Gastroenterology & Diabetes Effects Essay Examples & Outline

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The Effect of Omega 3 Fatty Acid intake on Blood Homocysteine and C-Reactive Protein in Cuban Americans With and Without Type 2 Diabetes

  
THE EFFECT OF OMEGA 3 FATTY ACID INTAKE ON BLOOD HOMOCYSTEINE AND C-REACTIVE PROTEIN IN CUBAN AMERICANS WITH AND WITHOUT TYPE 2 DIABETES   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 nonsignificant 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.




 

Gastroenterology



Client Complaints

GASTROENTEROLOGYThe 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.