What is the V300 nurse prescribing course?
The V300 nurse prescribing course is a qualification that allows nurses to prescribe medications from the British National Formulary (BNF) for specific clinical conditions. The course provides nurses with the knowledge and skills to prescribe safely, effectively, and appropriately within their area of practice.
V300 nurse prescribing course covers the following topics:· The principles of prescribing· Legal and ethical aspects of prescribing· Pharmacology for prescribing· Therapeutics for prescribing· Patient assessment for prescribing· Monitoring and evaluation of prescribing.
What is the pharmacist independent prescribing course?
The pharmacist independent prescribing (PIP) course is a postgraduate qualification that allows pharmacists to prescribe medications from the British National Formulary (BNF) for specific clinical conditions. The course provides pharmacists with the knowledge and skills to prescribe safely, effectively, and appropriately within their area of practice. The PIP course covers the following topics:· The principles of prescribing· Legal and ethical aspects of prescribing· Pharmacology for prescribing· Therapeutics for prescribing· Patient assessment for prescribing· Monitoring and evaluation of prescribing.
What is the difference between the V300 nurse prescribing course and the pharmacist independent prescribing course?
The main difference between the V300 nurse prescribing course and the pharmacist independent prescribing course is that the latter is a postgraduate qualification. In terms of content, both courses cover the same topics related to prescribing.
Who can take the V300 nurse prescribing course?
The V300 nurse prescribing course is open to all qualified nurses who want to prescribe from the British National Formulary (BNF).
Who can take the pharmacist independent prescribing course?
The pharmacist independent prescribing course is open to all qualified pharmacists who want to Prescribe from the British National Formulary (BNF).
What are the benefits of taking the V300 nurse prescribing course?
The main benefit of taking the V300 nurse prescribing course is that it enables nurses to prescribe medications from the British National Formulary (BNF) for specific clinical conditions. This can save time and money for patients who would otherwise have to see a doctor for a prescription. In addition, the course provides nurses with the knowledge and skills to prescribe safely, effectively, and appropriately within their area of practice.
What are the benefits of taking the pharmacist independent prescribing course?
The main benefit of taking the pharmacist independent prescribing course is that it enables pharmacists to prescribe medications from the British National Formulary (BNF) for specific clinical conditions. This can save time and money for patients who would otherwise have to see a doctor for a prescription. In addition, the course provides pharmacists with the knowledge and skills to prescribe safely, effectively, and appropriately within their area of practice.
What are the entry requirements for the V300 nurse prescribing course?
The entry requirements for the V300 nurse prescribing course are as follows:· You must be a qualified nurse with a valid Nursing and Midwifery Council (NMC) PIN number.
- You must have completed a recognised accredited prescribing course within the last three years.
- You must have a minimum of two years’ post-registration experience.· You must have completed a recognised accredited pharmacology course within the last three years.
- You must have a minimum of two years’ post-registration experience in a clinical area.
What are the entry requirements for the pharmacist independent prescribing course?
The entry requirements for the pharmacist independent prescribing course are as follows:· You must be a qualified pharmacist with a valid General Pharmaceutical Council (GPhC) registration.
- You must have completed a recognised accredited prescribing course within the last three years.
- You must have a minimum of two years’ post-registration experience.
- You must have completed a recognised accredited pharmacology course within the last three years.
- You must have a minimum of two years’ post-registration experience in a clinical area.
What will I need to do in order to complete my nonmedical prescribing course?
In order to complete your nonmedical prescribing course, you will need to pass all of the assigned assessments, which include exams, essay writing and completion of a portfolio.
These assessments will cover all of the topics related to prescribing that are covered in the course. In order to pass the course, you will need to demonstrate that you have a good understanding of all aspects of prescribing and that you can apply this knowledge in a clinical setting.
How long will it take me to complete my nonmedical prescribing course?
The length of time it takes to complete a nonmedical prescribing course varies depending on the provider, but most courses can be completed within six to twelve months. Some providers offer distance learning options which can allow you to study at your own pace and complete the course in a shorter timeframe.
Is the nonmedical prescribing course difficult?
The nonmedical prescribing course can be difficult for some students. However, with hard work and dedication, most students are able to pass the course. The assessments that need to be completed in order to pass can be challenging, but with a good understanding of the material and plenty of practice, most students are able to do well.
And it appears most nurse prescribing, and pharmacist independent prescribing students struggle with the completion of the essay component of the nonmedical prescribing course.
Therefore in this article, MEDLRN has provided an example of a nonmedical prescribing essay, such that you do not need to outsource your essay writing to an external and paid-for essay writing service. Furthermore, the essay written below is also suitable for allied healthcare professionals who are also looking to undertake a nonmedical prescribing course.
What is the nonmedical prescribing portfolio and essay?
While you’re independent prescribing course (as a pharmacist wanting to undertake the pharmacist independent prescribing or a nurse wanting to complete the V300 nurse prescribing course) – you will be required to complete an independent prescribing practice portfolio and write an essay on your scope of practice.
The nonmedical prescribing portfolio is a collection of documents that you must submit to demonstrate that you have met the requirements for the V300 nurse prescribing course.
The essay is one component of the portfolio and is mandatory. It must be submitted with the other documents.
The purpose of the essay is to assess your ability to critically appraise information and to communicate your thoughts and findings in a clear and concise manner. The essay should be no more than 2,500 words in length (however, this can vary from university to university). It must be well-structured and organised and must include a reference list.
What are the benefits of writing essays?
There are many benefits to writing essays, including the following:
- Essays allow you to demonstrate your understanding of the material.
- Essays allow you to communicate your thoughts and findings in a clear and concise manner.
- Essays help you to develop your critical thinking skills.
- Essays help you to develop your research skills.
- Essays can be used to support your application for further study or training.
What are the key points to remember when writing a nonmedical prescribing essay?
There are a few key points to remember when writing a nonmedical prescribing essay, including the following:
- Make sure that you understand the question that has been asked.
- Make sure that you research the topic thoroughly.
- Organise your thoughts and ideas in a logical manner.
- Write in a clear and concise manner.
- Edit and proofread your essay before submission.
Nonmedical prescribing essay example on hypertension
A supplementary prescribing episode
The following prescribing episode is based on an actual patient and supervised by the DMP; information that contains patients’ details has been anonymised, and consent was gained throughout in accordance with the guidance published by the General Pharmaceutical Council (2017).
For the purpose of this episode, the patient will be known as Bob.
1. Presenting Compliant
Mr Bob, aged 56, was referred to the hypertension clinic due to concerns over consistently high blood pressure readings.
This is a supplementary prescribing episode; supplementary prescribing represents a tripartite collaboration between an independent prescriber, a supplementary prescriber and a patient. The independent prescriber provides the initial diagnosis, and the supplementary prescriber is given the authority to implement an agreed patient-specific clinical management plan(CMP) with the patient’s consent (Department of Health 2005, pg 8 and Bissell, et al.,2008).
As such, in the summary of the above, the three-way partnership involves:
- An independent prescriber who is responsible for the initial assessment of the patient, including the diagnosis and the development of the CMP (NHS File,2009 and Department of Health, 2005)
- The supplementary prescriber is responsible for confirming the diagnosis during each review of the patient and must prescribe within the agreed CMP (NHS File,2009)
- The patient must be aware of and agree to initiate his/her care through a CMP (The textbook of nonmedical prescribing,2011).
The benefits of supplementary prescribing for patients include increased access and improved choice for patients (Department of Health, 2008) and for the prescriber include; increased job satisfaction and better use of their skills (Louise, Aspell and Mary, 2016)
LO2, LO4, LO6
The Calgary-Cambridge model was utilised to undertake the patient consultation. The consultation model is based on “a patient-centred approach”, as such promoting a collaborative partnership (Silverman, Kurtz and Draper, 1998) and providing a structure which complements a holistic approach (Munson and Willcox, 2007). The model involves five main stages, which provide me with an easy-to-follow structure allowing me to ask the appropriate questions, enhance patient safety and make informed decisions (Jane Rutt-Howard 2011, p123).
LO5, LO6
Initiating the session
I welcomed the patient and informed him I am a trainee independent prescriber under the supervision of my DMP. I explained the reason for the consultation and gained consent.
Gathering information
2. History of presenting complaint
Bob had previously been diagnosed with essential hypertension at stage 1 with no evidence of target organ damage. As such, Bob was offered a non-pharmacological approach to manage his hypertension (NICE,2016). However, at an annual review with the G.P., he was found to have an average systolic blood pressure reading 160mmHg over two weeks of repeated measurements.
3. Health status
Past medical history
Essential hypertension – 2017
Family History
Both parents suffer from hypertension
Social History
Bob works as a taxi driver and lives with his wife. He enjoys going for walks and does not drink or smoke
Allergies
None-Known
Drug history
Bob does not take any prescribed, herbal, OTC or recreational drugs
Physical Information
- A review of systems Included average hypertension readings over two weeks (refer to appendix 1).
- Differential diagnosis
The secondary cause of hypertension:
- Chronic Kidney disease – Excluded as upon investigation of blood tests, no abnormalities in particular potassium or creatinine were found indicative of renal disease (Weber et al., 2014)
- Excessive aldosterone secretion- Excluded as no abnormalities in serum potassium (Weber et al., 2014)
- Pheochromocytoma – Excluded as no symptoms of flushing, headache etc. (Viera et al.,2010)
- Sleep Apnea – Excluded as upon questioning on any other signs and symptoms, no problems identified (Viera and Neutze, 2010)
LO3A, LO5, LO6
1. Definitive diagnosis
Essential hypertension stage 2 – The diagnosis can clearly be made as demonstrated by the blood pressure results taken over a two-week period and having excluded any secondary causes of raised blood pressure. In addition, the patient’s past medical history and NICE guidelines (2016) also affirm the diagnosis characterised by clinic blood pressure of at least 160/100 mmHg and subsequent home blood pressure measurements average of at least 150/95 mmHg.
LO3A, LO5, LO6
1. Prescribing options
Antihypertensive as per clinical management plan, e.g.;
Calcium channel blocker(CCB)
Ace Inhibitors
Angiotensin receptor blockers
Thiazide diuretics
LO1, LO5, LO6
1. Prescribed medication
Amlodipine 5mg tablets ONCE daily (NICE, 2016 and BNF, 74) – CCB
Cost: 80p for 28 tablets
LO1, LO5,LO6
Pharmacokinetics (MHRA, 2008 and Abernethy,1992)
Absorption: Peak blood levels between 6-12 hours post-dose
Distribution: 97.5% protein-bound
Metabolism: Extensively metabolised in the liver with no significant pre-systemic metabolism
Elimination: Excreted in the urine with an elimination half-life of 35-50 hours
LO1, LO5, LO6
Pharmacodynamics
Amlodipine is known as a calcium ion channel inhibitor of the dihydropyridine group and inhibits the transmembrane influx of calcium ions into both cardiac and vascular smooth muscle (Fares H et al.,2016). As such, its antihypertensive effects are due to its direct relaxant effect on vascular smooth muscle, which reduces the total peripheral resistance against which the heart works (MHRA, 2008).
LO1,LO5, LO6
1. Contraindications (BNF, 74)
- Non relevant
LO1, LO5, LO6
1. Side effects (BNF, 74)
- Abdominal pain
- Ankle swelling
- Flushing
- Headache
LO1, LO5, LO6
1. Drug interactions
Bob is not currently on any medication that would interact.
LO1, LO5
Explanation, planning and closing of the session
Bob was reviewed in the presence of my DMP, and a clinical management plan was agreed upon (Appendix 2).
Bob explained that the diagnosis of hypertension is not in itself serious, but the control of blood pressure is necessary to prevent serious complications such as heart disease and stroke (Weber et al., 2014 NICE., 2016). Therefore, a calcium channel blocker (Amlodipine) was prescribed in line with current national guidelines (NICE, 2016) to reduce his blood pressure and prevent the development of cardiovascular complications (Fares H et al., 2016).
Bob was signposted to the NHS choices website, and an information sheet on hypertension and its management was given to reiterate and further explain what had been mentioned in the consultation.
In addition, it was explained to Bob to continue to exercise regularly and reduce his salt intake, both of which can reduce blood pressure (Weber et al., 2014). Bob was also advised to book a follow-up appointment after two weeks to review drug therapy (Nice., 2016) and should he have any questions or concerns, to contact me or the G.P.
LO3A, LO4 LO5, LO6
Hypertension is a major risk factor for cardiovascular events such as myocardial infarction, heart failure etc., stroke and chronic kidney disease (Weber et al., 2014; NICE, 2016). As such, the above suggests Bob, a 56-year-old gentleman, is at an increased risk of suffering a major cardiovascular event in the future should his systolic blood pressure remain greater than 140mmHg. This highlights the need for a prompt diagnosis and treatment according to NICE guidelines (2016).
Nice (2016) has provided an algorithm for the treatment of uncomplicated hypertension, which advises the use of a calcium channel blocker for adults above the age of 55 with stage two hypertension. As such, Bob has prescribed a calcium channel blocker known as Amlodipine.
Evidence: LO1,LO3A,LO5,LO6
1. Amlodipine Efficacy
The efficacy of Amlodipine in the management of hypertension has been demonstrated in many large-scale randomised controlled trials (Health Service Executive, 2016), which include:
- The 2007 ACCOMPLISH trial- the trial compared Amlodipine plus an Angiotensin Converting Enzyme (ACE) inhibitor to a thiazide plus an ACE inhibitor. The study showed both groups reduced blood pressure (B.P.) from baseline over the course of the trial. However, the combination of an ACE inhibitor plus Amlodipine was found to be superior to an ACE inhibitor plus a diuretic in reducing the risk of cardiovascular events and death (Jamerson K. et al. 2008).
- The 2004 Value trial- the trial investigated if Valsartan would reduce cardiac morbidity and mortality more than Amlodipine in patients who were hypertensive at high cardiovascular risk showed both groups lowered B.P., however, Amlodipine was found to reduce B.P. significantly more than Valsartan, especially in the first month of treatment (Julia S et al.,2004).
- The 2004 CAMELOT trial- the trial compared Amlodipine to Enalapril in order to determine the effects of these drugs on cardiovascular events in patients with coronary artery disease. The study showed both antihypertensives were found to significantly lower B.P. compared to placebo (Nissen S et al.,2004).
- The 2005 ASCOT-BPLA trial- the trial investigated the prevention of cardiovascular events with Amlodipine which was compared to Atenolol-based regimens. The study showed a lower B.P. in the Amlodipine treatment regimen throughout the trial. In addition, The primary endpoint of nonfatal MI or fatal CHD was 10% lower in the Amlodipine regimen when compared to the Atenolol regimen (Dalholf B et al., 2005).
- The 2002 ALLHAT trial- was one of the largest trials of antihypertensive therapy conducted (Alejandro de la Sierra., 2007) and showed Amlodipine reduced systolic B.P. from baseline levels and significantly lowered diastolic B.P. than Chlorthalidone and Lisniproil (ALLHAT, 2002 and Health Service Executive, 2016)
As such, international guidelines from Europe (European Society of Cardiology/ European Society of Hypertension,2013 ), America (American College of Cardiology/America n Heart Association, 2014) including the U.K. (NICE,2016., British Hypertension Society,2008 and Scottish Intercollegiate Guideline Network, 2007) all recommend a calcium channel blocker in their respective hypertension treatment algorithms (Health Service Executive, 2016).
Moreover, in line with the NICE guideline, a recently published formulary to promote the safe, clinically effective and cost-effective use of prescribed medicines in Northern Ireland recommends Amlodipine as the first-choice treatment for hypertension (Health Service Executive, 2016). In addition, other NHS trusts such as County Durham, NHS Lothian, and Darlington NHS trust and the Dorset Cardiology working group on hypertension also have selected Amlodipine as the first choice calcium channel blocker (Health Service Executive, 2016).
2. Amlodipine dosage and frequency
Bob has prescribed Amlodipine initially at a low dose of 5mgs once daily for four weeks; this was because NICE (2016), the BNF (74), and other guidelines (Qi Chen et al., 2017) recommend that a calcium channel blocker is indicated to prescribe a CCB that is taken once daily and to start initially at low doses.
In addition, NICE(2016) and the BNF (74) recommend titrating dosages at four-weekly intervals to maximum licensed dosages. Consequently, a major advantage of using an initial low dose approach and titrate dosages slowly is that it can lower the possible incidence of adverse effects and improve adherence(Qi Chen et al., 2017 Health Service Executive,2016).
Prescribing Issues
Adherence
The benefits of lowering blood pressure are well known (Nice,2016). However, despite the overwhelming clinical evidence supporting the benefits of antihypertensive treatment, it has been reported that less than 50% of treated hypertensives have good blood pressure control (Izzat,2009), with lack of adherence to antihypertensive medication being reported as a well-recognised cause for poor blood pressure control (Izzat,2009).
Adherence can be defined as ‘The extent to which the patient’s behaviour matches agreed-on recommendations from the prescriber’ (National Health Service Delivery and Organisation R&D, 2005).
Reasons for non-adherence are complex and multi-factorial; as such, from a patients perspective, barriers to adherence to medication include side-effect profile of drugs, poly-pharmacy, the complexity of treatment schedules, lack of understanding of treatment targets and limited patient involvement in treatment decisions (National Health Service Delivery and Organisation R&D, 2005 and Izzat,2009).
As such, during the consultation, Bob was assessed to identify if there were any factors which would prevent him from taking his medication; however, no issues were identified. Furthermore, in order to encourage adherence to the use of antihypertensives prescribed to Bob, the following steps were taken:
LO3A, LO5, LO6
A patient-centred approach to prescribing
Bob was thoroughly explained and given information leaflets as well as signs posted on websites such as ‘Patient.co.uk’ and the ‘British Hypertension Society’ in an attempt to empower and educate him on hypertension and its diagnosis and benefits of its management in order to create an incentive for adherence to his medication which has been shown to be beneficial when dealing with chronic, asymptomatic conditions such as hypertension (Izzat, 2009).
Moreover, in order to ensure Bob understood the contents of the leaflets and websites etc., he was asked to suggest what changes he would implement as a result of the new knowledge he has gained and encouraged to contact his g.p or me should he have any questions.
LO5, LO6
Medication specific factors
Simplified dosage regimen:
Bob has prescribed a once-daily dosage regimen as it has been shown simplification of the treatment schedule and a reduced number of daily doses is effective in increasing adherence to medication (Izzat, 2009; NICE,2016.). Furthermore, Bob was encouraged to take his medication in the morning wherever possible in an attempt to make this part of his morning routine.
LO3A, LO5, LO6
Adverse drug reactions(ADRs):
Bob was informed about the possible likely ADRs associated with Amlodipine and the likely hood of Bob suffering from the ADRs. Bob was informed of the interaction between grapefruit juice and Amlodipine, which may increase the plasma concentration of Amlodipine and lead to ADRs (Emc, 2018) and reduce Bob’s adherence to the medication. Therefore, it was explained to Bob to avoid the consumption of grapefruit juice and Amlodipine (Emc, 2018).
In addition, Bob was explained Amlodipine is widely used in hypertension, well-tolerated and safe (HSE, 2016). However, Bob was encouraged in the event of these ADRs to contact either myself or his G.P. in order to review the treatment regimen.
LO1, LO5, LO6
Health Education
Numerous lifestyle interventions have been shown to lower blood pressure, and these interventions are also implemented when managing most other cardiovascular risk factors (Weber et al., 2014).
Regular exercise
Bob explained the importance of exercise and how it helps make your heart and blood vessels more efficient and flexible, thus, lowering blood pressure (weber et al., 2014) and keeping you fit (The blood pressure association, 2008). It was explained to Bob that different kinds of exercise have different effects on the body; with activities that help your heart and blood vessels being shown to be most beneficial in lowering blood pressure, such as aerobic exercises (weber et al.,2014 and The blood pressure association,2008), e.g. walking, swimming, jogging, tennis, brisk walking, mowing the lawn etc. (The blood pressure association, 2008).
As such, Bob was encouraged to undertake 30 minutes of moderate exercise five times a week to become more fit and healthy, and in order to achieve this, the following was explained, and practical tips were given:
- A moderate exercise is an exercise that should be enough to make you breathe harder and feel warmer; however, you should still be able to talk without panting between words) (The blood pressure association, 2008).
- Increase your activity by small amounts allowing you to build up to the full 30 minutes over a few weeks by setting small goals that add up, i.e. initially split your 30 minutes into two 15 minutes or three 10-minute sessions, enabling you to build up your strength as well as helping you get accustomed to your new activity.
- If you feel the idea of exercise is boring, then try to get others involved, e.g. your wife, which can make it a lot more enjoyable (The blood pressure association,2008).
LO3A, LO5, LO6
Nutrition
Salt reduction
Bob has explained the importance of reducing his salt intake and how a low salt diet can help contribute to reducing his blood pressure (Weber et al.,2014). In addition, Bob was informed that the recommended salt intake for healthy adults is 6g per day, with NICE (2010) recommending that we all should aim to have less than 3g per day of salt by 2025.
Bob was given the following tips in order to identify high salt foods:
- Look for the ‘traffic light’ label on foods to help you make a healthier choice. ‘Traffic light’ colours help you to see at a glance if food is high, medium or low in salt, with green being low, orange being medium and red being high(British dietetic association,2018).
- For foods that do not yet display the ‘traffic light’ labelling, then 0g-3g of salt per 100g of food is low, 0.3g-1.5g of salt per 100g of food is medium and more than 1.5g of salt per 100g of food is high (British dietetic association,2018).
In addition, Bob was given the following practical advice to reduce salt intake (British dietetic association, 2018):
- Use little or no cooking salt instead; use extra herbs and spices such as black pepper
- Cut down on processed and ready meals and try to make your own food
- Compare salt levels among similar foods to choose those with lower salt
- Ask restaurants and takeaways for no added salt
- Be wary of salt substitutes as these product ranges may still likely add some form of salt to your diet.
LO5, LO6
Fat intake
Bob explained fats are an important part of our diet; however, eating too much fat can be unhealthy as it increases the chances of becoming overweight and developing serious health problems such as type 2 diabetes and some cancers (British dietetic association, 2018).
In addition, it was explained to Bob some fats are better than others, and there are three main types of fat; saturated (found in fats on meat, butter, cakes, biscuits,
takeaway meals etc.), Trans fats (found in cakes and pastries and may appear in the list of ingredients as ‘partially hydrogenated vegetable fats/oils) and unsaturated (found in plant foods such as seeds/grains, nuts, vegetables and fruits), i.e. polyunsaturated, monounsaturated and omega-3 (also known as essential fats found in oily fish such as salmon or plant foods, e.g. rapeseed oils etc.) with saturated and trans fats being considered to be less healthy as they increase our blood cholesterol levels and increase the risk of heart disease (British dietetic association, 2018).
Furthermore, Bob was explained when cooking to use small amounts of oil, ideally using pure vegetable, rapeseed, olive or sunflower oils etc. and was advised that a tablespoon of oil is enough for four people (British heart foundation, 2014). In addition, Bob was explained when having meat try to choose lean cuts of meat and remove any visible fats (Food standards agency, 2005)
Therefore, the following practical tips were given to Bob to allow him to make healthier choices (British dietetic association,2018 and NHS Choices, 2015 ):
- Where possible, look for the colour-coded system of food labelling to quickly see at a glance what key nutrients and calories there are in food, i.e. foods with over 17.5g fat per 100g would be red (i.e. high in fat), and those containing 3g per 100g of would be amber (medium) while those foods containing less than 3g per 100g of food would be green (low in fat).
- When buying meat, look for the leanest options. (e.g. turkey, chicken or fish etc.). As a rule of thumb, the more white you can see on the meat, the more fat it contains.
- Limit processed meat such as sausages, beef burgers, salami etc. and meat products in pastries, e.g. pies, sausage rolls etc
- Cut off any visible fat and skin before cooking and try to grill meat rather than frying.
- Roast meat on a metal rack above a roasting tin so fat can run off.
LO5, LO6
Fruit and Vegetables
Bob explained the benefits of eating plenty of fruits and vegetables, which include lowering the risk of many heart diseases and reducing blood pressure(British dietetic association, 2018). Therefore, Bob was encouraged to eat at least five (80gs) portions of a wide variety of fruits and vegetables a day
The following practical tips were given to Bob in order to achieve the five-a-day target (British dietetic association):
- Opt for fresh produce in the season
- Eat a variety of different coloured fruits and vegetables.
- Be careful not to consume more than 30g of dried fruit which counts towards your five-a-day target as fruit; once dried can become a concentrated source of sugar and calories (British dietetic association 2018).
- Check for nutrition information on food labels when selecting foods based on the ‘5-a day’ logo as some vegetables contained in convenience foods such as ready meals may also be high in salt, sugar or fat.
- Be aware that no matter how much fruit juice or varieties of fruit juices are consumed in a day, a glass (150mls) of unsweetened 100% fruit vegetable only counts as one portion of the five a day.
- Cut down on your portion of meat and increase your portion of vegetables.
LO5, LO6
Appendices
Appendix 1
Review of Patient
General: A middle-aged gentleman who exercises regularly and feels fit and healthy with no other symptoms
Neurological: No history of headaches, alert and orientated
ENT: No problems identified
Eyes: No visual disturbances, optic fundi was checked, and no problems identified.
Respiratory examination: No shortness of breath or chest pains indicative of coronary artery disease
Skin: No problems identified
Renal: No problems identified
Cardiovascular:
Pulse: Normal
ECG: Normal Sinus rhythm
No ankle swelling
Overall no problem was identified
Investigation
Blood pressure readings
Two weeks average blood pressure readings: 160mmHg/90mmHg
Clinic blood pressure average O/E 160mmHg/90mmHg
Urea and electrolytes
NA+: 133 (133-146) mmol/L
K+: 4 (3.5-5.3) mmol/l
Creatinine: 80 (50-120) Umol/L
Urea: 3 (1.7-7.1) mmol/L
Full blood count
Haemoglobin estimation: 15.9 (13-17) g/dL
Total White cell count: 5.41 (4-11) x1o*9/L
Platelet count: 233 (150-400)x10*9/L
Haematocrit: 0.456 (0.4-0.5)L/L
Red blood (RBC) count: 5.48 (4.50-5.50)x10*12/L
Mean corpuscular volume (MCV): 83.2 (83-105) fl
Mean Carpusc. Haemoglobin (MCH) 29 (27-32) pg
Mean Corpusc. Hb conc (MCHC) 34 (31.50-34.50) g/dl
Neutrophil count: 2.81 (2-7) x10*9/L
Lymphocyte count : 1.79 (1-4)x10*9/L
Monocyte count: 0.43 (0.2-1) x10*9/L
Eosinophil count: 0.38 (0-0.5) x10*9/L
Basophil count: 0.05 (0-0.1) x10*9/L
Haemoglobin: 15 (13.5-18)g/DL
Liver function Tests
Bilirubin:15 (,17) umol/L
ALT: 20 (5-40) umol/L
AST: 15 (12-40) umol/L
ALP: 50 (39-117) umol/L
Albumin: 40 (35-50) g/L
Lipids
Total Cholesterol: 4 (<5) mmol/L
Non HDL Cholesterol: 3.5 (<4) mmol/L
LDL- Cholesterol: 2 (<3) mmol/L
Fasting Triglyceride :1.9 (<2) mmol/L
Thyroid Function tests
TSH: 0.6 (0.4-4) mU/L
FT4: 12 (9-25) pmol/L
FT3: 3.9 (3.5-7.8) pmol/L
MISC
Fasting Glucose: 4 (<5.5) mmol/L
Urine albumin:creatinine ratio: 2.4 (<2.5) MG/mmol
O/E height: 181cm
Weight O/E: 80 kg
BMI: 24.4
QRISK 2 cardiovascular disease ten-year risk score: 10.4%
Alcohol consumption: 0 U/week
Smoking status: Never smoked
Smoker: Never smoked
The ranges shown in brackets are the normal ranges taken from Dickinson et al. (2005), and all clinic blood pressure readings were carried out in line with best practice guidelines (Weber et al., 2014, NICE 2016)
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