Cardiac case study and clinical analysis

¶ … Carl

Cardiac Case

Q1.What should the major objectives of this health maintenance visit be?

Although Carl does not have any preexisting chronic conditions such as diabetes or allergies, several facets of his health history pose causes of potential concern. First and foremost, his father died of a heart attack (albeit at a much older age), indicating that he may have a susceptibility to cardiac problems thanks to genetics. Although Carl's father only passed away in his seventies, heart problems take time to progress. Carl should have his cholesterol and blood pressure screened (to see if the earlier high reading was a 'fluke'), and if necessary he should be subjected to other tests to determine the health of his cardiac system (such as a stress test). Carl's shortness of breath and headaches are red flags for potential cardiac problems.

Depending on what the tests yield, Carl may need to change his diet and exercise patterns. High levels of 'bad' cholesterol and low levels of 'good' cholesterol and high blood pressure can be altered with diet, or, if necessary, medication. In general, total cholesterol levels below 200 mg/dL are desirable and put patients at lower risk for heart disease; 200-239 mg/dL is borderline high and over 240 mg/dL is a serious risk factor (What your cholesterol levels mean, 2013, AHA). The breakdown of Carl's overall cholesterol should be assessed: "With HDL (good) cholesterol, higher levels are better. Low HDL cholesterol (less than 40 mg/dL for men, less than 50 mg/dL for women) puts you at higher risk for heart disease" (What your cholesterol levels mean, 2013, AHA). In contrast, less than 100 mg/dL is optimal for LDL ('bad' cholesterol). Also, "a high triglyceride level combined with low HDL cholesterol or high LDL cholesterol seems to speed up atherosclerosis (the buildup of fatty deposits in artery walls). Atherosclerosis increases the risk for heart attack and stroke" (What your cholesterol levels mean, 2013, AHA).

Carl does not apparently have a weight problem or past issues with his blood sugar, but that does not make him immune to potential problems and complications. Stress, alcohol, and smoking can all contribute to heart disease. These can be very difficult lifestyle factors to alter, but unlike genetics they can be changed. Carl must be psychologically prepared to make such changes, however. Thus, as well as taking Carl's blood pressure and submitting a blood sample to have his cholesterol screened (getting his blood glucose level assessed, even though there were no problems in the past with this reading might also be wise), the nurse should try to obtain a full assessment of Carl's lifestyle. When and what does he eat? What are his work habits? His sleep habits? Has anything changed recently in his life? All of these factors could make a potentially meaningful impact upon both the test results and the eventual prescription for Carl to improve his health.