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Assessment
The client is a 57-year-old over-weight Caucasian male. Assessment of the clinical history of the patient shows that the patient had demonstrated an elevated blood pressure level five years back, which is under control with medication. In addition, the patient suffers from hyperuricemia, which is again under control with medication. Lipid profile and blood sugar is normal, but triglycerides are above normal.
The patient smokes about 20 cigarettes a day and leads a sedentary life. The family history shows that father died at the age of 73 years from coronary heart disease, the mother at 69 years from coronary heart disease, one brother at age 37 years from coronary heart disease, and one brother at age 59 years from coronary heart disease. Medications in use are indapamide 1.5mg sustained release tablets once a day and allopurinol 100 mg tablets once a day.
The life style of the patient and familial history put the patient at high risk for coronary heart disease and prevention of coronary heart disease is the topic chosen. The reason for choosing coronary heart disease is that it is the leading cause of mortality in the United States of America, extending over eighty years, and is a heavy drain on health-care expenditures estimated at approximately $151.6 billion in terms of direct and indirect costs (Neyer et al, 2007).
In addition to family history of coronary heart disease, tobacco smoking, hypertension, abnormal blood lipids and lipoproteins, physical inactivity, obesity, and diabetes are risk factors for coronary heart disease. The presence of two or more factors heightens the risk for coronary heart disease (Wilmore, Costill & Kenney, 2008). The patient lives with his wife and is from the middle income group. The children are gainfully employed and live separately.
Though there is no apparent cause for psychosocial stress, Ericksons theory of psychosocial development of an individual posits that an individual goes through different crisis stages in the various stages of life, and unless the individual masters the crisis, psychosocial stress results. In mid-life the crisis that is faced relates to generativity or stagnation, and failure to master this could lead to psycho-social stress in the individual (Roper-Coleman & Keckhausen, 2006).
At the clinical assessment stage it is possible to evaluate the coping styles of the patient through observing the statements made by the patient. In essence there are two coping styles internalizing and externalizing. Patients using internalizing coping styles are likely to use self-deprecating statements, as they look upon the cause of their problems and not their resolution within themselves. On the other hand, patients using externalizing coping styles get angry and blame everyone else but themselves, as they use externalizing behaviours as a means to reduce their stress (Mohr & Beutler, 2005). In the case of this patient externalizing coping style was observed.
Expected Outcome/ Planning & Goal Settings
The expected outcomes for the patient are smoking cessation and weight reduction by twelve kilos to achieve optimum body mass index (BMI)& These two outcomes are to be achieved over a planned time span, and are realistic for the patient and measurable. Through smoking cessation and weight reduction, the environmental risk factors are eliminated reducing the risk for coronary heart disease.
The plan for smoking cessation is to encourage the patient to enrol in group therapy to understand smoking cessation behaviour and remove stress. At this stage the life partner is also encouraged to become a partner in the smoking cessation activity. The next stage involves the actual stopping of smoking cessation supported by nicotine replacement therapy. The goals set in this plan is for a definite commitment by the patient to quit smoking within one month of the group therapy, and the actual cessation of smoking to happen immediate to this commitment (Belleudi et al, 2007)
The plan for weight reduction is to consume more foods that are liked that are low in carbohydrates and incorporate fruits and vegetables that are liked in the diet. At the same time an exercise program through walking is started. To start with this program looks at an exercise of brisk walking for 30 minutes 5 days a week that increases fortnightly by ten minutes till a brisk walking time of sixty minutes is reached. Again, the life partner is encouraged to be a part of this program. The weight reduction of twelve kilos is over a span of six months and the targeted weight loss is two kilos a month.
Nursing Interventions
The planned nursing interventions for smoking cessation are first to motivate the individual to quit smoking. This is done in two ways. The first is to demonstrate the lowered pulmonary functioning through spirometry and carbon monoxide tests feedback and presenting graphic representation of the degradation of the cardiovascular system through smoking. The second intervention is to enhance the coping ability of the individual to the crisis in the stage life. The final nursing intervention is in the form of frequent monitoring and counselling to evaluate progress of the program and take it forward (Rice & Stead, 2004).
The first nursing intervention in the weight reduction program is to give clarity to the goals and objectives of the programs and clarify the exercise and nutrition program in it. The second intervention is to provide weight loss counselling. The third intervention is to monitor the weight loss on a constant basis to take the weight production program forward (Briscoe & Berry, 2009).
Conclusion
The patient is at high risk for coronary heart disease due to the presence of more than one risk factor, in the form of smoking, excess weight and a sedentary life style. The smoking cessation program coupled with the weight reduction program will help to prevent the early onset of coronary heart disease in this patient.
Literary References
Belleudi , V., Bargagi, M., Davoli, M., Di Pucchio, A., Pacifici, R., Pizzi, E., Zuccaro, P. & Perucci, C. A. (2007). Characteristics and effectiveness of smoking cessation programs in Italy. Results of a multicentric longitudinal study. Epidemiologia e prevenzione, 31(2-3), pp. 148-157.
Briscoe, J. S. & Berry, J. A. (2009). Barriers to Weight Loss Counseling. Journal for Nurse Practitioners, 5(3), 161-167.
Mohr, D. & Beutler, L.E. (2005). The Integrative Clinical Interview. In Larry. E. Beutler & Gary Groth-Marnat (Eds.), The Integrative Assessment of Adult Personality, Second Edition (pp. 82-121). New York: Guilford Publications.
Neyer, J. R., Greenlund, K. J., Denny, C. H., Keenan, N. L., Labarthe, D. L. and Croft, J. B. (2007). Prevalence of Heart Disease United States, 2005. MMWR Weekly, 56(6), 113-118.
Rice, V. H. & Stead, L. F. (2004). Nursing interventions for smoking cessation. Cochrane Database of Systematic Reviews, Issue 1, Art No. CD001188.
Roper-Coleman, S. F. & Heckhausen, J. (2006). Adult Development. In Richard Schulz, Linda, S. Noelker, Kenneth Rockwood & Richard, L. Sprott (Eds.), The Encyclopedia of Ageing, Fourth Edition (pp. 21-25). New York: Springer Publishing Company.
Wilmore, J. H., Costill, D. L., & Kenney, W. L. (2008). Physiology of Sport and Exercise, Fourth Edition. Champaign, IL: Human Kinetics.
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