Author Question: You are working at the local cardiac rehabilitation center and R.M. is walking around the track. He ... (Read 145 times)

crobinson2013 · **on:** Jun 25, 2018

You are working at the local cardiac rehabilitation center and R.M. is walking around the track. He summons you and asks if you could help him understand his recent laboratory report.

He admits to being confused by the overwhelming data on the test and does not understand how the results relate to his
recent heart attack and need for a stent. You take a moment to locate his laboratory reports and review
his history. The findings are as follows.
R.M. is an active 61-year-old man who works full time for the postal service. He walks 3 miles every
other day and admits he doesn't eat a perfect diet. He enjoys two or three beers every night, uses stick
margarine, eats red meat two or three times per week, and is a self-professed sweet eater. He has tried
to quit smoking and is down to one pack per day. Cardiac history includes a recent inferior myocardial
infarction (MI) and a heart catheterization revealing three-vessel disease: in the left anterior descending
(LAD) coronary artery, a proximal 60 lesion; in the right coronary artery (RCA), proximal 100 occlusion
with thrombus; and a circumflex with 40 to 60 diffuse dilated lesions. A stent was deployed to the RCA
and reduced the lesion to 0 residual stenosis. He has had no need for sublingual nitroglycerin (NTG).
He was discharged on enteric-coated aspirin 325 mg daily, clopidogrel (Plavix) 75 mg daily, atorvastatin
(Lipitor) 10 mg at bedtime, and ramipril (Altace) 10 mg/day. Six weeks after his MI and stent placement, he
had a fasting advanced lipid profile with other blood work.

Six-Week Postprocedure Laboratory Work (Fasting)
Total cholesterol 188 mg/dL
HDL 34 mg/dL
LDL 98 mg/dL
Triglycerides 176 mg/dL
Homocysteine 18 mmol/dL
High-sensitivity C-reactive protein (hsCRP) 8 mg/dL
FBG 99 mg/dL
TSH 1.04 mU/L

When you start to discuss R.M.'s laboratory values with him, he is pleased about his results.
My cholesterol level is below 200and my 'bad cholesterol' is good That's good news,
right? What would you say to him?

Question 2

When A.H. is being prepared for discharge, you talk to him about health promotion and lifestyle change issues that are pertinent to his health problems.

Identify four health-related issues you might appropriately address with him and what you would teach in each area.

macybarnes · **Reply #1 on:** Jun 25, 2018

Answer to Question 1

He needs further information After review of his HDL and triglyceride levels, there is still more work
to be done. You might explain, LDL particles are small, dense particles that transport fat into the
walls of the arteries, promoting atherosclerosis. LDL levels, when elevated, are positively correlated
to coronary artery disease. That is why LDL is often called the 'bad cholesterol.' HDL, however, has a
protective action, when levels are sufficient. Your HDL is too low (should be above 40 mg/dL), which
decreases your protection from plaque formation. In addition, your triglyceride level should be
below 150 mg/dL. When triglycerides are elevated, then triglycerides are deposited into the fatty
tissues. You need to work on reducing your triglyceride level and increasing your HDL levels.

Answer to Question 2

HTN: Importance of low-sodium diet, proper use of antihypertensive medications, and exercise. With
his history of AAA, he will need to keep his BP under control.
Exercise: Rationale and methods. Exercise is valuable in the treatment of atherosclerosis and
depression, but it is essential that A.H. receive prescriptive exercise guidelines. Exercise carries
great benefit, but it also carries great risk if it is done inappropriately.
Diet and nutritional status: Importance of low-sodium, low-cholesterol, high-fiber diet. Does he have
adequate nutritional intake to promote healing? Obtain a referral to a registered dietitian (RD).
He might also benefit from an at-home meal service, such as Meals-on-Wheels, not only for the
improved nutrition, but also for the social stimulation.
Constipation: Importance of high-fluid, high-fiber intake and exercise.
Psychosocial support needs: Discuss resources available in A.H.'s community for meeting psychosocial
support needs.