need a response to peer post with reference and cite Learning…

Question Answered step-by-step need a response to peer post with reference and cite Learning… need a response to peer post with reference and citeLearning issues: Has Jerome lost weight since his last visit? His current BMI is recorded, but there is not a current weight. What type of diet does Jerome follow? He states that he has changed his diet but has difficulty with healthy choices when going out to eat. Why does Jerome feel that he has difficulty with making healthy eating choices when going out to eat? What type of alcohol does Jerome drink? He reports that he has two to three drinks per week.  Does Jerome practice any type of stress reduction practices? Six months ago, one of Jerome’s short-term goals was to reduce stress. Is Jerome checking his pulse and target heart rate with exercise? How many days a week is Jerome working out total? He reports that he goes to a health club three days a week and swims three days a week along with muscle-strengthening exercises. Did Jerome follow up with a dietitian? At his last visit, it states that a referral was going to be made to a dietitian.(Cappiello et al., 2017).Interpretation/Assessment: 47-year-old male that presents for follow up of blood work. Cholesterol level, while still elevated higher than normal, has improved from 257 to 221. A normal cholesterol level for an adult is less than 200 mg/dL (Pagana & Pagana, 2018). LDL-C has improved from 204 to 152.  3 Patient has had improvement with joint pain. Patient has had improvement of seborrheic dermatitis with use of ketoconazole-containing over-the-counter shampoo. Patient does not report practicing any stress reduction practices at today’s visit.(Cappiello et al., 2017)Therapeutic Options: Pharmacological: Statin therapy should be prescribed for Jerome. The statin to be prescribed for the patient would be simvastatin 20 mg by mouth nightly. The medication, dosage, and frequency is considered a moderate-intensity statin therapy regimen (Grundy, 2019). The goal of moderate-intensity therapy is to reduce the LDL-C by 30 percent with a goal of preventing atherosclerotic cardiovascular disease (ASCVD) (Grundy, 2019). Oftentimes, statin therapy is usually not considered until a dietary modification trial has been tried for at least 3 months (Woo & Robinson, 2020). Of note, it has been 6 months since Jerome’s last visit; therefore, it is appropriate to go ahead with prescribing Jerome a statin therapy regimen. Nonpharmacological: The patient should continue to exercise at least 30 minutes a day approximately 5 days a week (Woo & Robinson, 2020). Jerome would benefit from stress reduction practices. He reports that he is still working in a high-pressure job. There has been evidence that shows a relationship between job stress and high total cholesterol and LDL (Chen, 2017). Stress reduction techniques that Jerome could possibly implement include mindful meditation, deep breathing exercises, and relaxation to music (Cleveland Clinic, 2020). If Jerome has not followed up with a dietician as previously discussed, then a dietitian referral should be ordered again with close follow up of compliance.  4 Educational: Education should be provided to Jerome on the potential side effects of simvastatin. Side effects that are important to stress to Jerome include myalgias (muscle aches), constipation, and headache (Wilkins, 2020). It is also important that the patient is educated on potential adverse reactions or side effects of simvastatin to include new onset diabetes mellitus, rhabdomyolysis, and liver failure (Grundy, 2019). The patient should be re-educated on eating a healthy diet to include a therapeutic lifestyle change (TLC) diet. The TLC diet emphasizes avoiding heavy saturated fats, adjusting total calories to maintain a desired body weight, and increasing soluble fiber to 10 to 25 g/d (Woo & Robinson, 2020). While Jerome only consumes 2 to 3 drinks per week, alcohol consumption can be related to cardiovascular disease (Woo & Robinson, 2020). It is important to educate the patient on what is considered low-to-moderate alcohol intake. A moderate amount of alcohol intake is considered no more than 1 ounce of ethanol which equals 24 ounces of beer, 10 ounces of wine, or 2 ounces of whiskey (Woo & Robinson, 2020). As previously mentioned, education can be provided to Jerome on how to implement stress reduction techniques into his daily routine. Social Determinants of Health: Patient lives with his wife and three children. Employed as a certified public accountant. Nonsmoker for the last 15 years. He does drink 2 to 3 drinks a week currently. He has access to healthcare with no issues identified with health insurance. Reports improvement with healthy, active lifestyle.Differential diagnosis: Family history of familial hypercholesterolemia – Z83.42 Inappropriate diet and eating habits – Z72.4 Personal history of nicotine dependence – Z87.891  5 Alcohol use, unspecified – F10.9 Pure hypercholesterolemia, unspecified – E78.00Diagnostics: Alanine Aminotransferase (ALT) Alkaline phosphatase (ALP) Aspartate aminotransferase (ALT) Gamma-glutamyl transpeptidase (GGT) Creatinine Kinase (CK) Hemoglobin A1c(Wilkins, 2020)Final diagnosis: Familial hypercholesterolemia – E78.01Six months ago, Jerome’s initial LDL-C was 204. When reviewing Jerome’s family medical history, it was identified that his mother has a history of hypercholesterolemia. His mother also had to have surgery to her leg due to a vascular occlusion. It is not documented as to what caused Jerome’s mother to have to have surgery on her leg for vascular occlusion. However, it could potentially be related to hypercholesterolemia and peripheral artery disease (Dunphy et al., 2019). The main sign of familial hypercholesterolemia is a LDL-C level greater than 190 mg/dL (CDC, n.d.). Up until 6 months ago, it is unknown if Jerome had previously ever had any lab work drawn especially a lipid panel. Therefore, the final diagnosis chosen for Jerome is familial hypercholesterolemia.Follow up:  6Jerome should return for a follow up in 6 to 8 weeks (Woo & Robinson, 2020). Upon returning for his follow up visit, Jerome’s serum LDL-C should be evaluated. If compliant with adherence to medication and lifestyle changes, he should show lowering of his cholesterol levels within 4 to 6 weeks of initiation of therapy (Woo & Robinson, 2020). Jerome should return to the office immediately if he experiences extreme muscle fatigue, right upper quadrant pain, or dark-colored urine (Ezad et al., 2018). This could possibly indicate that he has developed rhabdomyolysis. At follow up, it may also be necessary to assess Jerome for any signs or symptoms of diabetes mellitus. As previously mentioned, statins can potentially cause new onset diabetes mellitus. However, high-intensity statin therapy is related to new onset of diabetes       Health Science Science Nursing NSG 5540 Share QuestionEmailCopy link Comments (0)

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