnea (breathless) or other problems that can keep him or her from sleeping well. Consult the physician regularly to monitor the BP.

5. Check the blood sugar level: You will learn what the blood sugar level should be. You will be given information on when to check the blood sugar level. You will learn what to do if the level is too high or too low. DIABETES About diabetes medicine: Oral diabetes medicine may be given to help control the blood sugar levels. The healthcare provider will teach you how and when to take the diabetes medicine. Insulin: Insulin may be added if oral diabetes medicine becomes less effective over time. You and the family members will be taught how to draw up and give insulin, if needed. You will learn how much insulin you need and what time to inject insulin. Insulin and insulin pumps: You will also be taught the benefits of an insulin pump. An insulin pump is an implanted device that gives you insulin 24 hours a day. An insulin pump keeps you from needing multiple insulin injections in a day. Diabetes mellitus is the group of metabolic disorders sharing the common feature of hyperglycemia. Hyperglycemia in diabetes results from defects in insulin secretion, insulin action or both. The chronic hyperglycemia may be associated with secondary damage in multiple organ systems, especially the kidney, eyes, nerves, and blood vessels.

6. How to prevent complications: Diabetes that is not well controlled can lead to health problems. Examples include foot sores, retinopathy (vision loss), and peripheral neuropathy (loss of feeling in the hands and feet). Also, risk for dementia can increase with blood sugar levels that are too high or too low for long periods of time. Try to be physically active Physical activity, such as exercise, helps keep the blood sugar level steady and lowers the risk for heart disease. Physical activity can help improve the balance and strength and lower the risk for falls. Physical activity, 30 to 60 minutes most days of the week. Set a goal for strength training: 2 times a week, Strength training helps you keep the muscles you have and build new muscles. Strength training includes lifting weights, climbing stairs, and doing yoga. Maintain a healthy weight: A healthy weight can help you control diabetes and prevent heart disease. Avoid alcohol intake and smoking.

7. ASTHMA Asthma is a condition in which our airways become narrow, swell up and become more glandular (produce extra mucus). This can make breathing difficult and trigger coughing, a whistling sound (wheezing) when we breathe out and shortness of breath. Education about the condition may include medicines, oxygen therapy, and how to stop smoking. Maintain low intake of sodium during the usage of glucocorticoids. During the treatment hydrocortisone, sun exposure should be avoided. The healthcare provider may recommend weight control, regular exercise, and stress management, and will also explain the method of using inhalers, etc. Regularly gargling should be done after use of inhalers, as it may make stain on the throat and may cause infection. The healthcare providers also give education on exercises of at least 20 minutes each day to help increase the energy and decrease shortness of breath. Keep away from the factors that triggers asthma such as dust, smoke, pets, cold, etc. Use air masks outside the home, Avoid secondhand smoke (This is smoke another person exhales)

8. Nutritional counselling may be needed if you weigh too much or too little. Both conditions can cause problems with the breathing. Drink liquids more than usual. Liquid will help to keep the air passages moist and help to cough up mucus. Exercises such as pursed-lip breathing can help you improve the breathing. Pursed-lip breathing helps keep the airways open longer and allows more air to flow through the lungs.

9. TUBERCULOSIS The bacteria usually attack the lungs, but TB bacteria can attack any part of the body such as the kidney, spine, and brain. Not everyone infected with TB bacteria becomes sick. If you’re infected with the bacterium, but don’t have symptoms, you have inactive tuberculosis or latent tuberculosis infection (also called latent TB). It may seem like TB has gone away, but it’s dormant (sleeping) inside your body. If you’re infected, develop symptoms and are contagious, you have active tuberculosis or tuberculosis disease (TB disease). TB can be spread when a person with active TB disease releases germs into the air through coughing, sneezing, talking, singing or even laughing. Only people with active pulmonary infection are contagious. “Tuberculosis is an infectious disease that can cause by a bacterium called Mycobacterium attack mainly your lungs.”

10. Take the medicine as directed. If you forget to take the pills one time, skip that dose and take the next scheduled dose. Write down that you missed a dose and tell the healthcare provider at the next visit. Get involved in the Directly Observed Therapy (DOT) program. DOT are the trained health care worker or other designated individual (excluding a family member) provides the prescribed TB drugs and watches the patient swallow every dose . Take the medicine at the same time every day. Each night, put out the pills for the next day. Mark a calendar each day you take the pills. Wash the hands often. Wash the hands several times each day. Wash after you use the bathroom, change a child's diaper, and before you prepare or eat food Use soap and water every time. Rub the hands together, lacing the fingers. Wash the front and back of the hands, and in between the fingers. Use the fingers of one hand to scrub under the fingernails of the other hand. Wash for at least 20 seconds. Cover a sneeze or cough. Use a tissue that covers the mouth and nose. Throw the tissue away in a trash can right away Tell family, friends, and coworkers that you have TB. They may have latent TB and need to take medicine to prevent it from becoming active. Follow up with the doctor as directed: You may need to return each month for tests to monitor the condition.

11. CHRONIC OBSTRUCTIVE PULMONARY DISEASES (COPD) “Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory lung disease that causes obstructed airflow from the lungs.” People with COPD are at increased risk of developing heart disease, lung cancer and a variety of other conditions. Symptoms include breathing difficulty, cough, mucus (sputum) production and wheezing. It's typically caused by long-term exposure to irritating gases or particulate matter, most often from cigarette smoke. Use pursed-lip breathing any time you feel short of breath. Take a deep breath in through the nose. Slowly breathe out through the mouth with the lips pursed. Try to take 2 times as long to breathe out as to breathe in. This helps you get rid of as much air from the lungs as possible.   Avoid anything that makes the symptoms worse. Stay out of high altitudes and places with high humidity. Stay inside, or cover the mouth and nose with a scarf when you are outside in cold weather. Stay inside on days when air pollution or pollen counts are high. Do not use aerosol sprays such as deodorant, bug spray, and hair spray. Exercise as directed. The healthcare provider may recommend at least 20 minutes of exercise each day to help increase the energy and decrease shortness of breath.

12. Do not smoke. Nicotine and other chemicals in cigarettes and cigars can cause lung damage and make the COPD worse. Avoid second-hand smoke. This is smoke another person exhales. Even if you have never smoked or have quit, it is important to avoid secondhand smoke. This smoke can also cause lung damage or trigger an exacerbation. Go to pulmonary rehabilitation (rehab) if directed. Rehab is a program run by specialists who help you learn to manage COPD. Examples include a pulmonologist (lung specialist), dietitian, or exercise therapist. The specialists will help you make a plan to avoid. Triggers that cause an exacerbation. It is imperative that advise patients on how to properly use their inhalers. Demonstrate proper techniques with inhaler use. Take the medicines as directed. Refill the medicines before you are out so that you do not miss a dose Protect yourself from germs. Germs can get into the lungs and cause an infection.

13. Acquired Immunodeficiency S yndrome ( AIDS) By damaging your immune system, HIV interferes with your body's ability to fight infection and disease. Areas to counsel: Before doing the test (pre-test) After the test (post-test) Crisis counselling Adherence counselling Pre test: This is the counselling that is given to the person who is willing to test for HIV Steps in counselling. Making the patient comfortable. Reason for testing. Concepts and misconceptions. Clarifications about HIV and AIDS. Health education. Clarify about the test. Practicalities of the test. Coping mechanism. Confidentiality. “ AIDS is  a chronic, potentially life-threatening condition caused by the human immunodeficiency virus (HIV) .”

14. Patient Education for HIV and AIDS Indicate that patient could be a source of infection to others and should take actions to prevent transmission - no exchange of blood or body fluids. Encourage patient to disclose HIV status to sex partners and needle-sharing partners. After The Test (Positive): Medical Plan Plan for the future Reduction of high risk behavior Networking Support the patient Crisis Counselling : A person who is HIV positive will face many crisis in life. They needs to be counselled. The patient should decide the best option for their situation. The patients should report back to the counsellor and tell about the progress that they are making. Adherence Counselling: It involves change in behavior so that the patient is disciplined and conditioned to take medication. It should start from the time the diagnosis of HIV is made.

15. Emphasize to HIV positive woman that child should be tested for HIV. Establish both a primary care and HIV provider for the patient and encourage regular follow-up care. For HIV : follow-up visits every 3 months with laboratory assessment of CD4+, HIV RNA viral load, CBC with differential, and comprehensive metabolic panel. Teach patient to recognize and report important symptoms: Change in pattern or magnitude of temperature elevation. Development of a new focal complaint: skin spots, sore mouth, and diarrhea. Emphasize to injection drug users that continued use may expose them to additional infection, and such infections may accelerate disease progression. finding drug treatment - Assist them in finding drug. Encourage patient to modify sexual behaviors for safer sex. – Use latex male condoms. - If a man will not use a condom, the woman can use a female condom. Encourage patient to read literature from various AIDS action groups on safer sex techniques. Teach patient to optimize immune system function through: sound dietary practices, exercise, regular sleep - Promote changes in the direction of more healthful living. Some patients may use complementary or alternative therapies, such as vitamins, herbs, and teas. Caution the patient to share these additional therapies with the primary provider. Refer patient to resources such as, Patient-oriented sites.