PATIENT PROFILE CURE ACTION PROJECT 3
Patient Demographics Name: John Smith Sex: Male Gender: Male Age: 52 Height: 160 lbs Weight: 5’10” Medical History: He is allergic to shellfish. He got an allergic reaction. His throat swelled up and his face turned red. He had an appendicitis surgery. His body was in pain for one week. He could not laugh. Lifestyle Behaviors: He exercises less than 75 minutes a week and eats lots of greasy foods and some vegetables. On average, he gets about 8 hours of sleep a night. Medical Concerns/Family History: He is worried about getting heart disease. Purpose of Consultation: I will be focusing on heart disease. This patient does not want to get heart disease and he knows that his father has had heart disease. He is scared of getting heart disease because he might die.
PATIENT PROFILE CURE ACTION PROJECT 3 Patient Risk Familial Risk: Out of the 11 people in the family 1 person had the disease in John’s family and that person died. This is an experimental probability of 1/11 (roughly 9%) of a family getting that disease probably in their 80s. Risk Assessment: The Siteman Cancer Center has a risk assessment for heart disease. Based on this assessment, John has a 35% of getting heart disease. If John decides to start smoking, the chance of getting heart disease will increase dramatically.
No author (2018) Heart Risk Calculator Link.
PATIENT PROFILE CURE ACTION PROJECT 3 Treatment/Prevention Suggestions (Pt 1) Medications: Fluvastatin (Lescol)
Atorvastatin (Lipitor)
According to rxlist.com, “Stop taking fluvastatin and call your doctor at once if you have any of these serious side effects: ● unexplained muscle pain, tenderness, or weakness;
According to drugs.com, “You should not use Lipitor if you are allergic to atorvastatin, or if you have: ● liver disease; ● if you are pregnant or breastfeeding. To make sure this medicine is safe for you, tell your doctor if you have ever had: ● confusion, memory problems; ● liver problems; ● muscle pain or weakness; ● fever, unusual tiredness, and dark colored ● kidney disease; urine; ● diabetes; ● a thyroid disorder; ● pain or burning when you urinate; ● if you drink more than 2 alcoholic beverages daily. ● swelling, weight gain, urinating less than Lipitor is usually taken once a day, with or usual or not at all; without food. Take the medicine at the same time each day. ● increased thirst, increased urination. Do not break an Lipitor tablet before taking it. You may need to stop using this medicine for a 20 mg to 80 mg/ day. short time if you have: ● uncontrolled seizures; LESCOL/LESCOL XL can be administered orally ● an electrolyte imbalance (such as high or low potassium levels in your blood); as a single dose, with or without food. ● severely low blood pressure; ● a severe infection or illness; Do not break, crush or chew LESCOL XL tablets ● surgery or a medical emergency or open LESCOL capsules prior to administration.
Usual Adult Dose for Prevention of Cardiovascular Disease: Do not take two LESCOL 40 mg capsules at one Initial dose: 10 mg to 80 mg orally once a day. time. The initial dosage of Lipitor recommended for Since the maximal effect of a given dose is seen this patient in the prevention of cardiovascular disease is 10 mg to 80 mg orally once a day. within 4 weeks, periodic lipid determinations This medicine may be administered at any time
should be performed at this time and dosage adjusted according to the patient's response to therapy and established treatment guidelines. Pediatric Patients (10-16 years of age) with Heterozygous Familial Cardiovascular Disease The recommended starting dose is one 20 mg LESCOL capsule. Dose adjustments, up to a maximum daily dose administered either as LESCOL capsules 40 mg twice daily or one LESCOL XL 80 mg tablet once daily should be made at 6 week intervals. Doses should be individualizedc according to the goal of therapy.”
of the day without regard for meals. Dose adjustments should be made at intervals of 2 to 4 weeks. Take the missed dose as soon as you remember. Skip the missed dose if your next dose is less than 12 hours away. Do not take extra medicine to make up the missed dose. Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. Get emergency medical help if you have signs of an allergic reaction to Lipitor: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. In rare cases, Also call your doctor at once if you have: ● pain or burning when you urinate; ● liver problems - upper stomach pain, weakness, tired feeling, loss of appetite, dark urine, jaundice (yellowing of the skin or eyes); ● kidney problems - little or no urinating, swelling in your feet or ankles, feeling tired or short of breath. Common Lipitor side effects may include: ● joint pain; ● stuffy nose, sore throat; ● diarrhea; ● pain in your arms or legs. This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.”
Nutrition Plan: According to heart.org, “Choose foods low in saturated fat, trans fat, and sodium. As part of a healthy diet, eat plenty of fruits and vegetables, fiber-rich whole grains, fish (preferably oily fish-at least twice per week), nuts, legumes and seeds and try eating some meals without meat. Select lower fat dairy products and poultry (skinless).” Lifestyle Recommendations: According to mayoclinic.org, “What types of activities should the patient be doing or not doing? What changes in their overall lifestyle will lead to treatment or prevention? Consider sleep patterns, exercise, environment, and more when making these recommendations.”
“You can slowly work up to at least 2½ hours (150 minutes) of moderate-intensity aerobic physical activity (e.g., brisk walking) every week or 1 hour and 15 minutes (75 minutes) of vigorous intensity aerobic physical activity (e.g., jogging, running) or a combination of both every week.” “Additionally, on 2 or more days a week you need muscle-strengthening activities that work all major muscle groups (legs, hips, back, abdomen, chest shoulders, and arms). Children should get at least 60 minutes of activity every day.”
Alternative Therapies: According to draxe.com, “Essential Oils: There are many natural plant-derived essential oils that can help heal inflammation and symptoms related to heart disease. Some include lemon oil, lemongrass oil, frankincense oil, helichrysum oil and ginger oil. The active ingredients found in plants are their most potent in this concentrated form.”
PATIENT PROFILE CURE ACTION PROJECT 3 Patient Goals According to clevelandclinic.org goals you should have to lower the risk of having heart disease are: 1. Lower your cholesterol a. Drink alcohol only in moderation. b. Quit smoking, if you do smoke, and stay away from others who do smoke. John does not smoke. c. Weight has a big impact on lowering your cholesterol levels. “Losing as little as five to ten pounds can improve cholesterol levels.” 2. Lower high blood pressure a. Ideal blood pressure is less than 120/80. For patients with diabetes and established cardiovascular disease, blood pressure should be less than 130/85. b. Control blood pressure through diet (low-salt diet), exercise, weight management, and if needed, medications. c. Also limit alcohol, as it can increase blood pressure. 3. Maintain a healthy body weight a. A normal BMI ranges from 18.5 to 24.9 kg/m2. Overweight is defined as having a BMI higher than 25. A BMI higher than 30 is considered obese. b. For men, waist measurement should be less than 40 inches. c. For women, waist measurement should be less than 35 inches. d. Achieve and maintain a healthy weight. A diet and exercise program will help you reach your goal weight. If you want to calculate your BMI, click here. 4. Exercise a. Moderate exercise 30 minutes a day, on most days. More vigorous activities are associated with more benefits. Exercise should be aerobic, involving the large muscle groups. Aerobic activities include brisk walking, cycling, swimming, jumping rope, and jogging. b. If walking is your exercise of choice, use the pedometer goal of 10,000 steps a day. c. Consult your doctor before starting any exercise program. 5. Follow a heart healthy diet a. Eat foods low in sodium, saturated fat, cholesterol, trans fat (partially hydrogenated fats), and refined sugar. b. Omega-3 fatty acids are good fats and come from tuna, salmon, flaxseed, almonds, and walnuts. c. Mono-unsaturated fats also are preferred and are found in olive, canola and peanut oils. d. Also eat plant-based foods such as fruit and vegetables, nuts, and whole grains.
PATIENT PROFILE CURE ACTION PROJECT 3 Sources Used in Consultation Cleveland Clinic. Cardiovascular Disease: Prevention & Reversal Risk Factor Goals | Cleveland Clinic. 31 May 2018. Link.
Dr. Axe. Top Natural Remedies for Coronary Heart Disease - Dr. Axe. 31 May 2018. Link. Drugs.com. Lipitor: Uses, Dosage, Side Effects & Warnings - Drugs.com. 31 May 2018.Link. Healthline. Heart Disease Drugs: What They Are and What They Do. 31 May 2018. Link. Heart.org. How to Help Prevent Heart Disease - At Any Age. 31 May 2018. Link. “Heart Disease Risk Calculator.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 31 May 2018. Link.
“Lescol (Fluvastatin Sodium): Side Effects, Interactions, Warning, Dosage & Uses.” RxList, 31 May 2018. Link. Mayo Clinic. Top 5 lifestyle changes to improve your cholesterol. 31 May 2018. Link. Nhlbi.nih.gov. Calculate Your BMI - Standard BMI Calculator. 31 May 2018. Link.