OP 2: Chronic Diseases

Question 1

What’s is a chronic illness/disease?

Answer 1

Any illness/disease that lasts longer than 3 months. They cause about 70% of deaths in the US.

Question 2

Comorbidity

Answer 2

The presence of more than one chronic illness/disease at the same time.

Question 3

How does comorbidity increase health complications?

Answer 3

• Multiply chronic diseases will increase case complexity
• Cause adverse drug reactions
• Compounding symptoms can lead to poor compliance with treatment plans
• Patient is at higher risk of organ failure if comorbidities affect similar organs

Question 4

Hypertension (HTN)

Answer 4

An increase of blood pressure within the arteries that creates damage to the artery walls over time.

Question 5

Systolic vs Diastolic

Answer 5

Systolic - pressure within the arteries when heart is contracting
Diastolic - pressure within the arteries when the heart is relaxed (between heart beats)

Question 6

Normal Hypertension BP

Answer 6

90/60 to 120/80

Question 7

Hypotensive BP

Answer 7

Less than 90/60

Question 8

Prehypertensive BP (borderline)

Answer 8

121/81 to 140/90

Question 9

Hypertensive BP

Answer 9

Greater than 140/90 (either number)

Question 10

What other chronic illnesses can hypertension lead to?

Answer 10

• Impaired Vision
• CVA (brain bleed)
• Renal Failure
• CAD/MI (heart attack)
• CHF (congestive heart failure)

Question 11

What can you do to manage Hypertension?

Answer 11

• Low Sodium Diet
• Exercise
• Smoking & ETOH Cessation (vasoconstrictors that make blood vessels smaller)
• Keep a BP Log
• ACE Inhibitors (med name will end in ‘pril’)
• Ca Channel Blockers (amlodipine)
• Diuretics (Hydrochlorothiazide)
• ARBs (med name will end in ‘tan’)

Question 12

Type 1 Diabetes

Answer 12

Pancreas does NOT produce insulin. Patient is insulin insufficient.

Question 13

Type 2 Diabetes

Answer 13

Pancreas does not produce enough and/or cells have become resistant to the insulin produced by the body.

Question 14

What other chronic illnesses can Diabetes lead to?

Answer 14

• Diabetic Retinopathy
• Renal Failure
• Cardiac Disease
• Neuropathy
• PVD

Question 15

What can you do to manage Diabetes?

Answer 15

• Low Carb Diet
• Exercise
• Weight Loss
• Blood Glucose Log
• Insulin (Humalog, Lantus, Sliding Scale)
• Oral Medications (Metformin Glyburide)

Question 16

Hyperlipidemia (HLD)

Answer 16

Elevated levels of lipid (cholesterol) buildup in the blood that causes plaque build-up along arterial walls causing them to narrow.

Question 17

Low Density Lipoprotein (LDL)

Answer 17

Bad cholesterol that deposits cholesterol floating in the blood onto the arterial walls.

Question 18

High Density Lipoprotein (HDL)

Answer 18

Good cholesterol that removes arterial wall build up and recycles it back to the liver.

Question 19

What other chronic illnesses can hyperlipidemia lead to?

Answer 19

• Pancreatitis
• Arterial Atherosclerosis (thickening and hardening of the arterial walls)
• CVA (ischemic)
• CAD/MI (heart attack)

Question 20

What can you do to manage Hyperlipidemia?

Answer 20

• Low Lipid Diet
• Decrease ETOH
• Weight Loss
• Exercise
• Close Follow-up (labs and testing)
• Statins (med names will end in ‘statin’)

Question 21

Coronary Artery Disease (CAD)

Answer 21

Narrowing of the coronary arteries that limits blood supply to the heart muscle causing ischemia.

Question 22

What are the symptoms of Coronary Artery Disease?

Answer 22

• Chest Pain that becomes worse with exertion
• Chest Pressure that becomes worse with exertion

Question 23

What other chronic illnesses can Coronary Artery Disease lead to?

Answer 23

CAD is the number 1 risk factor for MI (heart attack)

Question 24

What can you do to manage Coronary Artery Disease?

Answer 24

• Manage risk factors (HTN, HLD, DM, etc)
• Exercise/Weight Loss
• Smoking Cessation
• Manage Stress
• Aspirin 81mg daily (Acetylsalicylic Acid)
• Nitroglycerin (NTG) ; (vasodilator)
• Cardiac Catheterization
• Angioplasty (a balloon is inserted then inflated to open area of blockage -> balloon comes out)
• Coronary Stent (same as Angioplasty, but a stent is left in place)
• Coronary Artery Bypass Graft (CABG) ; (open heart surgery conducted to bypass area of blockage using another artery from thigh)

Question 25

Common Chronic Illnesses

Answer 25

• Asthma
• Chronic Obstructive Pulmonary Disease (COPD0
• Congestive Heart Failure (CHF)
• Chronic Kidney Disease (CKD)
• Osteoarthritis (OA)
• Rheumatoid Arthritis
• Autoimmune Conditions
• Dementia & Alzheimer’s Disease
• Mood Disorders (Anxiety, Depression, Bipolar, etc.)

Question 26

What is the patient problem list?

Answer 26

A portion of the chart that allows us to review ALL active and past illnesses/conditions/surgeries/history.

Question 27

What types of patient history will NOT be included in patient problem list?

Answer 27

• Family History
• Social History

Question 28

What info is included on the patient problem list?

Answer 28

• Diagnosis
• Status (active/resolved)

Question 29

Who edits the past history and patient problem list?

Answer 29

The SCRIBE updates both the past history and patient problem list!

Question 30

How do we add problems to the patient problem list?

Answer 30

• Add problem while charting the diagnosis
• Add problem directly into problem list

Question 31

How do we add problems to the patient problem list?

Answer 31

• Update status (problems that are resolved need to be resolved: strep/flu)
• Update active problems
• Update list to show active problems at the top of the list (then rank by risk)

Question 32

How do we signify patients with no problems?

Answer 32

Document that the patient has ‘no known problems’ with an ‘active’ status.

Question 33

Can we delete problems from the patient problem list?

Answer 33

• DO NOT delete resolved problems (change status to resolved)
• ONLY delete problems that were added erroneously