need a response to peer post with reference Case Study #16 Jerome… need a response to peer post with referenceCase Study #16 Jerome WilsonLearning IssuesTell me how often you eat red meat. Are you adding fiber? How much red meat do you consume? Diets high in red meat increase cholesterol levels, and soluble fiber helps lower LDL (Cleveland Clinic, 2019).How do you feel about starting on a cholesterol-lowering medication?Have you been able to manage your stress with the suggestions provided at your last office visit?During your last prostate exam, it was noted that there was some firmness. Do you have any family history of prostate cancer? A firm or hard region in the prostate needs have further testing to check for prostate cancer (Perlmutter Cancer Center, 2022). Interpretation of Cues, Patterns, and Information Your cholesterol and LDL levels have decreased with a diet; however, they are still not at the optimum level for someone of your age and family history (Cleveland Clinic, 2019). This patient’s psychosocial issues are his stressor, leading to anxiety (Holems, 2017). Due to his high-stress job and having young children, this could lead to elevated stress levels. Differential Diagnoses With ICD 10 CodesHypercholesterolemia E78.2Metabolic Syndrom E88.81Encounter for screening for malignant neoplasm of prostate Z12.5. If the PSA level is normal, this can be ruled out. However, the American Cancer Society does not recommend regular PSA testing until age 50, and there is no family history indicating he would be at high risk (American Cancer Society, 2019). Diagnostic Cardiac Calcium Score. A coronary calcium scan provides pictures of the heart to measure and detect calcium-containing plaque in the arteries (Mayo Clinic, 2021). EKG to see if there are any abnormal rhythms due to blocked arteries. PSA due to hardend prostate. Liver enzymes prior to starting a statin. Final Diagnosis Hypercholesterolemia. Due to the patient’s age and family history of hypercholesterolemia, his LDL levels should be below 100, and his HDL should be higher than 40 (Cleveland Clinic, 2019). Metabolic syndrome. According to the Mayo Clinic, if a person has three or more of the following risk factors, they may have a metabolic syndrome that requires more of a rigorous cholesterol-lowering agent (Mayo Clinic, 2019). For example, he has triglycerides of 150 or higher at 157, a low HDL (lower than 40 in men), 38, and his blood pressure is elevated at 130/70 (Mayo Clinic, 2019). Therapeutic Options Nonpharmacological options include adding fiber to the diet, such as whole grains. The fiber binds to the cholesterol and allows the body to eliminate through stool, preventing the fat from entering the bloodstream and clogging the arteries (Cleveland Clinic, 2019). Pharmacological options include taking a high-intensity statin such as Atorvastatin 40-80mg orally daily (Family Practice Notebook, 2022). For constipation, a pharmacological option would be Milk of Magnesium 15-60 ml PO daily (Family Practice Notebook, 2022). Education would be regarding a high fiber diet to lower LDL and help with constipation; however, he would also need to hydrate with water (Family Practice Notebook, 2022). Social Determinants of Health would be his lifestyle. For example, he has a high-stress job that might not consume healthy foods. Follow up If the patient agrees to start a statin, he will need labs to monitor liver enzymes. This particular medication is metabolized in the liver. He will also need labs rechecked 4-12 weeks and then yearly for LDL monitoring. I would advise him to see a cardiologist monitor any cardiac issue that may arise or prevent long-term complications. If his constipation does not improve or resolve, he should be referred to GI for further tests. Health Science Science NursingNSG 5540
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