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Care map body, Older Adult Patient - CAC, 75 years old F, Hyperlipidemia,…
Anxiety
Believed to be caused by imbalances in norepinephrine, serotonin, dopamine, and gamma-aminobutyric acid (GABA)
Patients with anxiety often have an overactive amygdala, increasing there response to fear
S/S: tachycardia, tachypnea, shortness of breath, dizziness, sweatiness, anorexia, nausea, vomiting, diarrhea, constipation, tensed muscles
Medications include:
Benzodiazepines, such as Xanax and Valium
Buspirone (brand name = Buspar)
Antidepressants, such as selective serotonin reuptake inhibitors (SSRIs), tricyclics, and monoamine oxidase inhibitors (MAOIs)
SSRIs are considered first-line
Beta blockers (ex. atenolol) to help treat the physical symptoms
Non-pharmacological treatment options and lifestyle changes:
Exercise and meditation can be helpful when incorporated into a patient's life
Avoiding caffeine may be beneficial
Therapy, such as psychotherapy, can help teach patients methods for coping with their anxiety
There are no labs or or scans to diagnose anxiety, but these types of tests may still be run to rule out other issues
Diagnosed based on history and symptoms
Asthma
Complex pathophysiology that involves airway inflammation, intermittent obstruction of airflow, and bronchial hyperresponsiveness
Diagnostics:
History of acute episodes of symptoms, such as wheezing, shortness of breath, and coughing
Incentive spirometry at baseline, and then spirometry after administration of a bronchodilator
X-ray of the chest, though it might show nothing abnormal
Pulse oximetry
Exercise spirometry for patients with suspected exercise- induced asthma
Rule out of other potential causes of the patient's symptoms
Medications:
Controller medications to help decrease frequency of symptoms:
Long- acting beta agonists - my patient is using an mometasone-formoterol inhaler
Long- acting anticholinergics
Leukotriene modifiers
Mast cell stabilizers
Bronchodilator, theophylline
Immunomodulator injection for asthma caused by allergies
Fast-acting medications for quick relief of symptoms:
Short- acting bronchodilators
Anticholinergics
Systemic corticosteroids - my patient is taking prednisone
Chronic Obstructive Pulmonary Disease (COPD)
Begins when the airways and alveoli of the lungs get damaged or undergo trauma
Decreased oxygen and carbon dioxide exchange occurs as a result of decreased lung function
Medications:
Early treatment of respiratory infections with antibiotics to avoid COPD exacerbations
Inhaled steroids to help decrease inflammation (ex. budesonide)
Inhaled bronchodilators such as albuterol (short-acting for use before activities) or arformoterol (long-acting for daily use)
Inhalers with both a steroid and a bronchodilator or a combination of multiple bronchodilators
Oral corticosteroids
Phosphodiesterase-4 inhibitors to reduce inflammation and relax the airways
Theophylline is used when other treatments have not worked or cost is an issue
Non-pharmacological treatment options and lifestyle changes:
Oxygen therapy and BiPAP
Oxygen should not be given at flow rates higher than 3L/min because of changes in the drive to breathe in COPD patients
Surgical options:
Lung volume reduction surgery
Lung transplant
Bullectomy
Smoking cessation
Pulmonary rehabilitation program are recommended; they include a education, exercise, and nutrition changes to improve quality of life for COPD patients
Diagnostics:
Arterial blood gas test
Chest X-ray
Spirometry test
Pulse oximetry
CT scan
*Many tests must be performed because there is no definitive lab for COPD and other diagnoses must be ruled out
Coronary Artery Disease (CAD)
Damage that occurs to the major blood vessels that feed the heart as a result of plaque buildup causing narrowing
Damage can be a result of cigarette smoking, hypertension, high cholesterol, diabetes mellitus, sedentary lifestyle, and poor diet choices
S/S: angina, shortness of breath, myocardial infarction, arrhythmias
Diagnostics:
Electrocardiogram
Echocardiogram
Exercise stress test
Nuclear stress test
Cardiac catheterization and angiogram
Cardiac CT scan or CT coronary angiogram
Medications:
Cholesterol medications (included under the "High Cholesterol" branch
Aspirin to prevent clots
Blood pressure medications included under the "Hypertension" branch
Ranolazine and nitroglycerin to help manange angina
Non-pharmacological treatment options and lifestyle changes:
Smoking cessation
Eat a healthy diet
Limit or avoid intake of alcohol
Exercise
Maintain a healthy weight
Decrease stress as much as possible
Regular check-ups with your doctor
Surgical options:
Angioplasty and stent placement to keep blood vessel open
Coronary artery bypass surgery in which a vessel from another part of the body is grafted to carry blood around the blocked vessel in the heart
Gastroesophageal Reflux Disease (GERD)
S/S (i.e. chest pain, heartburn, belching, and regurgitation) occur as a result of stomach acid backing up into the esophagus
The backing up of stomach acid can occur as a result of lower-esophageal sphincter dysfunction, ineffective esophageal clearance, and hiatal hernia
Medications:
Antacids
H2 blockers
Proton pump inhibitors - my patient is taking pantoprazole
Non-pharmacological treatment options and lifestyle changes:
Elevate the head of the bed
Limit intake of alcohol, caffeine, fatty foods, and theophylline
Smoking cessation
Maintain a healthy weight
Do not eat within 2-3 hours of your bedtime
Eat smaller, more frequent meals
Diagnostics:
Upper digestive system x-rays
Endoscopy
Ambulatory pH test to measure pH of esophagus
Esophageal impedance test to measure esophageal movements
Diabetes Mellitus Type 2
A disease in which the body does not produce enough insulin and/or cells do not respond appropriately to the little insulin produced
Long term uncontrolled high blood glucose levels can have very negative effects on the microvascular organs of the body
Medications:
Metformin is usually the first line treatment for type 2 diabetics
Sulfonylureas increase your body's secretion of insulin
Glinides increase the secretion of insulin from the pancreas
Thiazolidinediones to increase tissue sensitivity to insulin
DPP-4 inhibitors help reduce blood glucose levels
GLP-1 receptor agonists lower blood glucose levels by slowing digestion
SGLT2 inhibitors decrease uptake of glucose into the bloodstream in the kidneys
Insulin is not always necessary for management of type 2 diabetes. If the patient is not sensitive to insulin, there is no point in administering insulin. My patient was not on insulin.
Non-pharmacological treatment options and lifestyle changes:
Eat a healthy diet
Live an active lifestyle and exercise
Maintain a healthy weight
Avoid long periods of inactivity
Decrease stress as much as possible
Diagnostics:
Glycated hemoglobin (A1C) blood level above 5.7% indicates a need for follow-up
Random blood glucose test (regardless of when last meal was eaten) greater than 200 mg/dL indicates a need for follow-up
Fasting blood glucose test greater than 100 mg/dL indicates a need for follow-up
High cholesterol/ Hyperlipidemia
Disease process in which there are high levels of low-density lipoprotein (LDL) and low levels of high-density lipoprotein (HDL) in the blood, which can cause damage to the vessels
Can lead to coronary artery disease, myocardial infarction, and strokes
Diagnostics:
Lipid panel looking at the levels of fat and cholesterol in the blood, including the LDL and HDL
Medications:
Statins - this patient is taking atorvastatin
Cholesterol absorption inhibitors
Bempedoic acid
Bile-acid-binding resins
PCSK9 inhibitors
Non-pharmacological treatment options and lifestyle changes:
Smoking cessation
Low-sodium diet with high intake of fruits, vegetables, and whole grains
Limit amount of animal fats
Exercise and physical activity
Limit or avoid alcohol
Decrease stress as much as possible
Lifestyle changes are FIRST LINE treatment
Hypertension (HTN)
Disease of high blood pressure, which can cause damage to the heart and circulatory system
Can be caused by many different factors
Sympathetic nervous system activation
Increased peripheral resistance
Issues with the reniin-angiotensin-aldosterone system
Obesity
High sodium and high fat diets
Diagnostics:
Blood pressure greater than 120/80 on three or more separate occasions
Ambulatory measuring, which is a 24-hour test of blood pressure
Electrocardiogram and echocardiogram to explore potential underlying causes
Medications:
Diuretics - my patient is taking furosemide
Angiotensin-converting enzyme (ACE) inhibitors
Angiotensin II receptor blockers
Calcium channel blockers
Non-pharmacological treatment options and lifestyle changes:
Low-sodium diet
Eat a healthy, well-balanced diet
Maintain a healthy weight
Smoking cessation
Limit or avoid alcohol
Exercise
Limit stress as much as possible
Degenerative Disc Disease
This disease process occurs when the normal changes of aging in the spine cause chronic pain
S/S: pain in lower back, thighs, or buttocks; pain that comes and goes; pain that is less severe when standing or walking than when sitting; numbness and tingling in arms or legs can occur
Diagnostics:
Diagnosed by your healthy history and presentation of symptoms
X-rays and MRIs may be performed to rule out or identify other issues, such as fractures
Medications:
Over-the-counter pain medications, such as NSAIDs
Prescriptions medications, including muscle relaxants and opioids - my patient is taking gabapentin, methocarbamol, and oxycodone-acetaminophen
Epidural steroid injections to help decrease pain inflammation
Non-pharmacological treatment options and lifestyle changes:
Chiropractic manipulation
Massage therapy
Heat to decrease muscle spasms
Ice to decrease inflammation and numb some pain
Physical therapy
Surgical options:
Lumbar spinal fusion surgery to reduce movement between vertebrae with the goal of reducing pain by fusing them together
My patient just had this surgery
Artificial disc replacement surgery that removes the spinal disc and replaces it with an artificial disc with a height that can better support the lower back
Older Adult Patient - CAC, 75 years old F
Arthritis
Swelling and stiffening of joints, caused most commonly by osteoarthritis or rheumatoid arthritis
Osteoarthritis occurs when cartilage breaks down
Rheumatoid arthritis (RA) occurs when the immune system attacks the joints and causes inflammation
S/S: pain, stiffness, swelling, decreased range of motion, redness, tenderness
Risk factors: family history of arthritis, increasing age, women more likely to develop RA than men, men more likely to develop other types, previous joint trauma, obesity
Diagnostics:
Imaging tests, including x-rays and magnetic resonance imaging, to identify joint problems
Laboratory tests that can identify the type of arthritis
Medications:
Nonsteroidal anti-inflammatory drugs (NSAIDs)
Counterirritants
Steroids - my patient is taking prednisone
Disease-modifying antirheumatic drugs (DMARDs)
Non-pharmacological treatment options and lifestyle changes:
Physical therapy
Surgical options:
Joint repair
Joint replacement - hx of knee replacement
Joint fusion
Hyperlipidemia, hypertension, and diabetes mellitus all contribute to vascular damage that can lead to coronary artery disease, myocardial infarction, and stokes.
Patients with asthma are at a higher risk of developing GERD because it can cause the lower esophageal sphincter to relax, allowing stomach acid to flow back up into the esophagus.
The asthma medication, theophylline, can worsen GERD symptoms.
GERD can worsen asthma symptoms by causing irritation to the airways.
