Mrs. X.
Relationship of high cholesterol levels to the development of cardiovascular disease
Diabetes, heart disease, and high cholesterol are all strongly correlated. Even when diabetes is being well-managed, the patient's risks factors increase for comorbidity with these disorders. "High blood pressure has long been recognized as a major risk factor for cardiovascular disease. Studies report a positive association between hypertension and insulin resistance. When patients have both hypertension and diabetes, which is a common combination, their risk for cardiovascular disease doubles" (Cardiovascular disease and diabetes, 2014, AHA). Also, in the case of Ms. X, because of her uncontrolled diabetes, her risk for high cholesterol is higher than average even in the absence of obesity and inactivity. "This triad of poor lipid counts often occurs in patients with premature coronary heart disease. It is also characteristic of a lipid disorder associated with insulin resistance called atherogenic dyslipidemia, or diabetic dyslipidemia in those patients with diabetes" (Cardiovascular disease and diabetes, 2012, AHA). Because of the nature of diabetes, patients tend to have lower 'good' cholesterol and higher 'bad' cholesterol and the imbalance grows over the duration of the patient's illness.
Thus as an older woman suffering from poorly-managed diabetes, diabetic dyslipidemia should be one of the major high-risk conditions monitored for by a nurse attending to Ms. X. Corresponding with this risk, high blood pressure and stroke (particularly given the family history) is also of concern since high blood pressure is the number one risk factor for stroke. Once again, even for diabetic patients without other risk factors, the dangers of stroke are much greater. "Overall, the health risk of cardiovascular disease (including stroke) is two-and-a-half times higher in men and women with diabetes compared to people without diabetes" (Stroke and diabetes, 2013, WebMD). And Ms. X already has a number of additional risk factors, including obesity and inactivity, as well as her age for stroke. "High blood pressure is the number one risk factor for stroke. Other risks include smoking cigarettes and high levels of LDL ('bad') cholesterol" (Stroke and diabetes, 2013, WebMD). Furthermore, while stroke is potentially deadly in all patients, it is even more so in patients with diabetes. "When the oxygen supply is cut off, other arteries can usually deliver oxygen by bypassing the blockage. In people with diabetes, however, many of the bypass arteries are also affected by atherosclerosis, impairing blood flow to the brain" (Stroke and diabetes, 2013, WebMD).
Since Ms. X is a smoker (with emphysema), lung cancer is a distinct possibility even though she is asymptomatic, given the notably higher risk of smokers for contracting this type of cancer. "People who smoke are 15 to 30 times more likely to get lung cancer or die from lung cancer than people who do not smoke" (What are the risk factors, 2013, CDC). There is a history of bowel cancer in the family and smoking is associated with not only lung cancer but also a variety of other types of cancers. Smoking raises the risk of heart disease, high blood pressure, and smoke even independent of diabetes. Often, the symptoms of lung cancer do not manifest themselves immediately but only after the cancer becomes advanced.
The problems Ms. X is experiencing with her feet are not unusual for a patient with diabetes. "Uncontrolled diabetes can damage your nerves. If you have damaged nerves in your legs and feet, you might not feel heat, cold or pain. This lack of feeling is called diabetic neuropathy. If you do not feel a cut or sore on your foot because of neuropathy, the cut could get worse and become infected" (Foot and skin conditions, 2010, Cleveland Clinic). Additionally, the risk for peripheral vascular disease is also increased with diabetes: "Diabetes also affects the flow of blood. Without good blood flow, it takes longer for a sore or cut to heal" (Foot and skin conditions, 2010, Cleveland Clinic). Although the conditions of most immediate concern...
Researchers used this information, and designed it in such a way that it fit in with the lifestyle that this population was accustomed to (Acton, Shields, Rith-Najarian, Tolbert, Kelly, Moore, Valdez, Skipper, & Gohdes, 2001). This allowed the researchers not only to study the population more closely, but also to achieve a major degree of success that might not have been possible in a standard intervention program. The study found
Treatment Plan: The treatment plan should include medication for high blood pressure and diabetes. Indeed, according to some evidence, the long term usage of diuretic antihypertensives to reduce the presence of excess salts in the body can help to lower blood pressure. (Klatt, 1) Given that the subject of this discussion also suffers from an elevated risk of myocardial infarction, the danger of cardiac arrest or general heart failure is of greater concern than the presence of
Diabetes Management Diabetes mellitus is one of the non-communicable diseases that have continued to be in the forefront of public health challenges. Diabetes occurs when the body system is unable to produce sufficient insulin. Typically, insulin is a hormone secreted from the beta cell within the pancreases that regulates the blood sugar as well as assisting in conversion of glucose into energy. Diabetes occurs when there is high level of glucose
COUNSELING Counseling: Case ConceptualizationSubstance use disorder is not a healthy life activity that should be continued at any stage of life. There are only risks associated with this condition since the individual and his family suffer from this addiction. It leads to physical harm such as chronic pains, heart diseases, mental disturbances, physical disabilities, loss of mobility, etc., and creates severe and adverse negative reactions on cognitive functioning. Not only
Pharmacological Case StudiesStudent�s NameInstitutional AffiliationCourse NameDateSCENARIO 1In this scenario, Donald is experiencing shortness of breath, wheezing, a chronic productive cough and fatigue. This problem is associated with chronic obstructive pulmonary disease (COPD). This is especially given that he smokes cigarettes every day. To establish the extent of Donald�s pulmonary action, according to clinical practice guidelines, there is need to conduct various tests including spirometry, lung volume test, lung diffusion test,
Tina's Story There is a considerable of variation in the occurrence of MDD among U.S. youth as reported by research studies on depression in adolescents. Fleming and Offord (1990) conducted a critical review and found that currently the occurrence depression ranges from .4-5.7%, with a mean occurrence of 3.6%. Similarly another study in which the sample were high school students (between the ages of 14-18 years), the results revealed that the
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