Aberfoyle Park Medical Centre
Cnr Manning & Summerford Roads Aberfoyle Park, SA, 5159
Phone 82705211 Fax 83707153
Management Plan - 15/08/2006
Mr T
Review Date:
15/2/2007
Active:
|
Date |
Condition -- Comment |
|
HYPERCHOLESTEROLAEMIA Target established is 4.0 |
|
|
LEFT VISUAL LOSS 6/60 |
|
|
MULTIPLE BCC'S |
|
|
1982 |
HYPERTENSION |
|
2000 |
CORONARY STENT |
|
2000 |
DIABETES Dietary management - low fat, low sugar and high fibre diet. Regular exercise - walking 5Km alternate days. |
|
2000 |
GOUT |
|
2000 |
INFERIOR MYOCARDIAL INFARCTION |
|
2003 |
MODERATE HYPERTRIGLYCERIDAEMIA |
|
2005 |
?NECK INDUCED TINGLES RIGHT THUMB AND FOREFINGER |
Inactive
:|
Date |
Condition -- Comment |
|
2003 |
SMALL LEFT VARICOCELE |
|
2005 |
BCC RE-EXCISION-EAR & SSG(Right) |
|
15/8/2006 30/12/2005 |
721 2517 |
Current Medications
:|
Drug Name |
Strength |
Dose/Freq./Special |
|
ASTRIX 100 Tablet |
100mg |
1 daily |
|
ATORVASTATIN Tablet |
40mg |
1 daily |
|
FLUVAX Syringe |
TRIVALENT |
For Doctor's use only |
|
FLUVAX Syringe |
TRIVALENT |
For Doctor's use only |
|
METFORMIN HYDROCHLORIDE Sr Tablet |
500mg |
1 t.i.d. |
|
NITROLINGUAL PUMPSPRAY Spray |
400mcg/dose |
1-2 as required. Don't inhale it |
|
PERINDOPRIL ERBUMINE Tablet |
2mg |
1 daily |
|
VIAGRA Tablet |
50mg |
Use one tablet at a time. Allow one hour for effect. |
Immunisations:
|
29/05/2001 |
INFLUENZA |
|
|
30/05/2002 |
INFLUENZA |
|
|
4/06/2002 |
PNEUMOVAX |
|
|
7/11/2002 |
ADT |
|
|
15/04/2003 |
INFLUENZA |
|
|
1/04/2004 |
FLUVAX |
|
|
30/03/2005 |
INFLUENZA |
|
|
28/03/2006 |
FLUVAX |
Allergies:
No known allergies.
Warnings:
Difficulty with anaesthetic induction HT,NIDDM,MI stent
Comments:
DIABETES
GOAL ONE
Maintain glycosylated haemoglobin less than 7%
Glycosylated haemoglobin is a measure of how sugar is affecting the cells of the body.
A level of less than 7% is very good, a level between 7% & 8% is adequate, and over 8% is associated with poor control of blood sugar levels as well as an unacceptably high occurrence of nerve and blood vessel damage.
MANAGEMENT STEP
Three to six monthly blood test for HbA1c - glycosylated haemoglobin
PERSON RESPONSIBLE
T and Dr. Terry Rose
GOAL TWO
Monitor Kidney function. This is achieved by assessing the amount of a protein in the urine called microalbumin, and by measuring the blood creatinine level
MANAGEMENT STEP
Annual urine test for urinary microglobulins and creatinine
PERSON RESPONSIBLE
T and Dr. Terry Rose
GOAL THREE
Maintain cholesterol below 4.0
This minimizes the effects of diabetes on the blood vessels
MANAGEMENT STEP
Six monthly cholesterol reading
PERSON RESPONSIBLE
T and Dr. Terry Rose
GOAL FOUR
Maintain blood pressure as close as possible to 120/80 if it is naturally higher.
This minimizes damage to small blood vessels throughout the body
MANAGEMENT STEP
Monitor blood pressure three monthly
PERSON RESPONSIBLE
T and Dr. Terry Rose
Smoking status: not known
|
Test name |
Why is this measure important? |
Your latest reading is |
Your target level is |
|
HbA1C |
This measure reflects average blood sugar readings, but is not an actual blood sugar reading |
8.2 % |
Less than 7% |
|
Cholesterol |
The fat in the blood that is most responsible for the build up of chunks of fat on the inside of arteries |
5.6 |
under 4 |
|
Blood Pressure |
The lower the better |
120/60 |
130/80 or less |
|
Current weight |
Again, keeping your body weight as close to ideal as possible will help minimise complications of diabetes |
90 Kg |
If your Body mass index is over 25, aim for a 5% weight loss over the next 6 months |
|
Body mass index |
This is the measure that lets us work out your ideal weight based on your height |
31.9 |
25 |
|
Creatinine clearance |
This measure helps us know how your kidney is going |
Over 60 |
|
|
Urine Micro- albumin |
We measure this protein in the urine to see if the holes in the filter system of the kidneys are being damaged. Weight loss helps |
24 |
Less than 15 |
|
Last Eye specialist consult |
The blood vessels in the eye are very sensitive to high sugar levels and can start to leak and clog up. A lot of these changes can be helped if diagnosed early |
Your last specialist appointment
15/2/ 2006 |
A visit to the eye specialist within the past two years |
DIET AND EXERCISE
There is considerable scope for lifestyle modification including:
We recommend at least 3 hours a week brisk walking
We recommend a low fat, high fibre diet with at least 2 litres of water per day
PREVENTIVE HEALTH
We recommend a yearly fluvax and a pneumonia vaccination every 5 years.
"Insure" screen for bowel cancer every year. This test is very specific for human blood, as well as being quite sensitive. A negative test is good news, but does not totally exclude a bowel tumour. A positive test indicates bleeding from somewhere and this can include bleeding form a tooth, the stomach and also from a polyp in the bowel. So a positive test is an indicator for follow up, and is not diagnostic of a tumour.
Progress notes shortcuts - copy and paste them into the "Comments" section in the Progress notes
"cdm" = chronic disease management
Benefits and procedures of a management plan considered, explained and agreed.
Goals, needs and actions discussed.
Other providers mutually chosen and contacted, and permission to share relevant information obtained.
Items –
721 Plan 725 Review
723 Coordination 727 Review
Treatment/services to be provided by collaborating providers
"diab" = diabetes 12 month assessment
Diabetes 12 month assessment
Patient educated about diet, exercise and risk factors
Medication reviewed
BP and BMI measured and feet examined within past 6 months and performed twice in this cycle of care
Feet - normal colour, temp, sensation and pulses
HbA1c, lipids and microalbumin checked within past year
Ophthalmologist seen within past 2 years
Items level B 2517, level C 2521, level D 2525