OP 2: Chronic Diseases

Chronic Diseases

An illness is typically classified as _ when it lasts longer than 3 months.

_ illnesses cause about 70% of deaths in the US.

Approximately 90% of seniors have a chronic illness and over 75% have two or more.

Comorbidity

“The simultaneous presence of two chronic diseases or conditions in a patient.”

Ex: Patient has both hypertension and hyperlipidemia.

Having _ will increase a patient’s complexity and health risk.

Comorbidity = Complex

1. The treatment of one disease may affect or contradict the treatment of the second.

2. Adverse drug interactions.

3. Compounding symptoms may lead to poor compliance with treatment plan.

4. If both illnesses affect a specific organ system, the patient is at increased risk of organ failure.

If a patient has had respiratory symptoms for the past 5 weeks, are the symptoms considered chronic?

No

What is hypertension?

An increase in blood pressure causes excess force against the arterial walls, damaging arteries over time.

Risk factors of hypertension

FHx of HTN, obesity, high sodium diet, smoking, ETOH (ethyl alcohol - alcohol consumption)

Symptoms of Hypertension

• Often asymptomatic

• Headache is the most common symptom

Diagnosis for hypertension

Diagnosed through blood pressure reading. Typically, it takes several high readings to confirm hypertension.

Systolic Blood Pressure

Measures the pressure in the arteries when the heart contracts (beats).

Diastolic Blood Pressure

Measures the pressure in the arteries when relaxed (between heart beats).

How to read a blood pressure reading

Systolic / Diastolic

Hypotensive Blood Pressure reading

Systolic: Less than 90

Diastolic: Less than 60

Normal Blood pressure reading

Systolic: 90 to 120
Diastolic: 60 to 80

Prehypertensive blood pressure reading

Systolic: 121 to 140
Diastolic: 81 to 90

Hypertensive blood pressure reading

Systolic: Greater than 140
Diastolic: Greater than 90

What other chronic illnesses can hypertension lead to?

• Impaired vision: increased pressure through the delicate vessels of the eyes causes them to thicken/rupture causing vision loss.

• Renal failure: increased blood pressure through the kidneys causes weakening leading to renal failure.

• CVA (Cerebrovascular accident - stroke): Consistently increased pressure through the vessels of the brain causes weakening of arteries leading to potential rupture and hemorrhagic CVA.

• CAD (coronary artery disease)/MI: Untreated _ causes arteriosclerosis (thickening of arteries) which increases the risk of CAD or acute MI.

• CHF (Congestive heart failure): The heart experiences increased effort and decreased efficiency, pumping excess fluid through the body.

Overall: damages blood vessels (blood vessels around the heart, in the eyes, and in the brain).

Hypertension causes high pressure through the vessels of the brain. This can cause weakening of arteries, leading to a potential rupture and_.

Hemorrhagic stoke

Non-pharmacological Management of HTN

• Low sodium diet: sodium increases blood pressure because it causes kidneys to hold excess fluid in the body, thereby increasing one’s overall volume. Decreasing sodium intake lowers blood pressure.

• Exercise: Consistent exercise (30 minutes, more than 3 times per week).

• Smoking and ETOH Cessation: Nicotine and alcohol are vasoconstrictors (shrinks blood vessels).

• BP Log at home: measure BP at home throughout the day and record the effects of lifestyle changes.

Pharmacological Management of HTN

Type of Drug:

• ACE Inhibitors - relax arteries and block reabsorption of water by kidneys.

→ Lisinopril (Zestril)

→ Lotensin (benazepril)

• Ca Channel Blockers - Dilate the arteries and reduce the force of the heart’s contractions.

→ Norvasc (amlodipine)

→ Cardizem (diltiazem)

• Diuretics - Reduce the volume of fluid in the blood vessels by urinating excess fluid.

→ Hydrochlorothiazide (HCTZ)

• ARBs - Dilate the arteries.

→ Cozaar (losartan)

→ Benicar (Olmesartan)

Type 1 DM - AKA

Insulin Insufficiency

Type 2 DM - AKA

Insulin Resistance

Type 1 DM - Insulin Insufficiency

Pancreas is unable to produce insulin which moves glucose from the blood into cells.

Only 5% of today’s DM patients.

Always treated with insulin.

Typically diagnoses early in life. Strong FHx component.

Type 2 DM - Insulin Resistance

Consistently high blood glucose levels cause cells to become resistant to insulin.

95% of today’s DM patients.

Can be treated with diet changes, non-insulin meds, or insulin.

FHx component, but also SHx factors including diet and exercise.

Type 1 diabetics can manage their condition with oral medication alone?

False

Side note: Both type 1 and type 2 DM can be insulin dependent.

Risk factors of Type 2 DM

FHx of DM, obesity, high carb diet, lack of exercise.

What is type 2 DM

The inadequacy of insulin in controlling the blood glucose level (insulin resistance).

Symptoms of type 2 DM

• Unusual weight loss or gain.

• Polyuria, polydipsia, blurred vision, N/V (Nausea/vomiting)

Diagnosis of type 2 DM

Fasting blood glucose/hemoglobin A1c.

What other chronic diseases can Diabetes lead to:

• Diabetic Retinopathy: Damage to the small vessels of the eyes can cause them to hemorrhage, leading to blurred vision, nearsightedness, or loss of vision.

• Renal failure: Chronically elevated blood glucose destroys the glomeruli of the kidneys, leading to renal failure.

• Cardiac disease: diabetes is a risk factor for multiple cardiac conditions, including CAD, CHF, and diabetic cardiomyopathy.

• PVD (Peripheral vascular disease): Damages blood vessels and decreased blood flow to extremities results in infections, ulcers, and potential amputations.

• Neuropathy: Chronically high blood glucose damages the peripheral nervous system causing distal paresthesia’s and extremity pain.

Non-pharmacological management of DM

• Low carb diet: carbohydrates raise blood glucose more than other foods, meaning the body must produce more insulin to digest them.

• Exercise: consistent exercise (30 minutes, more than 3 times per week).

• Weight loss: in type 2 diabetes, losing weight can reduce or eliminate your need for medication.

• Blood glucose log: measure blood glucose at home throughout the week and record the effects of lifestyle changes.

Pharmacological management of DM: Injected

(Remember Humalog or Lantus)

• Humalog - rapid acting insulin, injected immediately before or after meals.

• Lantus - long-acting insulin, injected once daily.

• Sliding scale - insulin dosage based on current glucose.

Pharmacological Management of DM: Oral

(Remember Metformin)

• Metformin - long-acting oral med, taken with meals.

• Glyburide - induces pancreas to produce insulin. Taken with meals.

Hyperlipidemia

An elevated level of lipid in the blood causes plaque build-up along arterial walls.

Risk factors of lipidemia

FHx of HLD, obesity, high lipid diet (high in saturated fats), ETOH, physical inactivity.

Symptoms of hyperlipidemia

• Asymptomatic

Diagnosis of Hyperlipidemia

Bloodwork (lipid panel) measuring cholesterol and triglyceride levels - elevated LDL.

LDL - Low density lipoprotein

Commonly known as “bad cholesterol.”

LDL transports cholesterol to arterial walls and aids the formation of plaques.

HDL - High density lipoprotein

Commonly known as “good cholesterol.”

HDL is able to remove cholesterol from artery plaques and recycle it back to the liver.