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Project 4.4.2 Heart Disease Intervention

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by

Skyla Garcia

on 1 June 2016

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Transcript of Project 4.4.2 Heart Disease Intervention

Kevin Wong
Kevin is a 46 year old widow and father of three boys. He shuttles his sons to school and sports practices every day of the week. Many of the family’s meals are consumed out at restaurants or quickly in the car. Kevin has severe asthma and food allergies to both peanuts and milk. Because of his asthma he has always shied away from physical exertion. In the last 5 years, he has put on over 100 pounds, most of which is right at his waist. He was rushed to the hospital last month with a mild heart attack. Subsequent testing revealed two blocked coronary arteries that can be best treated with bypass surgery. Kevin’s mother died during surgery in her 50s, so he is cautious about having the procedure done.
Medical Information
Gender: Male
Age: 47 years old
Smoker: No
Height: 5'11"
Weight (lbs): 295 (Considered obese for age)
Waist Circumference (in.): 42
Blood Pressure: 145/90
Cholesterol:
- Total (mg/dL): 265
- LDL (mg/dL): 155
- HDL (mg/dL): 38
Triglycerides (mg/dL): 165
Fasting Blood Sugar (mg/dL): 110
Medical Complications
Patient has had brief heart attack but no confirmed conditions and or procedures.
Has not been diagnosed with diabetes.
Fasting blood sugar is too high.
Is not currently being treated for high blood pressure.
Triglycerides level is too high. (Higher than 150 mg/dL)
High risk of heart complications
Abdominal obesity
Low HDL cholesterol
High total cholesterol
High blood pressure
High risk of Metabolic Syndrome (tbh probably has it already)
Project 4.4.2 Heart Disease Intervention
Patient: Kevin Wong
Metabolic Syndrome
Metabolic syndrome is a group of risk factors that increases your risk of heart disease, stroke, and diabetes.
Losing Weight
Best approach to losing weight is the correct amount of eating healthy and regular exercise. Kevin would be advised to set a goal for himself to lose at least one pound a week (burn up 3500 calories more than he takes in). It should reduce blood pressure and blood cholesterol and control blood sugar levels. Mainly focusing on developing healthy habits and keeping weight off throughout life.
Lifestyle Changes
Control Cholesterol & Triglycerides
Change eating habits and maintain a healthy eating plan
Losing weight by exercise
Taking medication as prescribed
No smoking
Alcohol limitation
Medical Procedures
Heart Bypass Surgery
Heart bypass surgery, also known as coronary artery bypass surgery, focused on replacing damaged arteries in the heart. A surgeon uses blood vessels from another area of the body to repair the damaged arteries. This surgery is used when the coronary arteries become blocked or damaged. The coronary arteries supply the heart's muscles with oxygenated blood. If they are blocked or the flow of blood is restricted, the heart can't function properly. This can lead to heart failure.
By: Skyla Garcia Period: 01
You may have metabolic syndrome if you have three of these risk factors or more:
Large waist circumference (abdominal obesity)
High blood pressure
High fasting blood sugar
High triglycerides
Low HDL (good) cholesterol
In this case, Kevin has all five of these symptoms and does have this syndrome.
The safest and best way to prevent or treat metabolic syndrome is to make changes in your habits: lose weight, exercise, and eat correctly.
Control Blood Sugar
Losing weight.
Following a healthy eating plan
Doing physical activity regularly.
Taking medicines as your doctor prescribes.
Balloon Angioplasty
Balloon angioplasty of the coronary artery, or percutaneous transluminal coronary angioplasty (PTCA) is a non-surgical procedure that relieves narrowing and obstruction of the arteries to the muscle of the heart (coronary arteries). This allows more blood and oxygen to be delivered to the heart muscle. This is accomplished with a small balloon catheter inserted into an artery in the groin or wrist, and advanced to the narrowing in the coronary artery. The balloon is then inflated to enlarge the narrowing in the artery.
Recommended Medications
Drug Therapy for Cholesterol
Many medications can lower blood cholesterol levels. Statins are recommended for most patients because they are the only cholesterol-lowering drug class that has been directly related with reduced risk of heart attack and stroke. Your doctor may consider other medications as well, especially if you have side effects or not a sufficient response to statin therapy. This class of drugs work in the liver to prevent the formation of cholesterol, lowering the amount of cholesterol circulating in the blood. Statins are most effective at lowering LDL (bad) cholesterol, but also modest effects on lowering triglycerides and raising HDL (good) cholesterol.
Most side effects are mild and generally go away as your body adjusts, but your doctor may order regular liver function tests. Patients who are pregnant or have chronic liver disease should not take this medication. Statin medications being Lipitor, Fluvastatin, Lovastatin, Pravastatin, Simvastatin, etc.
Blood Pressure Controlling Medication
Many medications known as antihypertensives are available by prescription to lower high blood pressure. Diuretics help the body get rid of excess sodium (salt) and water and help control blood pressure. They are often used in combination with additional prescription therapies. Diuretic medications like furosemide, indapamide, metolazone, hydrochlorothiazide, etc.
Post-Procedure
Bypass Surgery Post Operative Care
Even if everyone recovers at a different rate, you'll need about six to eight weeks of healing before you can go back to a normal routine. (Kevin better not go back to his old ways, I swear.)
During that time, keep in touch with your doctor and follow his or her instructions.
Avoid lifting greater than 10 pounds, pushing/pulling activities with your arms.
Showers are permitted but bath tubs are discouraged. Avoid extremely hot water. Avoid driving a car for 4-6 weeks after surgery due to medication and fatigue. Keep in mind your legs will need to continuously have circulation, in long rides, take breaks every 1-2 hours.
Do not cross your legs while laying in bed or sitting.
Sleep the number of hours that you normally slept before surgery.
Space out activities and pace them to minimize fatigue.
Stair climbing is not discourage, but take it slow.
Swelling on chest incision is normal and will take months to disappear.
Most patients experience incision discomfort in the sternum. This discomfort will decrease in time.
Avoid stress
Take temperature every morning for one week after discharge, notify doctor if it stays above 100 degrees more than a day.
Check weight every morning for the first two weeks. If weight is gained, notify doctor.
Keep record of your medications and medical history when traveling.

Angioplasty Post Care
Most angioplasty patients remain in the hospital overnight. Usually in the cardiac care unit (CCU) or a special unit for patients undergoing cardiac catheterization and angioplasty. They should arrange for someone to drive them home from the hospital.
Before leaving the hospital, patients receive info about long-term therapy that may help prevent future coronary artery disease, and instructions regarding when and to what extent they can resume normal activity.
Heavy lifting and vigorous activity is discouraged for several days to ensure that arteries heal properly.
Personal Health Goals
It is important to know what you are working towards, and what is a healthy amount of cholesterol and blood pressure compared to your own. It would be highly advised to set goals for yourself and know what you need to get to.
Total Cholesterol Level:
Less than 200 mg/dL would be desirable
LDL (Bad) Cholesterol Level:
Less than 100 mg/dL would be optimal but 100-129 is near optimal
HDL (Good) Cholesterol Level:
40-59 mg/dL is alright, but the higher, the better.
Healthy Weight for Kevin's Age:

182 pounds
Systolic Blood Pressure:

120-139
Cardiologist
Cardiologists are doctors who specialize the diagnosing and treating diseases or conditions of the heart and blood vessels, the cardiovascular system. You will visit a cardiologist to find out what measures you can take for better heart health. When dealing with a complex health condition like heart disease, it is important that you are referred to a cardiologist and they evaluate your symptoms.
Dietitian
A dietitian provides nutrition-related services directly to patients or clients. The role of a dietitian caries, depending on where he or she practices. Some work in environments like hospitals and school, supervising large-scale food production and ensuring that everyone gets the foods that they need to do well.
In other cases, a dietician may work one-on-one with clients, providing personal advice to help people lose weight. For example, Kevin would be a client to focus on losing weight to be better in health.
For example, Kevin would work with his Cardiologist to continue to work on his issues with his heart. Considering his brief heart attack and future procedures he will need.
Psychologist
Psychology is the study of human thought, emotion and behavior. Someone who is trained in this discipline is called a psychologist. The most popular areas are clinical, counseling and school psychology. Although trained differently, a clinical or counseling psychologist both asses individuals in order to diagnose and subsequently treat their mental, emotional and behavioral disorders.
Considering Kevin's caution about going into surgery, a psychologist to speak with him about this fear would be appropriate. This is definitely a surgery he will need sooner or later, his fear of death shouldn't get in the way of that. Whether he decides to go the sessions to speak about it, is up to him.
Monthly Plans
Progress will be measured and constantly will be expected to be recorded. From Kevin and from his physicians. Monthly he should be going in for blood tests weekly Kevin should monitor his diet and weight. These tests should be spread as he becomes more healthy over time.
Resources!
http://www.heart.org/HEARTORG/Conditions/HighBloodPressure/PreventionTreatmentofHighBloodPressure/Types-of-Blood-Pressure-Medications_UCM_303247_Article.jsp#.V04so4-cGM8
http://www.wisegeek.org/what-is-a-nutritionist.htm
http://www.heart.org/HEARTORG/Conditions/Cholesterol/PreventionTreatmentofHighCholesterol/Drug-Therapy-for-Cholesterol_UCM_305632_Article.jsp#.V05MxY-cGM9
http://www.healthcommunities.com/heart-surgery/postprocedure-angioplasty.shtml
http://www.texasheart.org/HIC/Topics/FAQ/wicardio.cfm
http://www.healthline.com/health/heart-bypass-surgery
http://careerplanning.about.com/od/occupations/p/psychologist.htm
https://www.nlm.nih.gov/medlineplus/magazine/issues/summer12/articles/summer12pg6-7.html
http://www.swheartlung.com/surgical-procedures/bypass-surgery-post-op.html
http://www.medicinenet.com/coronary_angioplasty/article.htm
Full transcript