Class 2 Flashcards
What percent of deaths in the US are caused by chronic diseases?
70%
What defines a chronic illness?
An illness that lasts longer than 3 months
Comorbidity
the simultaneous presence of two chronic diseases or conditions in a patient
ex: patient with both HTN and HLD
What does comorbidity increase?
Complexity and health risk
What makes patients with comorbidities complex?
1) Treatment of one disease may contradict the treatment of the other
2) Adverse drug interactions
3) Compounding symptoms may lead to poor compliance with treatment plan
4) Patient is at increased risk of organ failure if the comorbidity affects the same organ system
Etiology of HTN
an increase in blood pressure causes excess force against the arterial walls, damaging arteries over time
Risk factors of HTN
FHx of HTN, obesity, high sodium diet, smoking, alcohol
Symptoms of HTN
often asymptomatic
headache is the most common symptom
Diagnosis of HTN
Several high BP readings
Systolic blood pressure
Top pressure reading
Measures pressure in the arteries when the heart contracts
Diastolic blood pressure
dominator
measures the pressure in the arteries when relaxed
Hypotensive BP
less than 90/60
Normal BP
90/60 to 120/80
Prehypertensive BP
121/81 to 140/90
Hypertensive BP
greater than 140/90
What are other chronic illnesses that HTN can lead to?
Hemorrhagic CVA, CAD/MI, CHF, Renal Failure, impaired vision
How does HTN cause other chronic diseases?
HTN damages blood vessels in the brain, heart, eyes and kidneys
Non-pharmacological management of HTN
low sodium diet, stop smoking and drinking alcohol, exercise, BP log at home
How does a low-sodium diet help manage HTN?
sodium increases BP because the kidneys retain more water, so eating less sodium can help the kidneys decrease fluid volume and lower pressure
How does stoping smoking and drinking alcohol help manage HTN?
Nicotine and alcohol are vasoconstrictors
Vasoconstrictors shrink blood vessels (less area = more pressure)
Pharmacological management of HTN
ACE inhibitors
Ca Channel Blockers
Diuretics
ARBs
ACE Inhibitors
relax arteries and block reabsorption of water by kidneys, which help lower BP
Lotensin, Zestril
Ca Channel Blockers
Dilate the arteries and reduce the force of the heart’s contractions, helps lower BP
Norvasc, Cardizem
Diuretics
Reduce the volume of fluid by increasing urination
HCTZ
ARBs
Dilate the arteries, which lowers BP
Cozaar, Benicar
Can a patient be diagnosed with HTN without showing any symptoms?
Yes
Type 1 DM
insulin insufficiency
pancreas is unable to produce insulin
strong FHx component of developing
What is the most common type of DM?
Type 2 (95% of patients)
What is the role of insulin?
to move glucose into the cells
so if you don’t have insulin or body resists insulin, your blood glucose levels rise
How is Type 1 DM treated?
Always treated with insulin
Type 2 DM
insulin resistance
overtime body stops responding to insulin
some FHx component, but strong SHx component
Hw is Type 2 DM treated?
Can be treated with diet changes, non-insulin meds or insulin
Type 2 DM etiology
The inadequency of insulin to control the blood glucose level
Risk factors of Type 2 DM
FHx, obesity, high carb diet, lack of exercise
Symptoms of Type 2 DM
unusual weight gain or loss
polyuria, polydipsia, blurred vision, N/V
What are polyuria and polydipsia?
symptoms of Type 2 DM
polyuria = frequent urination
polydipsia = frequent thirst
How is Type 2 DM diagnosed?
Fasting blood glucose / hemoglobin A1c
What other illnesses can DM lead to?
CAD, CHF, PVD, Neuropathy, Renal failure, Diabetic retinopathy
PVD
peripheral vascular disorder
damaged blood vessels and decreased blood flow to extremities
Neuropathy
damage to the peripheral nervous system
Diabetic retinopathy
DM damages blood vessels in eyes which leads to blurred vision
Non-pharmocological treatment of DM
Low carb diet, weight loss, exercise, blood glucose log
How does low carb diet help with DM?
carbohydrates raise blood glucose more than any other food which leads to increased release of insulin and eventually insulin resistance
What are the three types of insulin?
Humalog (short-term), lantus (long-term(, sliding scale
Oral meds for DM
Metformin and Glyburide
HLD etiology
an elevated level of lipid in the blood causes plaque build up along arterial walls
Risk factors for HLD
FHx, obesity, high lipid diets, alcohol, sedentary lifestyle
Symptoms of HLD
asymptomatic
Diagnosis of HLD
blood work, measuring cholesterol and lipid panels
LDL
low density lipoprotein
commonly known as “bad cholesterol”
allows cholesterol to build up on arterial walls and case plaque
HDL
high density lipoprotein
commonly known as “good cholesterol”
HDL is able to remove cholesterol from arterial walls
How does HLD lead to other diseases?
HLD leads to narrow blood vessels
Arterial atherosclerosis
caused by HLD
accumulation of cholesterol causes blood vessels to thicken and harden
What other diseases can HLD lead to?
pancreatisis, TIA, ischemic CVA, CAD/MI, arterial artherosclerosis
Non-pharmocological management of HLD
Low lipid diet, decrease alcohol, exercise, close follow up
Pharmacological management of HLD
statins
any medication ending in statin is used to treat HLD by inhibiting the production of cholesterol
CAD etiology
narrowing of the coronary arteries limits blood supply to the heart muscle causing ischemia
Risk factors of CAD
HTN, HLD, DM, smoking, FHx <55y/o
Symptoms of CAD
chest pain or pressure (worse with exertion)
improved rest or nitroglycerin (NTG)
Diagnosis of CAD
cardiac catherization to diagnose
What is the number one risk factor for a MI?
CAD
If you have an MI which disease do you automatically have?
CAD
Non-pharmacological management of CAD
manage other risk factor, stop smoking, manage stress, exercise
How does stopping smoking help manage CAD?
nicotine is a vasoconstrictor which narrows the coronary arterties
Pharmacological management of CAD
Aspirin (acetylsalicylic acid, ASA)
Nitroglycerin (NTG)
NTG
Nitroglycerin
Vasodilator used to treat CAD
Surgical management of CAD from least to most invasive
Angioplasty, coronary stent, CABG
Angioplasty
deflated balloon is inserted to open area of blockage and then removed
treats CAD
Coronary stent
similar to angioplasty however the stent is kept in
treats CAD
CABG
open heart surgery to bypass area of blockage
treats CAD
Patient problem list
Section of the chart that helps organize the patient’s history and allows the doctor to identify active issues quickly
What is included in the problem list?
All active and resolved conditions
Chronic illnesses, surgeries/procedures, injuries, symptoms
What is difference between patient list and past history?
Patient list does not include FHx or SHx
Patient list includes the status of problems
How are chronic illnesses classified?
chronic illnesses are always ACTIVE even if they are currently managed
What goes at the top of a patient list?
active problems
What goes on patient list for patient with no problems?
“No known problems”
What should you not put in a note on the problem list?
Side of body or severity
This should just be included in a more detailed description of the problem
