Description
Acute Case Scenario Observed in Clinic in an Adult (35-65 years of age)
40-year-old male with a history of obesity, alcohol use disorder (stated 8-10 beers 2-3 times per week), and elevated BP readings in office presented for follow up. His annual physical was in June 2023 at which time his BP was 151/89 and weight 215 (BMI 31.7). Per the June 2023 visit note on file, the patient was educated on recommended dietary changes, exercise guidelines and recommendations, reducing or eliminating alcohol use, and the risks of HTN, obesity, and excessive alcohol intake on his health. The patient refused medications at the time of his annual exam, and stated he wanted to try to make lifestyle changes to manage his BP and weight. Labs reviewed from annual exam revealed a fasting glucose of 98, total cholesterol of 269, HDL 76, LDL-C 147, and triglycerides 352.
The patient is not currently taking any daily medications, Rx, or OTC. Current vital signs: Height 5’9”, weight 210lbs, BMI 31, BP 155/92, HR 89, RR 16, O2 97% on RA, T 98.2; the patient’s weight is concentrated centrally. Per the patient, current alcohol intake is 8-10 beers 1-2 times per week. The patient states he has not started to exercise because it’s been too hot to walk outside, and his schedule does not allow time for exercise in the early morning or evenings. The patient states he has been eating more vegetables and has decreased his intake of foods high in saturated fat (fast food) and points out he lost 5lbs since his last visit.
How this Could Develop into Chronic Disease Management
If the patient fails to implement (and maintain) effective lifestyle changes (as he has failed to do thus far), he will require long-term medication management with antihypertensives, statins, and possibly antihyperglycemic agents. The patient will be at risk for developing conditions including (but not limited to) ASCVD (and increased risk of MI and stroke), worsening HTN and diabetes (and increased risk of kidney disease, PVD, vision loss, neuropathy), organ damage from alcohol intake (liver disease, CKD, dementia) (Dunphy et al., 2019).
Evidence that Supported the Intended Outcomes
The patient was counseled on metabolic syndrome and criteria reviewed as follows; 1) central or abdominal obesity greater than 40 inches in men (>35 inches in women), 2) triglycerides >150mg/dL (or if taking medication to lower triglycerides), 3) HDL <40 mg/dL for men (<50 mg/dL in women), 4) elevated BP 130/85 mmHg (or if taking antihypertensives), and 5) fasting glucose >100 mg/dL (or if taking medication for hyperglycemia) (American Heart Association [AHA], 2023). Lab results, BP readings, and weight (central obesity) reviewed, and the patient was informed that he currently meets the criteria for diagnosis of metabolic syndrome.
The patient was educated on the effects of alcohol on chronic disease development; alcohol increases inflammation in the body and contributes to tissue and organ damage, obesity, HTN, atherosclerosis, and insulin resistance (Dunphy et al., 2019).
Additional education included exercise recommendations for adults which are 150 minutes of moderate intensity aerobic activity plus two days of strength training per week, or 75 minutes of vigorous intensity aerobic exercise plus two days of strength training per week, or an equivalent combination of moderate and vigorous intensity aerobic exercise plus two days of strength training per week for optimal health benefits (Centers for Disease Control and Prevention [CDC], 2021).
A thorough discussion ensued with recommendations including the initiation of atorvastatin 10mg PO QD, lisinopril 10mg PO QD, eliminating alcohol intake, increasing, and maintaining exercise, and dietary changes. The patient was educated on the risks of continued management of his conditions with lifestyle modifications alone, based on his current condition (as compared to his last visit), and that if he initiates pharmaceutical therapy in combination with effective lifestyle changes, he may be able to discontinue the medications in the future.
References
American Heart Association. (2023). Symptoms and diagnosis of metabolic syndrome. www.heart.org. https://www.heart.org/en/health-topics/metabolic-syndrome/symptoms-and-diagnosis-of-metabolic-syndrome
Centers for Disease Control and Prevention. (2021). Faststats: Exercise or physical activity. Cdc.gov. https://www.cdc.gov/nchs/fastats/exercise.htm
Dunphy, L. M., Winland-Brown, J. E., Porter, B. O., & Thomas, D. J. (2019). Primary care: Art and science of advanced practice nursing – an interprofessional approach (Fifth ed.). F.A. Davis Company.
