Course 2: Chronic Illnesses and the Patient Problem List Flashcards
1. Why are chronic illnesses concerning? 2. What is hypertension and how is it managed? 3. What is diabetes mellitus and how is it managed? 4. What is hyperlipidemia and how is it managed? 5. What is coronary artery disease and how is it managed? 6. What is asthma and how is it managed? 7. Project list
1
Q
comorbidity
A
the simultaneous presence of two chronic diseases or conditions in a patient (i.e. asthma, HTN, HLD, DM, CAD)
2
Q
etiology
A
the cause of a disease
3
Q
systole (systolic)
A
phase of the heartbeat during which the muscle contracts, pumping blood to the body
4
Q
diastole (diastolic)
A
phase of the heartbeat during which muscle is relaxed and the heat fills with blood
5
Q
diuretic
A
a substance that promotes the production of urine
6
Q
paresthesia
A
sensation of tingling or numbness
7
Q
polydipsia
A
excessive thirst
8
Q
ischemia
A
lack of blood supply
9
Q
anticoagulant
A
a drug that prevents blood clotting
10
Q
When does an illness become classified as chronic?
A
when it lasts longer than 3 months
11
Q
Why are patients with comorbidities considered complex?
A
1, the treatment of one Dz may affect or contradict the treatment of a second (i,e, CHF & chronic renal failure – recommended therapy of reduced fluid intake vs. increased fluid intake, respectively)
- adverse drug interactions
- compounding symptoms may lead to poor compliance with treatment plan
- if both illnesses affect a specific organ system, the patient is at increased risk of organ failure
12
Q
For complex patients, it is important to document what 3 three things?
A
- symptoms in chronological order
- the status and progress of each illness
- level of compliance with treatment plan
**note: complex pt often bill to a higher level, so it is important to document thoroughly and accurately.
13
Q
HTN: etiology
A
an increase in blood pressure causes excess force against the arterial walls
14
Q
HTN: risk factors (5)
A
FHx of HTN, obesity, high sodium diet, smoking, ETOH
15
Q
HTN: CC (chief complaint/s)
A
- often asymptomatic (a.k.a. silent killer)
- hypertension (measure at home)
- headache, chest pain, palpitations, blurred vision, epistaxis (usually present when HTN begins to affect other organ systems)
16
Q
HTN: PE (specific exam findings that correlate with HTN)
A
lower extremity edema, carotid bruit (heard by auscultation), JVD, abnormal heart sounds
17
Q
HTN: Dx by…
A
BP check and monitoring with a sphygmomanometer
18
Q
carotid stenosis
A
also called carotid artery disease; caused by narrowing of the carotid arteries (2 major arteries that carry blood from heart to brain, located in the neck)
19
Q
HTN: systolic blood pressure
A
measures pressure in the arteries when the heart contracts (beats); top number
20
Q
HTN: diastolic blood pressure
A
measure pressure in the arteries when the heart is relaxed (between heart beats); bottom number
21
Q
HTN: hypotensive BP readings
A
sys: less than 90 / dia: less than 60
22
Q
**HTN: normal range
A
sys/dia : 90/60 to 120/80
23
Q
HTN: prehypertensive
A
sys/dia : 121/81 to 140/90
24
Q
**HTN: hypertensive
A
sys/dia: greater than 140/90
25
Dz caused by HTN: MI/CAD
untreated HTN causes arteriosclerosis (thickening of arteries) which increases the risk of CAD or acute MI
26
Dz caused by HTN: CHF
the heart experiences increased effort and decreased efficiency, pumping excess fluid though the body
27
Dz caused by HTN: CVA
consistently increased pressure through the vessels of the brain causes weakening of arteries, leading to potential rupture and hemorrhagic CVA
28
Dz caused by HTN: Renal Failure
increased blood pressure through the kidneys causes weakening, leading to renal failure
29
Dz caused by HTN: Impaired Vision
increased pressure through the delicate vessels of the eyes causes them to rupture or thicken, causing vision loss
30
Pharmacological management HTN: diuretics
- reduce the volume of fluid in the blood vessels by urinating excess fluid
- ex: hydrochlorothiazide (HCTZ)
31
Pharmacological management HTN: beta-blockers
- slow the heart rate and reduce the heart's workload
- ex: brand name (generic)
lopressor (metoprolol)
toprol (metoprolol)
tenormin (atenolol)
32
Pharmacological management HTN: Ca channel blockers
- dilate the arteries and reduce the force of the heart's contractions
- ex: norvasc (amlodipine); cardizem (diltiazem)
33
Pharmacological management HTN: ACE inhibitors
- relax the arteries and block re-absorption of water by the kidneys
- ex: lotensin (benazepril)
zestril (lisinopril)
34
Pharmacological management HTN: ARBs
- dilate the arteries
- ex: cozaar (losartan)
benicar (olmesartan)
35
HTN: treatment with a specific medication depends on...
- severity of HTN
- effect of medication on comorbidities
- cost of medication/insurance coverage
- patient/provider preference
- effectiveness of medication for specific patient
36
HTN: non-pharmacological management?
- BP log (measure BP at home throughout the day and record the effects of lifestlye changes
- decreased ETOH intake
- low sodium diet
- smoking cessation
- exercise (consistent exercise for 30 mins, >3x week)
37
Why a low sodium diet for HTN patients?
- sodium increases BP b/c it causes kidneys to hold excess fluid in the body, thereby increasing one's overall volume
- decreasing sodium intake lowers BP
**don't forget to document "low sodium diet encouraged" in the pt chart when directed by provider
38
Diabetes Mellitus (DM): Type I
- insulin insufficiency: pancreas is unable to produce insulin (which moves glucose from the blood into cells)
- make up only 5% of today's DM patients
- treated ONLY with insulin
- Dx early in life. Strong FHx component
* **can ONLY be Insulin Dependent DM (IDDM)
39
DM: Type II DM
- insulin resistance: consistently high blood glucose levels cause cells to become resistant to insulin
- 95% of today's patients
- can be treated with diet changes, non-insulin meds, or insulin
- FHx component, but also SHx factors including diet and exercise
* ** can be EITHER Insulin Dependent DM (IDDM) OR Non-Insulin Dependent DM (NIDDM)
40
Type II DM: etiology
inadequacy of insulin in controlling blood glucose level (insulin resistance)
41
Type II DM: risk factors
obesity, high carb diet, lack of exercise, HTN, HLD, FHx
**DM is not caused by HTN, however, comorbidities negatively affect the body and can cause other chronic illnesses. Also, overall health/diet can lead to both. HTN is a risk factor but NOT a direct cause for DM.
42
Type II DM: CC
- unusual weight loss or gain
| - polyuria (excessive urination), polydipsia (excessive thirst), blurred vision, fatigue, N/V
43
Type II DM: PE
- distal paresthesia (tingling, prickling, numbness, "pins-and-needles" sensation)
- pedal edema
- weight change since last visit
44
Type II DM: Dx by...
- fasting blood glucose (nml < 100mg/dL)
| - hemoglobin A1c (3mo avg BG) (nml <5.7%, preDM = 5.7-6.4%)
45
Dz caused by type II DM: cardiac disease
diabetes is a risk factor for multiple cardiac conditions including CAD, CHF, and diabetic cardiomyopathy
46
Dz caused by type II DM: PVD
damaged blood vessels and decreased blood flow to extremities results in infections, ulcers, and potential amputations
47
Dz caused by type II DM: peripheral neuropathy
chronically elevated blood glucose damages the pheripheral nervous system, causing distal paresthesias and extremity pain
48
Dz caused by type II DM: renal failure
chronically elevated blood glucose destroys the glomeruli of the kidneys, leading to renal failure
49
Dz caused by type II DM: diabetic retinopathy
damage to the small vessels of the eyes can cause them to hemorrhage, leading to blurred vision, nearsightedness, or loss of vision
50
DM: non-pharmacological management
- blood glucose log (measure blood glucose at home throughout the week and record the effects of lifestyle changes
- weight loss
- low carb diet
- exercise (consistent exercise - 30mins, >3x week
51
DM: pharmacological management
Injected (insulin) medication (type I & II DM)
- *Humalog (short acting insulin before or immediately after meals)
- *Lantus (long acting insulin, injected once daily)
- Sliding scale treatment: patient determines insulin dosage based on current blood glucose
Oral medication (type II DM only)
- *Metformin (long acting, taken with meals)
- *Glyburide (induces pancreas to produce insulin, taken with meals)
52
HLD: etiology
an elevated level of lipid in the blood causes plaque to build up along arterial walls
53
HLD: risk factors
obesity, high lipid diet, physical inactivity, FHx, ETOH use
54
HLD: CC
- asymptomatic
| - typically diagnosed during routine blood work
55
HLD: Dx by...
blood work measuring cholesterol and triglyceride levels -- elevated LDL
56
HLD: HDL (high density lipoprotein)
"happy"
- commonly known as good cholesterol
- able to move cholesterol from artery plaques and recycle it back to the liver
57
HLD: LDL (low density lipoprotein)
"lousy"
| - transports cholesterol to arterial walls and aids the formation of plaques
58
Dz caused by HLD: arterial atherosclerosis
accumulation of cholesterol in the blood vessels causes thickening and hardening of vessel walls
59
Dz caused by HLD: CAD/MI
atherosclerosis of the coronary arteries puts the patient at risk of acute MI
60
Dz caused by HLD: CVA/TIA
atherosclerosis of the carotid arteries may lead to carotid stenosis (narrowing of the carotid artery), putting the patient at risk of TIA or CVA (can think of as ischemic CVA)
61
Dz caused by HLD: pancreatitis
free fatty acids in the blood can damage pancreatic cells, leading to inflammation of the pancreas
62
HLD: non-pharmacological management
- decrease ETOH
- lose weight
- close follow-up
- consistent exercise (30 mins, >3x week)
- diet change (high fiber, high omega 3, avoid cholesterol)
63
HLD: pharmacological management
- any medication ending in "statin" is used to treat HLD by inhibiting the production of cholesterol.
- 3 common drugs:
lipitor (atorvastatin)
zocor (simvastatin)
crestor (rosuvastatin)
64
Coronary Artery Disease (CAD): etiology
narrowing of the coronary arteries limits blood supply to the heart muscle, causing ischemia
65
CAD: risk factors
HTN, HLD, DM, smoking, FHx <55 y/o
66
CAD: CC
- chest pain or pressure
| - worse with exertion, improved with rest or nitroglycerin (NTG)
67
CAD: associated medications
ASA, NTG, anticoagulants - blood thinning medications
68
CAD: Dx by...
cardiac catheterization by cardiologist and/or stress test
69
CAD: main concern
- coronary artery disease
- acute coronary syndrome
- myocardial infarction
* **CAD is the #1 biggest risk factor for MI
70
CAD: non-pharmacological management
- control risk factors (careful management of HTN, HLD, and DM will minimize the negative impact of CAD)
- weight loss
- manage stress and depression
- smoking cessation
- consistent exercise (30 mins, >3x week)
71
CAD: pharmacological management
- ASA (aspirin),
| - NTG (nitroglycerin)
72
CAD: surgical management (least invasive to most invasive)
cardiac cath, angioplasty, stent, CABG
73
cardiac cath
- diagnoses CAD
- catheter is inserted through groin or wrist and extends up to the heart. IV dye is released to outline areas of bloackage
74
angioplasty
- minimally invasive cardiac procedure
| - deflated balloon is inserted then inflated to open area of blockage; balloon is then removed
75
stent
- more invasive cardiac procedure
| - similar to angioplasty; however, inserted tubing is left in the artery to keep it open
76
CABG
- invasive surgery
| - open heart surgery to bypass area of blockage, usually using a vessel taken from the thigh
77
Asthma: etiology
constriction of the airway due to inflammation and muscular contraction of the bronchioles, known as "bronchospasm"
78
Asthma: risk factors
FHx of asthma, obesity, allergic rhinitis
79
Asthma: CC
- shortness of breath
| - wheezing (improved with nebulizer treatments)
80
Asthma: PE
wheezes (inspiratory or expiratory)
81
Asthma: Dx by...
peak flow testing
82
Asthma: assessing severity - what questions may the provider ask to assess severity?
Do you have a home nebulizer --> Have you been prescribed steroids recently --> Have you previously been hospitalized for asthma? --> Have you previously been intubated (breathing tube)?
83
Asthma: Dx - Peak Flow
- peak expiratory flow (PEF)
- measured with a peak flow monitor
- measured in liters/minute
- baseline PEF must be established at the time of Dx
84
Asthma: inhaler vs. nebulizer
Inhaler
- pressurized device that released a "puff" of medication for inhalation
- one dose at a time
Nebulizer
- machine that delivers continuous aerosol mist
- treatment is delivered over a period of time
85
Asthma: pharmacological management - inhaled
bronchodilators (short acting)
- advair
- albuterol (ventolin)
- xopenex (levalbuterol)
- atrovent (ipratropium)
steriods (full course)
- pulmicort
- flovent
- symbicort
86
Asthma: pharmacological management - oral
steroids (full course)
- prednisone
- decadron
