Clinical Application Lesson 5 Elizabeth Worth is a 62 year old female with a pas

Question

Clinical Application Lesson 5 Elizabeth Worth is a 62 year old female with a past history of hypertension and dyslipidemia. Her mother sustained a myocardial infarction at the age of 68 which resulted in bypass surgery. She is 25 pounds overweight and exercises "very little". Her blood pressure is 178/94. Her heart rate is 72 and very regular. She obtained lab work prior to this visit. Significant findings include a bun of 35 with a creatinine of 2.5. Her fasting glucose is 137 with a Hgb of 297, HDL 18, LDL 187 and triglycerides of 258. She is currently taking HCTZ 25 mg daily and Zocor 20 mg each evening. Her last office visit was 18 months ago. She notes that she ran out of her medications about 10 days ago. She denies chest discomfort although she is fatiguing much quicker that usual and now gets short of breath when she climbs stairs. Physical exam is remarkable for 1+ edema of her lower extremities and an audible S4 AIC of 7.8. What is Elizabeth's goal for lipid control? What alterations will you implement to stabilize her lipid profile? What are the issues relative to her abnormal renal profile? Are there any classes of medications one might implement for pressure control that would also improve kidney function? What precautions will need to be implemented to ensure efficacy and monitor for efficacy? What are the issues relative to her elevated fasting blood sugar and Hgb A1C? What teaching needs to be implemented? Would you initiate any referrals?

Explanation / Answer

Ms/Mrs.Elizabeth's goal for lipid control is to do daily exercise and weight control.

usually dyslipidemia caused by
*cigarette smoking
*odesity and sedentary lifestyke
*consumptionof foods high in saturated fat and trans fat
*excessive alcohol consumption may also contribute to higher triglycerides.

Treatment:
The most commonly used medication is Statin,in order to maintain lipid profile.It helps to reduceLDL levels by interfering with cholesterol production in the liver.
Other cholesterol medications/non statin drugs include
1.ezetimibe (Zetia)
2.fibrates like fenofibrates (Fenoglide)
3.PCSK9 inhibitors

The issues related to abnormal renal profile are elavated BUN (Blood urea creatinine is 35 wit cratinine of 2.5)

Classes of medication that control pressure and slow progression of kidney disease are 2 types.
1.Angiotensin -converting enzyme (ACE)inhibitors and
2.Angiotensin receptor blockers.(ARBs)

TO ensure efficacy and monitor efficacy by adhering to the medication and the following the diet and nutrition and other measures which include as below,
exercise regularly
control carb intake
increase fiber intake
choose foods with a low glycemic index
control stress levels
monitor blood sugar levels
administer medication (insulin )as per the schedule

Health teaching includes
*healthy eating
*physical activity
*maintain a healthy weight
*quitting smoking
*managing stress.

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