Lipids: A nursing action plan for improving patients' lipoprotein levels

Note: The publications in Advanstar Communications' Life Sciences Group and its Web portal, http://ModernMedicine.com/, are collaborating in a coordinated, interdisciplinary initiative to address this major public health issue-cardiometabolic disorders and weight. To read the joint introductory articles in this series, visit the following links:

Cardiometabolic Disorders and Weight: Action for Outcomes

http://medicaleconomics.modernmedicine.com/memag/article/articleDetail.jsp?id=621950

http://medicaleconomics.modernmedicine.com/memag/article/articleDetail.jsp?id=621955

SARA IS A SINGLE 59-YEAR-OLD who works as a purchasing agent for a medical equipment company. She has three grown children and has been without major health problems or chronic illness, although for the last 35 years she has smoked half a pack of cigarettes per day. She has no allergies. She underwent a knee replacement following an accident while golfing seven years ago. Twenty years ago, her father passed away suddenly at age 68 following a ruptured aortic aneurysm; her mother, age 86, survives and is doing well despite having had two minor strokes. Last week, her only sibling, a younger brother, told her he'd had a fasting lipid profile (FLP) at an office screening health fair. He said, "It looks like my cholesterol may be too high, so they told me to get it checked again by my doctor." Sara commented that she hadn't had hers checked in several years because she had not been to that kind of a doctor. After talking with her brother, she made an appointment at a family health clinic for an FLP and was instructed to fast for at least 12 hours before having her blood drawn.¹

Her results revealed the following abnormalities: total cholesterol (TC) 240 mg/dL; high-density lipoprotein (HDL) 38 mg/dL; low-density lipoprotein (LDL) 164 mg/dL; and normal triglycerides (150 mg/dL).^1,2 A fasting blood glucose was normal. The following week, a nurse practitioner saw her for a physical exam and follow-up. Her sitting blood pressure was 138/80 mm Hg; resting heart rate 86 bpm; respirations non-labored at 16 per minute; and a review of systems and the rest of the physical exam unremarkable. Sara's body mass index (BMI) was 26.8 kg/m² , rendering her slightly overweight.³ Blood counts and chemistries, thyroid, and liver function studies were all normal.

The nurse practitioner went over these results with Sara. She explained the changes that occur in blood vessels as a result of uncontrolled hyperlipidemia, especially as this process relates to the development of coronary heart disease (CHD), which could lead to a heart attack. The same process, she went on to say, could occur in the carotid arteries-major arteries that feed the brain-and cause a stroke. Sara learned that an abnormal lipid profile such as hers, especially the high LDL, was of concern because it is a major risk factor for developing CHD. Other risk factors, such as her low HDL, smoking history, and age also contributed to Sara's risk for CHD, which was further influenced by her rather sedentary lifestyle and atherogenic diet.⁴

The nurse practitioner used all this data to calculate Sara's 10-year risk for developing CHD, the results of which would facilitate decisions regarding Sara's optimum treatment regimen.^2,4 The results indicated Sara was in the 'moderately high-risk' category.^4,5 Based on current guidelines, she was prescribed a statin-the most powerful class of drugs for lowering LDL hyperlipidemia-and therapeutic lifestyle changes (TLC).^4,6 As the nurse educator at the clinic, you have been asked to see Sara to assist in formulating a plan to meet the treatment goals.

After reviewing her chart, you meet with Sara to gather some more information. You learn she has a high school education and says she understands the importance of getting her "cholesterol numbers under control" as well as the need to quit smoking so she doesn't "drop dead of a heart attack or a stroke." Two years ago, she quit smoking for six months, so she said, "I know I can do it." She also admits to the need for-and in fact looks forward to-eating better and incorporating more activity into her lifestyle. She wants to learn how to take better care of herself, but does express anxiety about whether she'll be able to make all the changes. One of her best friends quit smoking two years ago. In addition, she does belong to an HMO via her work health insurance policy.

NURSING DIAGNOSIS^7,8

DESIRED OUTCOMES/EVALUATION CRITERIA^7,8

PLANNING AND IMPLEMENTATION^7,8