Q1.What should the major objectives of this health maintenance visit be?
Although Carl does not have any preexisting chronic conditions such as diabetes or allergies, several facets of his health history pose causes of potential concern. First and foremost, his father died of a heart attack (albeit at a much older age), indicating that he may have a susceptibility to cardiac problems thanks to genetics. Although Carl’s father only passed away in his seventies, heart problems take time to progress. Carl should have his cholesterol and blood pressure screened (to see if the earlier high reading was a ‘fluke’), and if necessary he should be subjected to other tests to determine the health of his cardiac system (such as a stress test). Carl’s shortness of breath and headaches are red flags for potential cardiac problems.
Depending on what the tests yield, Carl may need to change his diet and exercise patterns. High levels of ‘bad’ cholesterol and low levels of ‘good’ cholesterol and high blood pressure can be altered with diet, or, if necessary, medication. In general, total cholesterol levels below 200 mg/dL are desirable and put patients at lower risk for heart disease; 200-239 mg/dL is borderline high and over 240 mg/dL is a serious risk factor (What your cholesterol levels mean, 2013, AHA). The breakdown of Carl’s overall cholesterol should be assessed: “With HDL (good) cholesterol, higher levels are better. Low HDL cholesterol (less than 40 mg/dL for men, less than 50 mg/dL for women) puts you at higher risk for heart disease” (What your cholesterol levels mean, 2013, AHA). In contrast, less than 100 mg/dL is optimal for LDL (‘bad’ cholesterol). Also, “a high triglyceride level combined with low HDL cholesterol or high LDL cholesterol seems to speed up atherosclerosis (the buildup of fatty deposits in artery walls). Atherosclerosis increases the risk for heart attack and stroke” (What your cholesterol levels mean, 2013, AHA).
Carl does not apparently have a weight problem or past issues with his blood sugar, but that does not make him immune to potential problems and complications. Stress, alcohol, and smoking can all contribute to heart disease. These can be very difficult lifestyle factors to alter, but unlike genetics they can be changed. Carl must be psychologically prepared to make such changes, however. Thus, as well as taking Carl’s blood pressure and submitting a blood sample to have his cholesterol screened (getting his blood glucose level assessed, even though there were no problems in the past with this reading might also be wise), the nurse should try to obtain a full assessment of Carl’s lifestyle. When and what does he eat? What are his work habits? His sleep habits? Has anything changed recently in his life? All of these factors could make a potentially meaningful impact upon both the test results and the eventual prescription for Carl to improve his health.
Carl is still very young to run the risk of having a heart attack: the risk of having a heart attack increases dramatically after age 65) so engaging in positive changes now is wise and prudent (Heart health screening, 2013, AHA). It should be noted that blood cholesterol is not the only cause of heart-related problems and that a stress test may be required to detect arrhythmias and other cardiac abnormalities. However, given that no structural or congenital problems have been detected until now regarding Carl’s heart, statistically speaking, atherosclerosis is the more likely culprit. Altering his lifestyle would be the first step: a diet lower in saturated fat, higher in unsaturated fat; eliminating trans fats and processed foods; and increasing the proportion of fruits, vegetables and whole grains in the diet is suggested for persons who wish to address problems with high cholesterol. Exercise is also an important factor in maintaining a healthy weight and heart and can also serve as a stress-reducer. Cholesterol-lowering drugs such as statins may be needed, but are usually prescribed only after lifestyle modifications have failed (Drug therapy for cholesterol, 2013, AHA). Any underlying problems (such as undetected diabetes) which can contribute to heart problems should also be addressed.
Drug therapy for cholesterol. (2013). AHA. Retrieved:
Heart health screening. (2013). AHA. Retrieved:
What your cholesterol levels mean. (2013). AHA. Retrieved:
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