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Cardiovascular disease is one of the major complications that arise as a result of diabetes and cause about 65% of the people involved to die from it or stroke. The people that have type 2 diabetes have high blood pressure, obesity, lipid problems and coronary artery diseases. Smoking as researchers discovered doubles the chances of a person with diabetes getting CVD.
The C-reactive protein (CRP), based on several studies is one of the strongest predictors of cardiovascular illnesses. The models of the CRP showed an association that was not significant for the omega 3 levels and the odds of being of a higher CRP category. The CRP model, however, suggested that a higher BMI and diastolic blood pressure related slightly to the odds of one being a member of the higher CRP categories.
The results are non-significant to study because no other measures including those of diabetes status were in any way associated with CRP (Marso, 2003, p 102). Reason for the latter is that of the 290 people in the test (145 with diabetes and 148 without) the variables recorded for the Cubans were the waist circumference, gender, age and the calories eaten per day. The covariates befell tests alongside the adjustment variables without retention. The main reason as to why the results are non significant is that p=0.20 which is insignificant.
The ordinal logistic regression models of Homocysteine quartiles showed from the results that, greater levels of omega 3 fatty acids ensued high association with odds of low values of membership in higher compared to the lower Homocysteine quartiles with the inclusion of all the extra covariates. Another variable as per the data given is age. High levels of HbAlc link inversely with the odds of the upper Homocysteine quartile membership (Yudofsky, 2007, p 87).
Low intakes of n-3 are not an independent predictor of CRP as they were hypothesized. Ethnicity as per n-3 intake was significant. The ethnicity through then-3 intake was substantial. Cuban Americans that have low intakes of n-3 have higher chances of CRP compared to others (OR=0. 92, 95% CI = (0.85, 0.99). Although one having diabetes associates with a high CRP, the status of diabetes by then-3 intake was not much of a significant predictor for high CRP.
The findings agree with studies in that the omega 3 fatty acids improve the sensitivity of insulin at its normal state especially for individuals that have Type 2 Diabetes. The latter is on the basis that dietary omega 3 fatty acids have a protective feature in the prevention of CVD for the diabetes type 2 patients. Omega 3 fatty acids achieve the above through the improvement of the endothelial function (Kotsirilos, 2011, p 255).
Homocysteine is a risk factor of cardiovascular disease that stands on its own. The case study that involved 138 cardiovascular individuals and 290 others that did not have CVD but matched the age of the subjects in control expressed hugely, an outcome that was positive in terms of, the relationship between Homocysteine, age and high density lipoproteins (HDL). Looking at the other controlled study of forty individuals that have cardiovascular disease, specifically those that had mitochondria infractions that were acute and Atherosclerotic coronary artery disease and fifteen disease-free volunteers of similar age we see that the category of those involved that showed Nitric oxide related in a positive manner to the Homocysteine. An inference can be arrived at that, high levels of Homocysteine tend to generate free radicals that are some of the reasons for cardiovascular disease.
Studies show that, people that have diabetes have Homocysteine levels that are greater in terms of quantity compared to those that do not have it. A study for the purpose of finding out the Homocysteine levels between individuals that had diabetes type 2 and those that did not have both with coronary artery disease that was proven showed that, the levels of HCY were slightly higher in those that had diabetes than those that did not have it (Current medical research and opinion, p 76). A study of 1676 people that had diabetes but no known disease of the heart was all associated with the risk of CVD in the 8 years to come.
The rise in CRP levels intertwines with cardiovascular disease for some of the ethnic groups. Rises in hs-CPR are associated with Hyperglycaemia. Patients who are hypertensive and have type 2 diabetes possess the highest levels of plasma of his-CRP. The latter suggests that individuals have been having an ongoing inflammatory process that is active and predisposes them to CVD (Fuhrman, 2008, p 108).
The leading factor of death among the Cuban Americans is cardiovascular disease. The U.S. Census Bureau estimated that, as of July 1, 2011, there was roughly 16.7% of the Hispanic population, and it was estimated that it would reach an approximate value of 30% by July 1, 2050 The national survey for the years 2007 to the year 2009 for persons aged 20 years or above on the trail of age difference adjustments, showed that, among the Hispanics, the rates of diabetes were around 7.6% of the Cubans as well as the Southern and Central Americans One of the limitations that present itself is that, the research among the Cuban Americans that have type 2 diabetes and those that do not have, has not been furthered as of today.
A conclusion can be arrived at that the intake of omega 3 was associated highly with the HCY and the CRP levels for AA but not the HA. The status of diabetes and the consumption of omega 3 fatty acids did not predict considerably, the odds of high HCY or CRP among the Cuban Americans. The findings come to a suggestion of the requisite for potential and intercession studies of the measurement of the omega 3 fatty acids in the blood levels as well as, the cardiovascular events that follow up across the variables of the Cuban-Americans with and without type 2 diabetes.
References
Herman, W. H., & Wiley InterScience (Online service). (2010). The evidence base for diabetes care. Chichester, West Sussex: J. Wiley.
Unger, J., & Ovid Technologies, Inc. (2013). Diabetes management in primary care. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.
Marso, S. P. (2003). Handbook of diabetes mellitus and cardiovascular disease. London: Remedica.
Yudofsky, S. C., Hales, R. E., & American Psychiatric Publishing. (2007). The American Psychiatric Publishing textbook of neuropsychiatry and behavioral neurosciences. Washington, DC: American Psychiatric Pub.
Kotsirilos, V., Vitetta, L., & Sali, A. (2011). A guide to evidence-based integrative and complementary medicine. Sydney, N.S.W: Elsevier Churchill Livingstone.
Fuhrman, J. (2008). Eat for health: Lose weight, keep it off, look younger, live longer. Flemington, NJ: Gift of Health Press.
Current medical research and opinion. (1972). London, Eng: Clayton-Wray Publications Ltd.
Client Complaints
The client explains that he experiences a “gnawing hunger pain in the umbilical area.” The patient explains that the condition became complicated last night after having supper and he believes it was a fever because he felt warm and sweaty.
History of Present Illness
The patient explains that he has had the symptoms before but they were not that severe. According to the patient, the condition has been worse the past 24 hours. He had a similar situation today, but it was less severe compared to last night’s condition. He explains that the last night’s condition was more centralized in the periumbilical region. Today’s condition was more diffuse in the body. Furthermore, the patient asserts that the condition was generalized around the abdomen area last night. However, he explains that last night the condition radiated to the back area of the body.
Past Medical History
The patient has a medical history that comprises of hypertension, hypercholesterolemia and gout. Further, he has been previously diagnosed under an Upper Gastrointestinal medical process. He has had an appendectomy surgery dating back to twenty years ago. His previous prescriptions consist of non steroidal anti-inflammatory drugs, which help control his gout condition. However, he has no known drug allergies.
Significant Family History
The patient is a retired school teacher who still does part time teaching. He still earns from his retirement pension benefits. He has a wife who works at a local grocery story. The patient has a health insurance coverage including a prescription cover. He visits a primary care provider at least three times a year. His wife has been diagnosed with osteoarthritis condition, which has affected her knees and hips. Due to this condition, she cannot be fully active. The patient explains that they try to eat healthy although most of the times he ends up eating fast foods. Consequently, the patient explains that he engages in a street walk once or twice a week as part of his exercise. The patient refutes any chances of substance abuse and he admits to taking wine every night, sometimes drinking to excess.
Description of the client’s support system
According to the patient’s revelations, he has quite a positive support system. The patient explains that he receives support from his wife and some of his workmates at his retired workplace. He acknowledges that he does not receive social isolation and he admits that he would like to get more involved in the community. He thinks this will help him overcome his symptoms of depression.
Behavioral or nonverbal messages
The patient presents with various behavioral and non-behavioral messages. First, the patient seems kind of tensed with his medical condition. He admits that he is very concerned with his medical condition and that he would not like to lose his life early. Further, he seems to have emotional stress considering that his father died at around the same age that he is now.
Client awareness of his abilities, disease process and healthcare needs
The patient appears positive about his recovery process. He acknowledges that he needs to do more exercises, but his pain condition restricts him. He is quite persistent seeking for healthcare services. For instance, he explains that he visits the primary healthcare thrice or four times per year. He explains that the correct medical care will enable him achieve full recovery and he acknowledges that he thinks he is healthy. Further, the patient asserts that he does not see the need to change into a healthier lifestyle, since he lives well.
Physical assessments findings
Vital Signs: BP right arm sitting 175/70; T: 99 po; P: 64 regular; R: 18 and non-labored
HEENT: Within normal limits
Lymph Nodes: None palpated
Lungs: Clear to auscultation
Heart: RRR without murmur
Carotids: No bruits
Abdomen: + BS in all quadrants. Resonant to percussion throughout. Sharp pain with
palpation at the epigastric region, radiating to the back. No HSM. No peritoneal signs.
Rectum: Stool light brown and heme negative
Genital/Pelvic: Not examined
Extremities, Including Pulses: 2+ pulses throughout, not edema
Neurologic: Not examined
Lab tests and results
CBC: within normal limits
LFTs: within normal limits
H. pylori: Positive
Amylase & Lipase: within normal limits
Radiological Studies
Abdominal ultrasound: Gall bladder and liver are normal
EKG Interpretation
EKG: Normal sinus rhythm
Client’s support system as perceived by a healthcare professional
The client has a positive support system that can be incorporated in his recovery process. For instance, he receives a lot of positive support from his close friend and family. Consequently, it is possible to engage the local community in his support system. This is because his local environment seems positive as there is low rate of crime and other negative environment patterns.
Client’s locus of control and readiness to learn as perceived by healthcare professional
The client is very positive about his recovery process. He strongly believes in the success of his medical diagnoses. The patient can easily receive patient education effectively regarding his condition and the right physical therapy. He seems to have no problem with explaining his medical condition or visiting the primary healthcare provider.
Diagnoses/client problems
The patient has been diagnosed with hypercholesterolemia, gout and hypertension.
Advanced Practice Nursing Intervention Plan
According to advanced nursing practices, nursing services and diagnoses should be patient centered. This is in order to achieve effectiveness and success of the diagnosis. Therefore, in this clinical situation, it was necessary to educate the patient on the ideal lifestyle changes to reduce the prevalence of hypercholesterolemia. Hypercholesterolemia can be reduced even without the use of drugs. However, if the medical practitioner prescribes medication, then the patient should follow the medication prescription carefully (Buttarp, Trybulski, Polgar, Sandberg-cook, 2013).
Furthermore, hypertension has severe consequences and medication may fail if the positive lifestyle changes are not incorporated. Thus, apart from giving the patient prescription, it is necessary to advise him on the right lifestyle changes that will enable him reduce prevalence of the condition (Bowden & Sinatra, 2012). Similarly, the gout situation will also aim at improving the lifestyle behaviors of the patient. Gout is treated according to its signs and symptoms. For instance, the current medical situation simulates for management of inflammatory and pain caused by the gout condition.
Lifestyle changes
The lifestyle changes ideal for the patient, with regards to his diagnosed conditions, consists of multiple changes. First, the patient should engage more in physical exercises to reduce his chances of getting hypertension in the future. In addition, hypercholesterolemia also calls for lifestyle changes in terms of rate of activity (Bowden & Sinatra, 2012).
Dietary changes
Dietary changes are vital for the hypertension and the hypercholesterolemia conditions. Eating healthy is the key step towards establishing a healthy lifestyle. The patient admits that he usually takes fast foods. These may have increased his prevalence towards the diagnosed conditions (Terkeltaub, 2012). Thus, it is vital for the nursing practitioner to advice the patient on the ideal healthy foods. For instance, in the patient’s situation, it is easy changing his dietary habits since his wife works at a grocery store. Thus, the wife can easily change from fast foods into more organic and healthier options such as vegetables and fruits.
Therapy
The gout condition presents itself with severe pain as described by the patient. Therefore, it is necessary for the medical practitioner to give the patient the right pain therapy to reduce the pain levels. Therefore, in this medical situation I would arrange for a weekly pain session with a local physiologist. After the pain is maintained, then I would focus on treating the condition in the long-term. Further, the condition can be treated using corticosteroids; if the anti-inflammatory non-steroidal drugs fail (Terkeltaub, 2012).
Follow-up plan
It is necessary for the medical practitioner to formulate a follow-up plan for the patient. This is because of the patient’s condition. Follow-up plans involve diagnoses to measure the progress of the condition. Further, follow-up plans ensure that the patient follows prescription. In addition, it paves way for feedbacks, which engage the patient in the healing process (Buttarp, Trybulski, Polgar, Sandberg-cook, 2013). Thus, in this medical situation, I would arrange for a weekly visit to the patient’s home, to monitor the progress first hand. Furthermore, I would engage the patient in daily calls to get the feedbacks of diagnoses and therapy sessions. Hypertension drug prescriptions are very delicate and they may lead to worsening of the situation if they are not well administered. In this patient situation, I would make a keen follow-up on the hypertension condition of the patient.
References
Buttarp, M., Trybulski,J., Polgar, B, P., Sandberg-cook, J., (2013). Primary Care. Elsevier Health Science Division ISBN: 9780323075015.
Bowden, J., & Sinatra, S. T. (2012). The great cholesterol myth: Why lowering your cholesterol won't prevent heart disease-- and the statin-free plan that will. Beverly, MA: Fair Winds Press.
Terkeltaub, R. (2012). Gout and other crystal arthropathies. Philadelphia, PA: Elsevier/Saunders.
The intended readers of this paper are medical professionals and the public. This paper presents an awareness of Celiac disease.
1 in every 153 people in the U.S have Celiac disease and most of the time this disease goes undiagnosed, and this causes a myriad of problems for the individual with the disease (Green 112). Early and concise detection of the disease is important as it helps one to understand how to take care of one's body and therefore, avoid malnutrition and other diseases that come as a result of having Celiac disease.
Introduction
Celiac disease commonly referred to as celiac sprue is a digestive, allergic disorder that results in harm to the lining of the small intestine where goods that contain gluten are ingested. When person with celiac disease eat gluten (a protein that is often found in wheat, barley and rye), their bodies often mount immune responses that attack the small intestines. These attacks are often damaging to the Villi, that are small fingerlike projections that exist in the lining of the small intestines (Fasano 83). The Villi are important as they are the ones tasked with nutrient absorption and consequently when they are damaged; nutrients are often not able to be absorbed properly into the body.
Risk Factors
There are several genes-that are hereditary-that increase the risk of developing the disease. However, it of the quintessence to note that these gene mutations does not automatically mean that one will automatically have the celiac disease but rather, many at times other factors are involved which cause the disease together with the gene mutations. There are times where the disease is triggered and becomes robust after surgery, viral infection, severe emotional stress and discomfort as well as pregnancy. Celiac disease can affect any person. However, it often tends to be more common people in people that have the following risk factors. Firstly, people that have a family member with celiac disease or even dermatitis herpertiformis are often at a risk (increased) of getting the disease. Secondly, persons that have type 1 diabetes are also at an increased risk of getting celiac disease (Fasano 21). Person with natural disorders such as Down's syndrome and Turner's syndrome are also prone to the disease as compared to normal healthy people. Lastly, persons with autoimmune thyroid disease are also at a risk of acquiring this disease.
Signs and symptoms
The symptoms and signs of the disease can vary greatly. However, the classic signs that are always a pointer towards the disease include diarrhea and extreme weight loss. Most people that have celiac disease often experience few digestive signs and symptoms. In fact, according to research, about one-third of people diagnosed with Celiac disease that have experienced diarrhea, and about half of those that are living with the disease cited having weight loss. 20% of people that have Celiac disease often experience constipation, and a further 10% are Obese (Green 24). In addition to these problems, other signs and symptoms that are related to celiac disease include itchy skin, damage to the dental enamel, complete or partial nervous system injury. This often includes numbness as well as tingling of feet and possible problems with balance of the body. Another important symptom is the fact that the spleen is often reduced in its functioning. In Children, as many as 75% of the children that are diagnosed with Celiac disease are overweight. This is because their small intestines only absorb glucose that is turned into fat deposits. It is imperative to note that the digestive signs as well as symptoms that are often experienced by 25 to 35% of children with Celiac disease differ by age (Fasano 23).
One of the signs that are a red flag for Celiac disease is dermatitis herpertiformis. Dermatitis herpertiformis often creates an itchy, blistering skin disease that often stems from the intricate intestinal gluten intolerance. There is the formation of a rash which, usually, occurs on the torso, scalp, buttocks, knees and elbows. Dermatitis herpertiformis in many cases is often associated with deep changes to the lining of the small intestines, however, in most cases it does not go hand in hand with digestive symptoms. The digestive symptoms come either earlier before the dermatitis herpertiformis or later (Green 16).
Diagnosis of the disease
The disease is diagnosed through a careful physical examination by a physician. There is often a need to discuss one's medical history with the doctor in order for one to better understand the risk factors related to genetics. In many cases, the doctor often performs a blood test in a bid to measure the level of antibodies in the patient's blood. Antibodies are produced by the immune system in a bid to fight harmful pathogens. However, in this case, the body mistakes the gluten for pathogens and creates a fierce response to it (Thompson 12). People that have celiac disease often have high levels of antibodies in their blood stream. Another test is that of detecting nutritional deficiencies. A blood test to detect iron levels in the blood might be an indicator of whether one has celiac disease. However, this is, usually, a confirmatory test after the antibody test. A stool sample might be at times taken in order to detect traces of fat in the stool and hence it is concluded that celiac disease exists as it prevented fat from being absorbed into the blood. In severe cases, the doctor might be forced to acquire a biopsy of the small intestine in order to check for any abnormalities to the villi. The evaluation of the small intestine wall is the surest way to get the knowledge of whether or not one has celiac disease (Green 13). However, it is often conducted where all the other tests have failed to show whether a person has celiac disease and all the classic symptoms of the disease exist in the individual.
Treatment of the disease
There is no treatment of celiac disease. The only way the ailment can be kept in check is by a person avoiding any foods that have gluten. This includes food that have wheat, barley, oat, and rye. The dropping of gluten in the patient's diet is often important, and it, usually, improve the conditions with a few days and eventually all the symptoms of the disease disappear. In fact, research has shown that the villi that exist in the small intestine are often repaired in six months if the patient can maintain a gluten free diet (Thompson 37). However, there are some cases where Celiac disease has caused irreparable damage to the intestines and consequently a gluten free diet might not be of major help. In this cases, the patients are often forced to have intravenous nutrition supplements because the Villi that exists in their small intestines can no longer absorb enough nutrients as needed in the body. Following a gluten free diet is not easy as this means that one cannot be able to eat any staples food. This includes food such as pasta, cereals as well as many foods that have in their grains.
Conclusion
In conclusion, celiac disease is a digestive disorder in which the immune system often directs its antibodies to attack the small intestines. Celiac disease is caused by eating of gluten and its subsequent ingestion into the body. Gluten is a type of protein that is often found in Barley, oat, rye and wheat. The body's immune system is designed in a way to protect it from foreign pathogens. However, when people that have celiac disease eat foods that contain gluten, the immune system directs antibodies to attack the intestines as it views gluten as a foreign pathogen (Thompson 93). This reaction attacks the intestinal lining causing inflammation and eventually causing damages to the Villi responsible for absorption of nutrients and food into the blood. The most pronounced symptom for celiac disease is dermatitis herpertiformis which is a rash that is found in the elbow, neck, knees, scalp and buttocks. The diagnosis of the disease often requires an antibody test, blood test to check the level of nutrients in the body or a biopsy of the small intestines to see whether or not the Villi have been damaged. The treatment to the disease is having a gluten free diet, however, for those that the Villi has been destroyed they have to depend on intravenous injection to give them nutrients to their bodies.
Reference
Thompson, Tricia. Celiac Disease Nutrition Guide. Chicago, Ill: American Dietetic Association, 2006. Print.
Fasano, Alessio, R Troncone, and D Branski. Frontiers in Celiac Disease. Basel: Karger, 2008. Print.
Green, Peter H. R, and Rory Jones. Celiac Disease: A Hidden Epidemic. New York: HarperCollins e-books, 2010. Internet resource.
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