OP 2: Chronic Diseases Flashcards
Comorbidity
The simultaneous presence of 2 chronic diseases/conditions in a patient
- Increases complexity & health risk for developing other conditions
Hypertension (HTN)
Increase in blood pressure causes excess force against arterial walls, damaging arteries over time
Risk Factors for HTN
- Family History
- Obesity
- High Sodium Diet
- Smoking
- ETOH
Symptoms for HTN
Asymptomatic, headache most common
Diagnosis for HTN
Blood pressure reading
Systolic Blood Pressure
Measures pressure in arteries when heart contracts (beats)
Diastolic Blood Pressure
Measures pressure in arteries when relaxed (between heart beats)
Hypotensive
Sys: < 90
Dia: < 60
Normal
Sys: 90-120
Dia: 60-80
Hypertensive
Sys: > 120
Dia: > 90
HTN leads to:
- Impaired vision
- Renal failure
- Hemorrhagic CVA
- CAD/MI
- CHF
Pharmacological Management of HTN
- ACE Inhibitors
- Ca Channel Blockers
- Diuretics
- ARBs
Non-Pharmacological Management of HTN
- Low sodium diet
- Exercise
- Smoking & ETOH
- BP log at home
ACE Inhibitors
- Lisinopril
- Lotensin
Ca Channel Blockers
- Norvasc
- Cardizem
Diuretics
- Hydrochlorothiazide (HCTZ)
ARBs
- Cozaar
- Benicar
Type I Diabetes
Insulin Insufficiency
- Always treated with insulin
Type II Diabetes
Insulin Resistance
- Treated with diet changes, non-insulin meds, or insulin
Risk Factors for Type II DM
- FHx of DM
- Obesity
- High carb diet
- Lack of exercise
Symptoms for Type II DM
- Unusual weight loss or gain
- Polyuria
- Polydipsia
- Blurred vision
- N/V
Diagnosis for Type II DM
- Fasting
- Blood glucose/hemoglobin A1c
DM leads to:
- Diabetic Retinopathy
- Renal Failure
- Cardiac Disease (CAD, CHF, diabetic cardiomyopathy)
- PVD (Peripheral Vascular disease)
- Neuropathy
Non-Pharmocological Management of DM
- Low carb diet
- Exercise
- Weight loss
- Blood Glucose log
Pharmacological Management of DM
Injected:
- Humalog
- Lantos
- Sliding scale
Oral:
- Metformin
- Glyburide
Risk Factors for HLD
- FHx of HLD
- Obesity
- High lipid diet
- ETOH
- Physical inactivity
Symptoms for HLD
Asymptomatic
Hyperlipidemia (HLD)
An elevated level of lipid in the blood causes plaque build-up along arterial walls
Diagnosis of HLD
- Bloodwork (lipid panels)
- Measuring cholesterol and triglyceride levels (elevated LDL)
Low Density Lipoprotein (LDL)
“Bad” cholesterol
- Transports cholesterol to arterial walls and aides the formation of plaques
High Density Lipoprotein (HDL)
“Good cholesterol”
- Removes cholesterol from artery plaques & recycles it back to the liver
HDL leads to:
- Arterial atherosclerosis
- Pancreatitis
- CVA (ischemic)
- CAD/MI
- Carotid stenosis
Non-Pharmacological Management of HLD
- Low lipid diet
- Weight loss/exercise
- Decrease ETOH
- Close Follow-up (frequent lipid paneling)
Pharmacological Management of HLD
-statin medications
- Ex: Atorvastatin, Rosuvastatin, Simvastatin
Coronary Artery Disease (CAD)
Narrowing of the coronary arteries limits blood supply to the heart muscle causing ischemia
Risk factors for CAD
- HTN
- HLD
- DM
- Smoking
- FHx <55
Symptoms for CAD
- Chest pain or pressure
- Worse with exertion
- Improved with rest or nitroglycerin (NTG)
Diagnosis for CAD
Cardiac catheterization by cardiologist
Biggest risk factor for an MI
CAD -> Acute Coronary Syndrome -> MI
Non-pharmacological Management of CAD
- Managing Risk Fisk Factors (HTN, HLD, and DM)
- Exercise & Weight Loss
- Smoking cessation
- Manage stress
Pharmacological Management of CAD
- Acetylsalicylic acid (ASA)
- Aspirin - Nitroglycerin (NTG)
- Vasodilator
Surgical Management of CAD
In order from least to greatest invasiveness:
1. Cardiac Catheterization
2. Angioplasty
3. Coronary Stent
4. Coronary Artery Bypass Graft (CABG)
Patient Problem List
- Includes all active & resolved conditions
- Chronic illnesses
- Surgeries/procedures
- Injuries suffered by the patient
- Any symptom or disease that has affected the patient - Each problem includes:
- Problem/Diagnosis (mandatory)
- Status (mandatory)
- Note (optional)
- Onset date (optional)
- Resolved date (optional)
Chronic = active
Past surgery = resolved
Ranking Problem List
- Active high
- Active low
- Resolved high
- Resolved low