Pathophysiology and Diagnostic Testing
The client shows up with the complaints regarding the chest pain and debilitation. However, after the medication, the symptoms ease. Laboratory tests have indicated total cholesterol without abnormalities; LDL is very high; HDL is quite low suggesting that the patient has the unhealthy diet and inactive lifestyle; high triglycerides of 250 mg/dL whereas the norm is around 150 mg/dL and the borderline is 199 mg/dL; high fasting blood sugar of 140 mg/dL (the patient has diabetes type 2); and high HgbA1c of 7.5% related to the diabetes. No infiltrate in lungs was found. EKG demonstrated no change from baseline. Blood pressure is high, at the rate of 160/92 and pulse if 60. Temperature is 98 Fahrenheit suggesting the presence of certain abnormality such as the inflammatory process but no lymph nodes are indicated. The weight is 220 at the height of 70. HEENT is within the norm. The abnormalities detected within the physical examination are decreased breath sound throughout; right bruit carotids; android obesity and WC of 44 inches; and pedal pulses decreased with the lower leg edema.
The patient is subjected to the genetic and lifestyle risk factors. His father has heart disease and the mother has breast cancer. His brothers were diagnosed with the diabetes type 2 in their forties. The patient reports disinclination to exercise, and being accustomed to the atherogenic diet. He is economically-disadvantaged and is unable to consume sufficient amount of fruits and vegetables, instead he dwells on the high-fat and high-carbohydrates diet. The patient has the physically hard job. Other risk factors are the history of high blood pressure and high cholesterol, cholecysectomy ten year ago, high blood pressure, android obesity, hypercholesterolemia, type 2 diabetes, and smoking one pack of cigarettes daily.
Symptoms
The symptoms are crushing chest pain; shortage of breath with exertion and diaphoretic; and debilitation. The patient continues to suffer from the symptoms for six months. Prior to the admission, he felt substernal and crushing chest pain radiating to the neck and jaw. The pain resolved with rest. Other symptoms are the signs of major depression: heavy eating and long-time sleeping. The patient stated that he had been in the bad shape for the last six months. The symptoms disappeared with treatment and the patient came for a follow-up to consult regarding the risk factors and overall prognosis for his condition and treatment.
Progression Trajectory and Difference from Normal Development
The patient’s history can be classified as the history of Cardiac patient. His symptoms give a high probability for the Coronary Artery Disease (CAD). Progression trajectory for the patient’s condition will include hypertension, stenosis, atherosclerosis, and acute cardiovascular events. If the client does not stick to the healthcare provider’s recommendations, there is high probability of stroke or acute myocardial infarction at the later stage of the disease progression (Screening for High Blood, p. 779). The disorder places a wide range of limitations on the patient depriving him from his normal activity. In the long run, it may lead to the inability to work due to debilitation, infirmity, and the pain syndrome.
Treatment Options
Treatment options will include medication and education. At that, both the patient and his family need to be educated because they all should become a team to ensure patient’s normal functioning and leading a quality life while striving to improve the health condition.
Medication will be within the recommendations given by the physician from the cardiologic unit plus plavix or any other antiplatelet because the patient has high HgbA1c. Other option will include brillinta 90 md BID or effient 10 mg QD. To control his hyperchlestorelemia or hyperlipidemia, the vitamin niacin will implement as an additional help.
It is obligatory for the patient to lose weight and begin exercise. At least thirty minutes walks will improve his prognosis considerably. The patient needs to readdress his diet. This is possible even for his rate of income in case of effective planning. The client needs to increase his intake of fiber by eating more whole grains, vegetables, fruits, and beans. The results of blood tests suggest that he is also lacking omega-3-fatty acids and thus his regime requires eating nuts and the sea fish. Another important alteration of his diet is changing its schedule: instead of one heavy meal a day, a patient should have three or four smaller meals and those heavier ones are to be in the first part of the day to help the body improve metabolism.
Physical and Psychological Demands
The disorder prevents patient from normal functioning due to the lack of the living energy, pains, and general weakness. Moreover, the patient’s wife requires care due to the uncontrolled diabetes type 2. This circumstance places even more psychological pressure on him because he believes that a man should be strong and provide for the family despite any problems. The patient is the only provider for the family. He is in constant stress because of current inability to work and cover the bills each week. He is unsociable and has no social contacts to help him reduce the stress by talking it over with a friend.
Recommendations towards Optimal Disorder Management and Outcomes
Optimal disorder management implicates the multi-angled strategy including medication, education, lifestyle, and eating habits altering. According to McCanceet et al. (2013), in case all three parameters are followed properly, such patients may have an optimistic prognosis of leading a quality life for the further decades.
The patient’s current condition can be controlled quite well but it is only possible in the intersection of responsible attitude to medication, diet, and physical activity. The recent researches have also indicated the need of the psychological management for patients with this type condition (McCanceet et al., 2013). Therefore, to improve the client’s prognosis, he needs to go through the psychological therapy to relief stress and eliminate unnecessary worries. In this area, the wife’s cooperation is crucial, as well as emotional support from children and other family members.
Key Interdisciplinary Team Personnel
This case management requires cooperation from other participants including the patient’s primary care provider in his clinic and the physician from the coronary care unit. These specialists’ help will especially implement in the event of disease progression into its acute form.
Facilitators and Barriers to Optimal Disorder Management and Outcomes
Above all, patient’s awareness of the complexity of his condition is vital. The patient needs to be educated in terms of importance of sticking to the medication and altering his unhealthy habits and lifestyle. Smoking cessation is a must. Another serious barrier for the optimal progress is the stress and depression.
Prevention Strategy
To overcome the barriers identified, it is crucial to conduct repetitive educational discussions with the patient to increase his level of awareness of the need to stick to the medication, develop the healthy habits, and end up smoking. Finally, emotional management is required.
Care Plan
Recognition and Planning for the Disorder
This is a CAD patient with hypertension and hyperchlestorelemia or hyperlipidemia. To manage the given disorder, a complex of measures will implement. This person is not in compliance with his medication, he needs to be educated and keep the education reinforced (Reil et al., 2011).
Patient’s Socio-Cultural Background
The patient is of the economically-disadvantaged background. He has an Irish origin. He resides in the poor neighborhood with the low level of safety which prevents him from any sports activity outside the house, as well as socialization. The person has a wife disabled due to the uncontrolled diabetes type 2 and spends much of his time taking care of her.
Evidence-Based Approach to Address Key Issues
The key issues identified in this study are the lack of awareness in the patient regarding the importance of sticking to the medication and the healthy lifestyle. According to Mateo-Gallego et al. (2014), a positive prognosis for the CAD patients is only possible in case the therapy is multidimensional and includes the medicated control of the deviations and the lifestyle optimization.
Disorder Management Approach
The patient’s condition requires a thorough approach to its management. The person will need the following therapy: (1) medication to alter the abnormalities in metabolism of lipids and carbohydrates, as well as manage the work of the cardiovascular system; (2) smoking cessation; (3) diet optimization; (4) engaging in physical activity for at least 30-minutes a day; and (5) emotional management.
References
Mateo-Gallego, R., Perez-Calahorra, S., Cofán, M., Baila-Rueda, L., Cenarro, A., Ros, E., &Civeira, F. (2014). Serum lipid responses to weight loss differ between overweight adults with familial hypercholesterolemia and those with familial combined hyperlipidemia. The Journal Of Nutrition, 144(8), 1219-1226.
McCance, K. L., Huether, S. E., Brashers, V. L., & Rote, N. S. (2013). Pathophysiology: The biologic basis for disease in adults and children (7th ed.). St. Louis, MO: Mosby.
Reil, J., Custodis, F., Swedberg, K., Komajda, M., Borer, J. S., Ford, I., & Böhm, M. (2011). Heart rate reduction in cardiovascular disease and therapy. Clinical Research in Cardiology, 100(1), 11-19.
Screening for High Blood Pressure in Adults: U.S. Preventive Services Task Force Recommendation Statement. (2015). Annals of Internal Medicine, 163(10), 778-786.