EDUCATE ON DIARRHEA

ADVISED PT./PCG TO EVALUATE DEHYDRATION BY OBSERVING SKIN TURGOR

OVER STERNUM AND INSPECTING FOR LONGITUDINAL FURROWS OF THE
TONGUE. WATCH FOR EXCESSIVE THIRST, FEVER, DIZZINESS,
LIGHTHEADEDNESS, PALPITATIONS, EXCESSIVE CRAMPING, BLOODY STOOLS,
HYPOTENSION, AND SYMPTOMS OF SHOCK. SEVERE DIARRHEA CAN CAUSE
DEFICIENT FLUID VOLUME WITH EXTREME WEAKNESS AND CAUSE DEATH IN
THE VERY YOUNG, THE CHRONICALLY ILL, AND THE ELDERLY. ENCOURAGED
PATIENT TO EAT SMALL, FREQUENT MEALS AND TO CONSUME FOODS THAT
NORMALLY CAUSE CONSTIPATION AND ARE EASY TO DIGEST. BLAND,
STARCHY FOODS ARE INITIALLY RECOMMENDED WHEN STARTING TO EAT
SOLID FOOD AGAIN. EDUCATED THE PATIENT OR CAREGIVER ABOUT THE
FOLLOWING DIETARY MEASURES TO CONTROL DIARRHEA: AVOID SPICY,
FATTY FOODS, ALCOHOL, AND CAFFEINE. BROIL, BAKE, OR BOIL FOODS;
AVOID FRYING. AVOID FOODS THAT ARE DISAGREEABLE. THESE DIETARY
CHANGES CAN SLOW THE PASSAGE OF STOOL THROUGH THE COLON AND
REDUCE OR ELIMINATE DIARRHEA.

EDUCATE ON CKD
INSTRUCTED PT. ON DISEASE PROCESS OF CHRONIC KIDNEY DISEASE.
CHRONIC KIDNEY DISEASE (CKD) MEANS YOUR KIDNEYS ARE DAMAGED AND
CAN’T FILTER BLOOD THE WAY THEY SHOULD. THE DISEASE IS CALLED
“CHRONIC” BECAUSE THE DAMAGE TO YOUR KIDNEYS HAPPENS SLOWLY
OVER A LONG PERIOD OF TIME. THIS DAMAGE CAN CAUSE WASTES TO BUILD
UP IN YOUR BODY. CKD CAN ALSO CAUSE OTHER HEALTH PROBLEMS. THE
KIDNEYS’ MAIN JOB IS TO FILTER EXTRA WATER AND WASTES OUT OF YOUR
BLOOD TO MAKE URINE. TO KEEP YOUR BODY WORKING PROPERLY, THE
KIDNEYS BALANCE THE SALTS AND MINERALS—SUCH AS CALCIUM,
PHOSPHORUS, SODIUM, AND POTASSIUM—THAT CIRCULATE IN THE BLOOD.
YOUR KIDNEYS ALSO MAKE HORMONES THAT HELP CONTROL BLOOD
PRESSURE, MAKE RED BLOOD CELLS, AND KEEP YOUR BONES STRONG.
KIDNEY DISEASE OFTEN CAN GET WORSE OVER TIME AND MAY LEAD TO
KIDNEY FAILURE. IF YOUR KIDNEYS FAIL, YOU WILL NEED DIALYSIS OR A
KIDNEY TRANSPLANT TO MAINTAIN YOUR HEALTH.

S&SX:
INSTRUCTED PT. ON SIGNS AND SYMPTOMS OF CHRONIC KIDNEY DISEASE.
OUR KIDNEYS HAVE A GREATER CAPACITY TO DO THEIR JOB THAN IS NEEDED
TO KEEP US HEALTHY. FOR EXAMPLE, YOU CAN DONATE ONE KIDNEY AND
REMAIN HEALTHY. YOU CAN ALSO HAVE KIDNEY DAMAGE WITHOUT ANY
SYMPTOMS BECAUSE, DESPITE THE DAMAGE, YOUR KIDNEYS ARE STILL
DOING ENOUGH WORK TO KEEP YOU FEELING WELL. FOR MANY PEOPLE, THE
ONLY WAY TO KNOW IF YOU HAVE KIDNEY DISEASE IS TO GET YOUR KIDNEYS
CHECKED WITH BLOOD AND URINE TESTS. AS KIDNEY DISEASE GETS WORSE,
A PERSON MAY HAVE SWELLING, CALLED EDEMA. EDEMA HAPPENS WHEN
THE KIDNEYS CAN’T GET RID OF EXTRA FLUID AND SALT. EDEMA CAN OCCUR
IN THE LEGS, FEET, OR ANKLES, AND LESS OFTEN IN THE HANDS OR FACE.
SYMPTOMS OF ADVANCED CKD: CHEST PAIN, DRY SKIN, ITCHING OR
NUMBNESS, FEELING TIRED, HEADACHES, INCREASED OR DECREASED
URINATION, LOSS OF APPETITE, MUSCLE CRAMPS, NAUSEA, SHORTNESS OF
BREATH, SLEEP PROBLEMS, TROUBLE CONCENTRATING, VOMITING, WEIGHT
LOSS. PEOPLE WITH CKD CAN ALSO DEVELOP ANEMIA, BONE DISEASE, AND
MALNUTRITION.

MANAGEMENT:
ENCOURAGED PT./PCG TO MONITOR FLUID STATUS. ASSESS FLUID STATUS
AND IDENTIFY POTENTIAL SOURCES OF IMBALANCE. ADVISED PT TO
IMPROVED NUTRITIONAL INTAKE. IMPLEMENT A DIETARY PROGRAM TO
ENSURE PROPER NUTRITIONAL INTAKE WITHIN THE LIMITS OF THE
TREATMENT REGIMEN. ENCOURAGED PT./PCG TO PROMOTE POSITIVE
FEELINGS BY ENCOURAGING INCREASED SELF-CARE AND GREATER
INDEPENDENCE. INSTRUCTED PT./PCG TO INREASE INTAKE OF PROTEIN.
PROMOTE INTAKE OF HIGH-BIOLOGIC –VALUE PROTEIN FOODS: EGGS, DAIRY
PRODUCTS, MEATS. ADVISED TO TAKE MEDICATIONS PROPERLY. ALTER
SCHEDULE OF MEDICATIONS SO THAT THEY ARE NOT GIVEN IMMEDIATELY
BEFORE MEALS. ENCOURAGED PT. TO REST. ENCOURAGED ALTERNATING
ACTIVITY WITH REST.

EDUCATE ON INSOMNIA
EDUCATED PATIENT ON THE PROPER FOOD AND FLUID INTAKE SUCH AS
AVOIDING HEAVY MEALS, ALCOHOL, CAFFEINE, OR SMOKING BEFORE
BEDTIME. HAVING FULL MEALS JUST BEFORE BEDTIME MAY PRODUCE
GASTROINTESTINAL UPSET AND HINDER SLEEP ONSET. COFFEE, TEA,
CHOCOLATE, AND COLAS WHICH CONTAIN CAFFEINE STIMULATE THE
NERVOUS SYSTEM. THIS MAY INTERFERE WITH THE PATIENT’S ABILITY TO
RELAX AND FALL ASLEEP. ALCOHOL PRODUCES DROWSINESS AND MAY
FACILITATE THE ONSET OF SLEEP BUT INTERFERES WITH REM SLEEP.
ENCOURAGED DAYTIME PHYSICAL ACTIVITIES BUT INSTRUCT THE PATIENT TO
AVOID STRENUOUS ACTIVITIES BEFORE BEDTIME. IN INSOMNIA, STRESS MAY
BE REDUCED BY THERAPEUTIC ACTIVITIES AND MAY PROMOTE SLEEP.
HOWEVER, STRENUOUS ACTIVITIES MAY LEAD TO FATIGUE AND MAY CAUSE
INSOMNIA.

 ENCOURAGED PATIENT TO TAKE MILK. L-TRYPTOPHAN IS A COMPONENT OF

MILK WHICH PROMOTES SLEEP. INSTRUCTED PATIENT TO FOLLOW A
CONSISTENT DAILY SCHEDULE FOR REST AND SLEEP. REMINDED THE
PATIENT TO AVOID TAKING A LARGE AMOUNT OF FLUIDS BEFORE BEDTIME.
THIS WILL REFRAIN THE PATIENT FROM GOING TO THE BATHROOM IN
BETWEEN SLEEP. SUGGESTED AN ENVIRONMENT CONDUCIVE TO REST OR
SLEEP. A LOT OF PEOPLE SLEEP BETTER IN COOL, DARK, QUIET
ENVIRONMENT. ENCOURAGED THE PATIENT TO PREVENT FROM THINKING
ABOUT NEXT DAY’S ACTIVITIES OR ANY DISTRACTING THOUGHTS AT BEDTIME.
PROVIDING A DESIGNATED TIME FOR THESE CONCERNS ALLOWS THE
PATIENT TO “LET GO” OF THESE PROBLEMS AT BEDTIME.

EDUCATE ON HEMATURIA OR URINARY RETENTION

ENCOURAGED PT TO TAKE ADEQUATE FLUID INTAKE (2–4 L PER DAY),
AVOIDING CAFFEINE AND USE OF ASPARTAME, AND LIMITING INTAKE DURING
LATE EVENING AND AT BEDTIME. RECOMMEND USE OF CRANBERRY
JUICE/VITAMIN C. SUFFICIENT HYDRATION PROMOTES URINARY OUTPUT AND
AIDS IN PREVENTING INFECTION. NOTE: WHEN PATIENT IS TAKING SULFA
DRUGS, SUFFICIENT FLUIDS ARE NECESSARY TO ENSURE ADEQUATE
EXCRETION OF DRUG, REDUCING RISK OF CUMULATIVE EFFECTS. NOTE:
ASPARTAME, A SUGAR SUBSTITUTE (E.G., NUTRASWEET), MAY CAUSE
BLADDER IRRITATION LEADING TO BLADDER DYSFUNCTION. INSTRUCTED
PT./PCG TO OBSERVE FOR CLOUDY OR BLOODY URINE, FOUL ODOR. DIPSTICK
URINE AS INDICATED. SIGNS OF URINARY TRACT OR KIDNEY INFECTION THAT
CAN POTENTIATE SEPSIS. MULTISTRIP DIPSTICKS CAN PROVIDE A QUICK
DETERMINATION OF PH, NITRITE, AND LEUKOCYTE ESTERASE SUGGESTING
PRESENCE OF INFECTION.

ADVISED PT./PCG TO PROMOTE CONTINUED MOBILITY. THIS DECREASES RISK

OF DEVELOPING UTI. ADVISED PT TO CLEANSE PERINEAL AREA AND KEEP
DRY. PROVIDE CATHETER CARE AS APPROPRIATE. PROPER PERINEAL
HYGIENE DECREASES RISK OF SKIN IRRITATION OR BREAKDOWN AND
DEVELOPMENT OF ASCENDING INFECTION. INSTRUCTED PT. TO DO GOOD
HAND WASHING AND PROPER PERINEAL CARE. HANDWASHING AND PERINEAL
CARE REDUCE SKIN IRRITATION AND RISK OF ASCENDING INFECTION.

EDUCATION ON ANEMIA
INSTRUCTED ON THE DISEASE PROCESS OF ANEMIA. ANEMIA IS A CONDITION
IN WHICH YOU LACK ENOUGH HEALTHY RED BLOOD CELLS TO CARRY
ADEQUATE OXYGEN TO YOUR BODY'S TISSUES. HAVING ANEMIA CAN MAKE
YOU FEEL TIRED AND WEAK. THERE ARE MANY FORMS OF ANEMIA, EACH
WITH ITS OWN CAUSE. ANEMIA CAN BE TEMPORARY OR LONG TERM, AND IT
CAN RANGE FROM MILD TO SEVERE. SEE YOUR DOCTOR IF YOU SUSPECT
THAT YOU HAVE ANEMIA. IT CAN BE A WARNING SIGN OF SERIOUS ILLNESS.
TREATMENTS FOR ANEMIA RANGE FROM TAKING SUPPLEMENTS TO
UNDERGOING MEDICAL PROCEDURES. YOU MIGHT BE ABLE TO PREVENT
SOME TYPES OF ANEMIA BY EATING A HEALTHY, VARIED DIET.

S&SX:
EDUCATED ON THE SIGNS AND SYMPTOMS OF ANEMIA. ANEMIA SIGNS AND
SYMPTOMS VARY DEPENDING ON THE CAUSE. IF THE ANEMIA IS CAUSED BY A
CHRONIC DISEASE, THE DISEASE CAN MASK THEM, SO THAT THE ANEMIA
MIGHT BE DETECTED BY TESTS FOR ANOTHER CONDITION. DEPENDING ON
THE CAUSES OF YOUR ANEMIA, YOU MIGHT HAVE NO SYMPTOMS. SIGNS AND
SYMPTOMS, IF THEY DO OCCUR, MIGHT INCLUDE: FATIGUE, WEAKNESS, PALE
OR YELLOWISH SKIN, IRREGULAR HEARTBEATS, SHORTNESS OF BREATH,
DIZZINESS OR LIGHTHEADEDNESS, CHEST PAIN, COLD HANDS AND FEET,
HEADACHES. AT FIRST, ANEMIA CAN BE SO MILD THAT YOU DON'T NOTICE IT.
BUT SYMPTOMS WORSEN AS ANEMIA WORSENS.

MANAGEMENT:
ADVISED PT./PCG TO HAVE QUIET ATMOSPHERE, BED REST TO ENHANCE
REST TO LOWER BODY’S OXYGEN REQUIREMENTS, AND REDUCES STRAIN ON
THE HEART AND LUNGS. ENCOURAGED TO ELEVATE THE HEAD OF THE BED
AS TOLERATED TO ENHANCE LUNG EXPANSION TO MAXIMIZE OXYGENATION
FOR CELLULAR UPTAKE. INSTRUCTED PCG TO PROVIDE OR RECOMMEND
ASSISTANCE WITH ACTIVITIES OR AMBULATION AS NECESSARY, ALLOWING
PT. TO DO AS MUCH AS POSSIBLE TO ENHANCE SELF ESTEEM. ENCOURAGED
PT./PCG TO IMPLEMENT ENERGY SAVING TECHNIQUE LIKE SITTING WHILE
DOING A TASK.

EDUCATION ON INFECTION
ADVISED PT./PCG TO MAINTAIN ASEPSIS FOR DRESSING CHANGES AND
WOUND CARE, PERIPHERAL IV AND CENTRAL VENOUS MANAGEMENT, AND
CATHETER CARE AND HANDLING. ASEPTIC TECHNIQUE DECREASES THE
CHANGES OF TRANSMITTING OR SPREADING PATHOGENS TO THE PATIENT.
INTERRUPTING THE TRANSMISSION OF INFECTION ALONG THE CHAIN OF
INFECTION IS AN EFFECTIVE WAY TO PREVENT INFECTION. INSTRUCTED
PT./PCG TO WASH HANDS AND TEACH PATIENT AND SO TO WASH HANDS
BEFORE CONTACT WITH PATIENTS AND BETWEEN PROCEDURES WITH THE
PATIENT.INSTANCES WHEN TO WASH HANDS: BEFORE PUTTING ON GLOVES
AND AFTER TAKING THEM OFF. BEFORE AND AFTER TOUCHING A PATIENT,
BEFORE HANDLING AN INVASIVE DEVICE (FOLEY CATHETER, IV CATHETER,
AND SO ON) REGARDLESS OF WHETHER OR NOT GLOVES ARE USED. AFTER
CONTACT WITH BODY FLUIDS OR EXCRETIONS, MUCOUS MEMBRANES,
NONINTACT SKIN, OR WOUND DRESSINGS. IF MOVING FROM CONTAMINATED
BODY SITE TO ANOTHER SITE DURING THE CARE OF THE SAME INDIVIDUAL.
AFTER CONTACT WITH INANIMATE SURFACES AND OBJECTS IN THE
IMMEDIATE VICINITY OF THE PATIENT. AFTER REMOVING STERILE OR
NONSTERILE GLOVES. BEFORE HANDLING MEDICATIONS OR PREPARING
FOOD. FRICTION AND RUNNING WATER EFFECTIVELY REMOVE
MICROORGANISMS FROM HANDS. WASHING BETWEEN PROCEDURES
REDUCES THE RISK OF TRANSMITTING PATHOGENS FROM ONE AREA OF THE
BODY TO ANOTHER. WASH HANDS WITH ANTISEPTIC SOAP AND WATER FOR
AT LEAST 15 SECONDS FOLLOWED BY ALCOHOL-BASED HAND RUB. IF HANDS
WERE NOT IN CONTACT WITH ANYONE OR ANYTHING IN THE ROOM, USE AN
ALCOHOL-BASED HAND RUB AND RUB UNTIL DRY. PLAIN SOAP IS GOOD AT
REDUCING BACTERIAL COUNTS BUT ANTIMICROBIAL SOAP IS BETTER, AND
ALCOHOL-BASED HAND RUBS ARE THE BEST.

ENCOURAGED PT TO INTAKE OF PROTEIN-RICH AND CALORIE-RICH FOODS.

HELPS SUPPORT THE IMMUNE SYSTEM RESPONSIVENESS. ENCOURAGED PT.
ON FLUID INTAKE OF 2,000 TO 3,000 ML OF WATER PER DAY, UNLESS
CONTRAINDICATED. FLUIDS PROMOTE DILUTED URINE AND FREQUENT
EMPTYING OF BLADDER – REDUCING THE STASIS OF URINE, IN TURN,
REDUCES RISK FOR BLADDER INFECTION OR URINARY TRACT INFECTION.
ENCOURAGED COUGHING AND DEEP BREATHING EXERCISES; FREQUENT
POSITION CHANGES. HELPS REDUCE STASIS OF SECRETIONS IN THE LUNGS
AND THE BRONCHIAL TREE. WHEN STASIS OCCURS, PATHOGENS CAN CAUSE
UPPER RESPIRATORY TRACT INFECTIONS AND PNEUMONIA. ENCOURAGED
PT./PCG TO LIMIT VISITORS. RESTRICTING VISITATION REDUCES THE
TRANSMISSION OF PATHOGENS.

----------------------------------------------------------------------------------------
EDUCATION ON OA
INSTRUCTED PATIENT ON THE DISEASE PROCESS OF OSTEOARTHRITIS. 
OSTEOARTHRITIS IS A DEGENERATIVE, NON-INFLAMMATORY JOINT DISEASE.
THE CARTILAGE THAT PROTECTS THE ENDS OF BONES IS WORN AWAY. IT
CAN AFFECT ALL MOBILE JOINTS, ESPECIALLY WEIGHT-BEARING JOINTS: HIP,
KNEE, AND SPINAL COLUMN.  INSTRUCTED ON FACTORS THAT MAY INCREASE
RISK OF OSTEOARTHRITIS SUCH AS ADVANCED AGE, TRAUMA, OVERUSE OF
JOINTS, GENETIC TENDENCY, OBESITY, METABOLIC OR ENDOCRINE
ABNORMALITIES.

S&SX :
INSTRUCTED ON SIGNS AND SYMPTOMS OF OSTEOARTHRITIS SUCH AS
ACHING PAIN THAT INCREASES WITH ACTIVITY AND IS USUALLY RELIEVED
WITH REST, STIFFNESS ON RISING, HEBERDEN’S NODES (NODULAR BONY
ENLARGEMENTS WITHIN THE JOINT), FATIGUE, DECREASED EXERCISE
TOLERANCE, CREPITUS (CREAKING OR GRATING UPON JOINT MOVEMENT),
RESTRICTION OF JOINT MOVEMENT.  
MANAGEMENT:
EDUCATED ON MANAGEMENT OF OA. THERE IS NO CURE FOR
OSTEOARTHRITIS. MILD TO MODERATE SYMPTOMS ARE USUALLY WELL
MANAGED BY A COMBINATION OF PHARMACOLOGIC AND NON-
PHARMACOLOGIC TREATMENTS. MEDICAL TREATMENTS AND
RECOMMENDATIONS INCLUDE: MEDICATIONS (TOPICAL PAIN MEDICINES AND
ORAL ANALGESICS INCLUDING NONSTEROIDAL ANTI-INFLAMMATORY
MEDICATIONS, NSAIDS), EXERCISE (LAND- AND WATER-BASED, INTERMITTENT
HOT AND COLD PACKS (LOCAL MODALITIES), PHYSICAL, OCCUPATIONAL, AND
EXERCISE THERAPY, WEIGHT LOSS (IF OVERWEIGHT), HEALTHY EATING,
MANAGING DIABETES AND CHOLESTEROL, SUPPORTIVE DEVICES SUCH AS
BRACES, ORTHOTICS, SHOE INSERTS, CANE, OR WALKER, INTRA-ARTICULAR
INJECTION THERAPIES (STEROID, HYALURONIC ACID “GEL”),
COMPLEMENTARY AND ALTERNATIVE MEDICINE STRATEGIES, INCLUDING
VITAMINS AND SUPPLEMENTS. SURGERY MAY BE HELPFUL TO RELIEVE PAIN
AND RESTORE FUNCTION WHEN OTHER MEDICAL TREATMENTS ARE
INEFFECTIVE OR HAVE BEEN EXHAUSTED, ESPECIALLY WITH ADVANCED OA.
THE GOALS OF TREATMENT ARE TO: DECREASE JOINT PAIN AND STIFFNESS
AND DELAY FURTHER PROGRESSION, IMPROVE MOBILITY AND FUNCTION,
INCREASE PATIENTS' QUALITY OF LIFE. THE TYPE OF TREATMENT REGIMEN
PRESCRIBED DEPENDS ON MANY FACTORS, INCLUDING THE PATIENT'S AGE,
OVERALL HEALTH, ACTIVITIES, OCCUPATION, AND SEVERITY OF THE
CONDITION.

EDUCATION ON HTN
INSTRUCTED PATIENT ON THE DISEASE PROCESS OF HTN.  BLOOD PRESSURE
IS THE FORCE OF YOUR BLOOD PUSHING AGAINST THE WALLS OF YOUR
ARTERIES. EACH TIME YOUR HEART BEATS, IT PUMPS BLOOD INTO THE
ARTERIES. YOUR BLOOD PRESSURE IS HIGHEST WHEN YOUR HEART BEATS,
PUMPING THE BLOOD. THIS IS CALLED SYSTOLIC PRESSURE. WHEN YOUR
HEART IS AT REST, BETWEEN BEATS, YOUR BLOOD PRESSURE FALLS. THIS IS
CALLED DIASTOLIC PRESSURE. YOUR BLOOD PRESSURE READING USES
THESE TWO NUMBERS. USUALLY THE SYSTOLIC NUMBER COMES BEFORE OR
ABOVE THE DIASTOLIC NUMBER. A READING OF 119/79 OR LOWER IS NORMAL
BLOOD PRESSURE140/90 OR HIGHER IS HIGH BLOOD PRESSURE. BETWEEN
120 AND 139 FOR THE TOP NUMBER, OR BETWEEN 80 AND 89 FOR THE
BOTTOM NUMBER IS CALLED PREHYPERTENSION. PREHYPERTENSION MEANS
YOU MAY END UP WITH HIGH BLOOD PRESSURE, UNLESS YOU TAKE STEPS TO
PREVENT IT. HIGH BLOOD PRESSURE USUALLY HAS NO SYMPTOMS, BUT IT
CAN CAUSE SERIOUS PROBLEMS SUCH AS STROKE, HEART FAILURE, HEART
ATTACK AND KIDNEY FAILURE. YOU CAN CONTROL HIGH BLOOD PRESSURE
THROUGH HEALTHY LIFESTYLE HABITS AND TAKING MEDICINES, IF NEEDED.
S&SX:
INSTRUCTED ON SIGNS AND SYMPTOMS OF HTN SUCH AS DIZZINESS,
HEADACHES, OFTEN DESCRIBED AS THROBBING OR POUNDING,
PALPITATIONS, BLURRING OF VISION, FATIGUE, NOSEBLEEDS, INSOMNIA,
NERVOUSNESS, CHEST PAIN (ANGINA), SHORTNESS OF BREATH (DYSPNEA). 
INSTRUCTED ON FACTORS THAT INCREASE RISK SUCH AS AGE (PERSONS
OLDER THAN 35 YEARS), BLACK, CLOSE BLOOD RELATIVE WITH
HYPERTENSION, OVERWEIGHT, STRESS, HIGH SODIUM INTAKE, HIGH
CHOLESTEROL INTAKE, ORAL CONTRACEPTIVES, CIGARETTE SMOKING,
EXCESSIVE ALCOHOL USE, HISTORY OF DIABETES, GOUT, OR KIDNEY
DISEASE, SEDENTARY LIFESTYLE.

MANAGEMENT:
INSTRUCTED ON MEASURES TO CONTROL HYPERTENSION SUCH AS MONITOR
BLOOD PRESSURE AT HOME, AND KNOW WHAT IT SHOULD BE. TAKE
MEDICATION EXACTLY AS PRESCRIBED. LIFESTYLE CHANGES TO REDUCE
STRESS. EAT BALANCED MEALS LOW IN SATURATED FAT, CHOLESTEROL, AND
SODIUM. STOP SMOKING. LOSE WEIGHT IF OVERWEIGHT. AVOID ORAL
CONTRACEPTIVES. AVOID ALCOHOL. HAVE REGULAR MEDICAL CHECKUPS.
AVOID OVER-THE-COUNTER MEDICATIONS UNLESS RECOMMENDED BY
PHYSICIAN.  EXERCISE REGULARLY.  USE MEDIC ALERT CARDS/BRACELET. 
INSTRUCTED ON POSSIBLE COMPLICATIONS SUCH AS MYOCARDIAL
INFARCTION, HEART FAILURE, STROKE, KIDNEY FAILURE, MALIGNANT
HYPERTENSION.

EDUCATION ATHEROSCLEROSIS
PATIENT INSTRUCTED ON ATHEROSCLEROSIS.  ATHEROSCLEROSIS IS A
DISEASE IN WHICH PLAQUE BUILDS UP INSIDE YOUR ARTERIES. PLAQUE IS A
STICKY SUBSTANCE MADE UP OF FAT, CHOLESTEROL, CALCIUM, AND OTHER
SUBSTANCES FOUND IN THE BLOOD. OVER TIME, PLAQUE HARDENS AND
NARROWS YOUR ARTERIES. THAT LIMITS THE FLOW OF OXYGEN-RICH BLOOD
TO YOUR BODY. ATHEROSCLEROSIS CAN LEAD TO SERIOUS PROBLEMS,
INCLUDING: CORONARY ARTERY DISEASE. THESE ARTERIES SUPPLY BLOOD
TO YOUR HEART. WHEN THEY ARE BLOCKED, YOU CAN SUFFER ANGINA OR A
HEART ATTACK. CAROTID ARTERY DISEASE. THESE ARTERIES SUPPLY BLOOD
TO YOUR BRAIN. WHEN THEY ARE BLOCKED YOU CAN SUFFER A STROKE.
PERIPHERAL ARTERIAL DISEASE. THESE ARTERIES ARE IN YOUR ARMS, LEGS
AND PELVIS. WHEN THEY ARE BLOCKED, YOU CAN SUFFER FROM NUMBNESS,
PAIN AND SOMETIMES INFECTIONS. ATHEROSCLEROSIS USUALLY DOESN'T
CAUSE SYMPTOMS UNTIL IT SEVERELY NARROWS OR TOTALLY BLOCKS AN
ARTERY. MANY PEOPLE DON'T KNOW THEY HAVE IT UNTIL THEY HAVE A
MEDICAL EMERGENCY. A PHYSICAL EXAM, IMAGING, AND OTHER DIAGNOSTIC
TESTS CAN TELL IF YOU HAVE IT. MEDICINES CAN SLOW THE PROGRESS OF
PLAQUE BUILDUP. YOUR DOCTOR MAY ALSO RECOMMEND PROCEDURES
SUCH AS ANGIOPLASTY TO OPEN THE ARTERIES, OR SURGERY ON THE
CORONARY OR CAROTID ARTERIES. LIFESTYLE CHANGES CAN ALSO HELP.
THESE INCLUDE FOLLOWING A HEALTHY DIET, GETTING REGULAR EXERCISE,
MAINTAINING A HEALTHY WEIGHT, QUITTING SMOKING, AND MANAGING
STRESS.

S&SX:
INSTRUCTED PT. ON SIGNS AND SYMPTOMS OF ATHEROSCLEROSIS. MOST
SYMPTOMS OF ATHEROSCLEROSIS DON’T SHOW UP UNTIL A BLOCKAGE
OCCURS. COMMON SYMPTOMS INCLUDE: CHEST PAIN OR ANGINA, PAIN IN
YOUR LEG, ARM, AND ANYWHERE ELSE THAT HAS A BLOCKED ARTERY,
SHORTNESS OF BREATH, FATIGUE, CONFUSION, WHICH OCCURS IF THE
BLOCKAGE AFFECTS CIRCULATION TO YOUR BRAIN, MUSCLE WEAKNESS IN
YOUR LEGS FROM LACK OF CIRCULATION. IT’S ALSO IMPORTANT TO KNOW
THE SYMPTOMS OF HEART ATTACK AND STROKE. BOTH OF THESE CAN BE
CAUSED BY ATHEROSCLEROSIS AND REQUIRE IMMEDIATE MEDICAL
ATTENTION.THE SYMPTOMS OF A HEART ATTACK INCLUDE: CHEST PAIN OR
DISCOMFORT, PAIN IN THE SHOULDERS, BACK, NECK, ARMS, AND JAW,
ABDOMINAL PAIN, SHORTNESS OF BREATH, PERSPIRATION,
LIGHTHEADEDNESS, NAUSEA OR VOMITING, A SENSE OF IMPENDING DOOM.
THE SYMPTOMS OF STROKE INCLUDE: WEAKNESS OR NUMBNESS IN THE
FACE OR LIMBS, TROUBLE SPEAKING, TROUBLE UNDERSTANDING SPEECH,
VISION PROBLEMS, LOSS OF BALANCE, SUDDEN, SEVERE HEADACHE. HEART
ATTACK AND STROKE ARE BOTH MEDICAL EMERGENCIES. CALL 911 OR YOUR
LOCAL EMERGENCY SERVICES AND GET TO A HOSPITAL’S EMERGENCY ROOM
AS SOON AS POSSIBLE IF YOU EXPERIENCE SYMPTOMS OF A HEART ATTACK
OR STROKE.

MANAGEMENT:
INSTRUCTED ON MANAGEMENT AND TREATMENTS OF ATHEROSCLEROSIS.
TREATMENTS FOR ATHEROSCLEROSIS MAY INCLUDE HEART-HEALTHY
LIFESTYLE CHANGES, MEDICINES, AND MEDICAL PROCEDURES OR SURGERY.
THE GOALS OF TREATMENT INCLUDE: LOWERING THE RISK OF BLOOD CLOTS
FORMING, PREVENTING ATHEROSCLEROSIS-RELATED DISEASES, REDUCING
RISK FACTORS IN AN EFFORT TO SLOW OR STOP THE BUILDUP OF PLAQUE,
RELIEVING SYMPTOMS, WIDENING OR BYPASSING PLAQUE-CLOGGED
ARTERIES, HEART-HEALTHY LIFESTYLE CHANGES. YOUR DOCTOR MAY
RECOMMEND HEART-HEALTHY LIFESTYLE CHANGES IF YOU HAVE
ATHEROSCLEROSIS. HEART-HEALTHY LIFESTYLE CHANGES INCLUDE HEART-
HEALTHY EATING, AIMING FOR A HEALTHY WEIGHT, MANAGING STRESS,
PHYSICAL ACTIVITY AND QUITTING SMOKING. SOMETIMES LIFESTYLE
CHANGES ALONE AREN’T ENOUGH TO CONTROL YOUR CHOLESTEROL
LEVELS. FOR EXAMPLE, YOU ALSO MAY NEED STATIN MEDICATIONS TO
CONTROL OR LOWER YOUR CHOLESTEROL. BY LOWERING YOUR BLOOD
CHOLESTEROL LEVEL, YOU CAN DECREASE YOUR CHANCE OF HAVING A
HEART ATTACK OR STROKE. DOCTORS USUALLY PRESCRIBE STATINS FOR
PEOPLE WHO HAVE: CORONARY HEART DISEASE, PERIPHERAL ARTERY
DISEASE, OR HAD A PRIOR STROKE, DIABETES, HIGH LDL CHOLESTEROL
LEVELS. DOCTORS MAY DISCUSS BEGINNING STATIN TREATMENT WITH
PEOPLE WHO HAVE AN ELEVATED RISK FOR DEVELOPING HEART DISEASE OR
HAVING A STROKE. YOUR DOCTOR ALSO MAY PRESCRIBE OTHER
MEDICATIONS TO: LOWER YOUR BLOOD PRESSURE, LOWER YOUR BLOOD
SUGAR LEVELS, PREVENT BLOOD CLOTS, WHICH CAN LEAD TO HEART
ATTACK AND STROKE, PREVENT INFLAMMATION. TAKE ALL MEDICINES
REGULARLY, AS YOUR DOCTOR PRESCRIBES. DON’T CHANGE THE AMOUNT
OF YOUR MEDICINE OR SKIP A DOSE UNLESS YOUR DOCTOR TELLS YOU TO.
YOU SHOULD STILL FOLLOW A HEART HEALTHY LIFESTYLE, EVEN IF YOU TAKE
MEDICINES TO TREAT YOUR ATHEROSCLEROSIS.

EDUCATION ON ASTHMA
INSTRUCTED PATIENT ON THE DISEASE PROCESS OF ASTHMA. ASTHMA IS A
CONDITION MARKED BY RECURRENT ATTACKS OF DYSPNEA, WITH AIRWAY
INFLAMMATION AND WHEEZING DUE TO SPASMODIC CONSTRICTION OF THE
BRONCHI; IT IS ALSO KNOWN AS BRONCHIAL ASTHMA. ATTACKS VARY
GREATLY FROM OCCASIONAL PERIODS OF WHEEZING AND SLIGHT DYSPNEA
TO SEVERE ATTACKS THAT ALMOST CAUSE SUFFOCATION. AN ACUTE ATTACK
THAT LASTS FOR SEVERAL DAYS IS CALLED STATUS ASTHMATICUS; THIS IS A
MEDICAL EMERGENCY THAT CAN BE FATAL. INSTRUCTED PATIENT ON THE
CAUSES OF ASTHMA. ASTHMA CAN BE CLASSIFIED INTO THREE TYPES
ACCORDING TO CAUSATIVE FACTORS. ALLERGIC OR ATOPIC ASTHMA
(SOMETIMES CALLED EXTRINSIC ASTHMA) IS DUE TO AN ALLERGY TO
ANTIGENS; USUALLY THE OFFENDING ALLERGENS ARE SUSPENDED IN THE
AIR IN THE FORM OF POLLEN, DUST, SMOKE, AUTOMOBILE EXHAUST, OR
ANIMAL DANDER. MORE THAN HALF OF THE CASES OF ASTHMA IN CHILDREN
AND YOUNG ADULTS ARE OF THIS TYPE. INTRINSIC ASTHMA IS USUALLY
SECONDARY TO CHRONIC OR RECURRENT INFECTIONS OF THE BRONCHI,
SINUSES, OR TONSILS AND ADENOIDS. THERE IS EVIDENCE THAT THIS TYPE
DEVELOPS FROM A HYPERSENSITIVITY TO THE BACTERIA OR, MORE
COMMONLY, VIRUSES CAUSING THE INFECTION. ATTACKS CAN BE
PRECIPITATED BY INFECTIONS, EMOTIONAL FACTORS, AND EXPOSURE TO
NONSPECIFIC IRRITANTS. THE THIRD TYPE OF ASTHMA, MIXED, IS DUE TO A
COMBINATION OF EXTRINSIC AND INTRINSIC FACTORS.

FACTORS THAT MAY PRECIPITATE AN ATTACK OF ASTHMA:

WEEKLY HEAD TO TOE ASSESSMENT PERFORMED. SKIN IS WARM AND
INTACT. NO FALLS OR INJURIES REPORTED AT THIS VISIT. INSTRUCTED ON
FACTORS THAT MAY PRECIPITATE AN ATTACK OF ASTHMA SUCH AS
ALLERGENS, SUCH AS POLLENS, ANIMAL DANDER, OR MOLD. COCKROACHES
AND DUST MITES. AIR POLLUTION AND IRRITANTS. SMOKE. STRONG ODORS
OR SCENTED PRODUCTS OR CHEMICALS. RESPIRATORY INFECTIONS AND/OR
SINUSITIS. PHYSICAL EXERCISE. STRONG EMOTIONS AND STRESS. COLD AIR.
CERTAIN MEDICATIONS. PRESERVATIVES AND CHEMICALS ADDED TO
PERISHABLE FOODS. GASTROESOPHAGEAL REFLUX DISEASE (GERD). 
INSTRUCTED ON WARNING SIGNS AND SYMPTOMS SUCH AS WHEEZING,
COUGHING, SHORTNESS OF BREATH, CHEST TIGHTNESS OR PAIN, DISTURBED
SLEEP CAUSED BY SHORTNESS YTOF BREATH, COUGHING, OR WHEEZING,
INCREASED NEED TO USE BRONCHODILATORS, CHANGES IN LUNG FUNCTION
AS MEASURED BY A PEAK FLOW METER, CHILDREN OFTEN PRESENT WITH
AUDIBLE WHEEZING OR WHISTLING SOUND WHEN EXHALING, FREQUENT
COUGHING SPASMS.

MANAGEMENT OF ASTHMA:
INSTRUCTED ON MEASURES TO MANAGE ASTHMA SUCH AS IDENTIFY AND
AVOID PRECIPITATING FACTORS AND WARNING SIGNS. TAKE LONG-TERM
MEDICATIONS THAT ARE ORDERED TO CONTROL CHRONIC SYMPTOMS AND
PREVENT ATTACKS. QUICK RELIEF MEDICATIONS ARE ORDERED FOR RAPID,
SHORT-TERM RELIEF OF SYMPTOMS. OTHER MEDICATIONS ARE ORDERED TO
DECREASE SENSITIVITY TO ALLERGENS AND PREVENT REACTION TO THE
ALLERGENS. BE CAREFUL TO KEEP EXTRA MEDICATION ON HAND. KEEP
EMERGENCY MEDICATION AVAILABLE WITH YOU IN CASE OF ASTHMA ATTACK.
AVOID ASPIRIN AND OVER-THE-COUNTER DRUGS THAT CONTAIN ASPIRIN.
PREVENT UPPER-RESPIRATORY INFECTIONS: AVOID EXPOSURE TO PERSONS
WITH RESPIRATORY INFECTIONS. AVOID CROWDS AND POORLY VENTILATED
AREAS. OBTAIN IMMUNIZATION AGAINST INFLUENZA AND PNEUMONIA.
REPORT EARLY SIGNS OF INFECTION (I.E., INCREASED COUGH, SHORTNESS
OF BREATH, FEVER, AND CHILLS). EAT A WELL-BALANCED DIET. DRINK 2 TO 3
QUARTS OF FLUID EACH DAY TO LIQUEFY SECRETIONS. USE STRESS-
MANAGEMENT TECHNIQUES. EXERCISE DAILY, AVOIDING OVEREXERTION.
AVOID EXERCISE IN COLD TEMPERATURES. OBTAIN ALLERGY SHOTS AS
RECOMMENDED.  

HOW TO USE AN INHALER:

WEEKLY ASSESSMENT WAS DONE, NO ACUTE DISTRESS WAS NOTED OR
REPORTED AT THE VISIT, PATIENT  EDUCATED ON THE USE OF INHALER. IT IS
BRONCHODILATOR THAT RELAXES MUSCLES IN THE AIRWAYS TO IMPROVE
BREATHING. SHAKE THE INHALER FOR AT LEAST 5 SECONDS BEFORE EACH
SPRAY. AVOID BEING NEAR PEOPLE WHO ARE SICK OR HAVE INFECTIONS.  
SOME OF THE MINOR SIDE EFFECTS ARE HEADACHE, NAUSEA, VOMITING,
DIARRHEA, UPSET STOMACH,BACK PAIN, STUFFY NOSE, MUSCLE OR JOINT
PAIN, CHANGES IN YOUR VOICE. (TEMPORARY). INFORM TO HCP IF
EXPERIENCING THE SIDE EFFECTS. NOT TO STOP TAKING MEDICATION ITS
OWN. AVOID BEING IN THE CROWDED AREAS TO PREVENT INFECTION.  ALSO
EMPHASIZED IF SEVERE SOB OCCURS SEEK IMMEDIATE MEDICAL ADVISE.    
EDUCATION ON GOUT
INSTRUCTED PATIENT ON DISEASE PROCESS OF GOUT.  GOUT IS A COMMON,
PAINFUL FORM OF ARTHRITIS. IT CAUSES SWOLLEN, RED, HOT AND STIFF
JOINTS. GOUT HAPPENS WHEN URIC ACID BUILDS UP IN YOUR BODY. URIC
ACID COMES FROM THE BREAKDOWN OF SUBSTANCES CALLED PURINES.
PURINES ARE IN YOUR BODY'S TISSUES AND IN FOODS, SUCH AS LIVER,
DRIED BEANS AND PEAS, AND ANCHOVIES. NORMALLY, URIC ACID DISSOLVES
IN THE BLOOD. IT PASSES THROUGH THE KIDNEYS AND OUT OF THE BODY IN
URINE. BUT SOMETIMES URIC ACID CAN BUILD UP AND FORM NEEDLE-LIKE
CRYSTALS. WHEN THEY FORM IN YOUR JOINTS, IT IS VERY PAINFUL. THE
CRYSTALS CAN ALSO CAUSE ASTSTONES. OFTEN, GOUT FIRST ATTACKS
YOUR BIG TOE. IT CAN ALSO ATTACK ANKLES, HEELS, KNEES, WRISTS,
FINGERS, AND ELBOWS. AT FIRST, GOUT ATTACKS USUALLY GET BETTER IN
DAYS. EVENTUALLY, ATTACKS LAST LONGER AND HAPPEN MORE OFTEN. YOU
ARE MORE LIKELY TO GET GOUT IF YOU ARE A MAN, HAVE FAMILY MEMBER
WITH GOUT, ARE OVERWEIGHT, DRINK ALCOHOL. EAT TOO MANY FOODS RICH
IN PURINES. GOUT CAN BE HARD TO DIAGNOSE. YOUR DOCTOR MAY TAKE A
SAMPLE OF FLUID FROM AN INFLAMED JOINT TO LOOK FOR CRYSTALS. YOU
CAN TREAT GOUT WITH MEDICINES.

MANAGEMENT OF GOUT:
INSTRUCTED PATIENT ON THE MEASURES TO PREVENT GOUT. MEDICATIONS
ARE THE MOST PROVEN, EFFECTIVE WAY TO TREAT GOUT SYMPTOMS.
HOWEVER, MAKING CERTAIN LIFESTYLE CHANGES ALSO MAY HELP, SUCH AS:
LIMITING ALCOHOLIC BEVERAGES AND DRINKS SWEETENED WITH FRUIT
SUGAR (FRUCTOSE). INSTEAD, DRINK PLENTY OF NONALCOHOLIC
BEVERAGES, ESPECIALLY WATER. LIMIT INTAKE OF FOODS HIGH IN PURINES,
SUCH AS RED MEAT, ORGAN MEATS AND SEAFOOD. EXERCISING REGULARLY
AND LOSING WEIGHT. KEEPING YOUR BODY AT A HEALTHY WEIGHT REDUCES
YOUR RISK OF GOUT.  AVOID MEATS SUCH AS LIVER, KIDNEY AND
SWEETBREADS, WHICH HAVE HIGH PURINE LEVELS AND CONTRIBUTE TO
HIGH BLOOD LEVELS OF URIC ACID. SELECTED SEAFOOD. AVOID THE
FOLLOWING TYPES OF SEAFOOD, WHICH ARE HIGHER IN PURINES THAN
OTHERS: ANCHOVIES, HERRING, SARDINES, MUSSELS, SCALLOPS, TROUT,
HADDOCK, MACKEREL AND TUNA. ALCOHOL.

EDUCATION ON CVA (CEREBROVASCULAR

ACCIDENT)
PATIENT EDUCATED ON THE CVA. DAMAGE FROM A STROKE DEPENDS ON THE
LOCATION OF THE BLOCKAGE AND THE EXTENT OF TISSUE DAMAGE IT IS
CAUSED BY A TEMPORARY DECREASE IN BLOOD SUPPLY (OXYGEN) TO A
PART OF THE BRAIN. SIGNS AND SYMPTOMS VARY DEPENDING ON THE AREA
OF THE BRAIN AFFECTED. INSTRUCTED PATIENT TO SEEK IMMEDIATE
MEDICAL ADVICE IF, SUDDEN NUMBNESS, WEAKNESS, OR PARALYSIS OF
FACE, ARM, OR LEG (USUALLY ONLY ON ONE SIDE OF THE BODY) SUDDEN
BLURRED, DOUBLE, OR DECREASED VISION, SUDDEN DIFFICULTY SPEAKING
OR UNDERSTANDING SPEECH, SUDDEN DIZZINESS AND LOSS OF BALANCE OR
COORDINATION, CONFUSION OR PROBLEMS WITH MEMORY, SUDDEN SEVERE
AND UNUSUAL HEADACHE WITH STIFF NECK, FACIAL PAIN, VOMITING, OR
ALTERED CONSCIOUSNESS.

EDUCATION ON DM
INSTRUCTED PATIENT ON THE DISEASE PROCESS OF DIABETES.  DIABETES
MEANS YOUR BLOOD GLUCOSE, OR BLOOD SUGAR, LEVELS ARE TOO HIGH.
WITH TYPE 2 DIABETES, THE MORE COMMON TYPE, YOUR BODY DOES NOT
MAKE OR USE INSULIN WELL. INSULIN IS A HORMONE THAT HELPS GLUCOSE
GET INTO YOUR CELLS TO GIVE THEM ENERGY. WITHOUT INSULIN, TOO MUCH
GLUCOSE STAYS IN YOUR BLOOD. OVER TIME, HIGH BLOOD GLUCOSE CAN
LEAD TO SERIOUS PROBLEMS WITH YOUR HEART, EYES, KIDNEYS, NERVES,
AND GUMS AND TEETH.  

S&SX:

INSTRUCTED PT. ON SIGNS AND SYMPTOMS OF DIABETES. IT MAY VARY

DEPENDING ON HOW MUCH YOUR BLOOD SUGAR IS ELEVATED. SOME
PEOPLE, ESPECIALLY THOSE WITH PREDIABETES OR TYPE 2 DIABETES, MAY
NOT EXPERIENCE SYMPTOMS INITIALLY. IN TYPE 1 DIABETES, SYMPTOMS
TEND TO COME ON QUICKLY AND BE MORE SEVERE. SOME OF THE SIGNS AND
SYMPTOMS OF TYPE 1 AND TYPE 2 DIABETES ARE: INCREASED THIRST,
FREQUENT URINATION, EXTREME HUNGER, UNEXPLAINED WEIGHT LOSS,
PRESENCE OF KETONES IN THE URINE (KETONES ARE A BYPRODUCT OF THE
BREAKDOWN OF MUSCLE AND FAT THAT HAPPENS WHEN THERE'S NOT
ENOUGH AVAILABLE INSULIN), FATIGUE, IRRITABILITY, BLURRED VISION,
SLOW-HEALING SORES, FREQUENT INFECTIONS, SUCH AS GUMS OR SKIN
INFECTIONS AND VAGINAL INFECTIONS. TYPE 1 DIABETES CAN DEVELOP AT
ANY AGE, THOUGH IT OFTEN APPEARS DURING CHILDHOOD OR
ADOLESCENCE. TYPE 2 DIABETES, THE MORE COMMON TYPE, CAN DEVELOP
AT ANY AGE, THOUGH IT'S MORE COMMON IN PEOPLE OLDER THAN 40.

EDUCATION ON DM (HYPO/HYPERGLYCEMIA)

SN INSTRUCTED EARLY SIGNS AND SYMPTOMS OF DIABETIC HYPOGLYCEMIA

INCLUDE SHAKINESS, DIZZINESS, SWEATING, HUNGER, IRRITABILITY OR
MOODINESS, ANXIETY OR NERVOUSNESS, HEADACHE.PATIENT IS DRINKING
HER WATER AND HEALTHY CHOICES.EXPLAINED EARLY SIGNS OF
HYPERGLYCEMIA INCLUDE INCREASED THIRST, HEADACHES, TROUBLE
CONCENTRATING, BLURRED VISION, FREQUENT PEEING, FATIGUE (WEAK,
TIRED FEELING), WEIGHT LOSS. PATIENT VERBALIZED UNDERSTANDING

SKILLS TO DEAL WITH DM:

INSTRUCTED ON NECESSARY SKILLS TO DEAL WITH DIABETES SUCH AS

KNOW WHEN AND WHAT TO EAT, KNOW HOW TO TEST AND, RECORD BLOOD
GLUCOSE.  KNOW HOW TO RECOGNIZE AND TREAT LOW BLOOD SUGAR
(HYPOGLYCEMIA) AND HIGH BLOOD SUGAR (HYPERGLYCEMIA), KNOW HOW
TO TAKE INSULIN AND/OR ORAL MEDICATION, KNOW HOW TO ADJUST INSULIN
AND/OR FOOD INTAKE WHEN CHANGING EXERCISE AND EATING HABITS. 
INSTRUCTED ON MEASURES IMPORTANT IN MANAGEMENT OF DIABETES
MELLITUS SUCH AS: ACHIEVE AND MAINTAIN IDEAL WEIGHT. SOME PEOPLE
WITH TYPE 2 DIABETES FIND THAT THEY NO LONGER NEED ORAL MEDICATION
IF THEY LOSE WEIGHT AND INCREASE DAILY ACTIVITY. THE DIET SHOULD BE
CONSISTENT IN CARBOHYDRATES DURING THREE MEALS AND THREE
SNACKS DAILY.  EXERCISE (DO DAILY, PERFORM AT THE LEVEL APPROPRIATE
FOR CURRENT FITNESS LEVEL, MONITOR BLOOD GLUCOSE LEVELS BEFORE
AND AFTER EXERCISE, DRINK EXTRA FLUIDS (WITHOUT SUGAR) BEFORE,
DURING, AND AFTER EXERCISE, CARRY A DIABETIC IDENTIFICATION CARD,
CARRY CELL PHONE IN CASE OF EMERGENCY, CARRY FOOD THAT CONTAINS
A FAST-ACTING CARBOHYDRATE IN CASE YOU EXPERIENCE HYPOGLYCEMIC
REACTION.

MANAGEMENT:

EDUCATED PT. THAT THERE IS NO CURE FOR DIABETES, BUT IT CAN BE

TREATED AND CONTROLLED. THE GOALS OF MANAGING DIABETES ARE TO:
KEEP YOUR BLOOD GLUCOSE LEVELS AS NEAR TO NORMAL AS POSSIBLE BY
BALANCING FOOD INTAKE WITH MEDICATION AND ACTIVITY. MAINTAIN YOUR
BLOOD CHOLESTEROL AND TRIGLYCERIDE (LIPID) LEVELS AS NEAR THE
NORMAL RANGES AS POSSIBLE. CONTROL YOUR BLOOD PRESSURE. YOUR
BLOOD PRESSURE SHOULD NOT GO OVER 140/90. DECREASE OR POSSIBLY
PREVENT THE DEVELOPMENT OF DIABETES-RELATED HEALTH PROBLEMS. PT.
HOLD THE KEYS TO MANAGING DIABETES BY: PLANNING WHAT YOU EAT AND
FOLLOWING A BALANCED MEAL PLAN. EXERCISING REGULARLY. TAKING
MEDICATION, IF PRESCRIBED, AND CLOSELY FOLLOWING THE GUIDELINES ON
HOW AND WHEN TO TAKE IT. MONITORING YOUR BLOOD GLUCOSE AND
BLOOD PRESSURE LEVELS AT HOME. KEEPING YOUR APPOINTMENTS WITH
YOUR HEALTHCARE PROVIDERS AND HAVING LABORATORY TESTS
COMPLETED AS ORDERED BY YOUR DOCTOR. WHAT YOU DO AT HOME EVERY
DAY AFFECTS YOUR BLOOD GLUCOSE MORE THAN WHAT YOUR DOCTOR CAN
DO EVERY FEW MONTHS DURING YOUR CHECK-UP.
WHAT TO DO IF HIGH OR LOW BLOOD SUGAR:

WEEKLY HEAD TO TOE ASSESSMENT PERFORMED. NO FALLS OR INJURIES

REPORTED AT THIS VISIT.  NO EPISODE OF HYPERGLYCEMIA OR
HYPOGLYCEMIA HAS BEEN NOTED OR REPORTED AT THE VISIT.  INSTRUCTED
ON KNOWING WHAT TO DO IF SYMPTOMS OF HIGH OR LOW BLOOD SUGAR
OCCURS SUCH AS HIGH BLOOD SUGAR (GO TO THE EMERGENCY ROOM.),
LOW BLOOD SUGAR (EAT SOME FORM OF SIMPLE CARBOHYDRATE AS SOON
AS POSSIBLE, SOURCES OF CONCENTRATED SIMPLE CARBOHYDRATES ARE
SWEETENED FRUIT JUICE, CANDY, CAKE FROSTING, OR GLUCOSE TABLETS,
THE FOLLOWING ON THE LIST EACH CONTAIN ABOUT 15 GRAMS OF
CARBOHYDRATE: THREE GLUCOSE TABLETS, ONE-HALF CUP OF FRUIT JUICE
OR REGULAR SODA, SIX OR SEVEN HARD CANDIES (NOT SUGAR FREE), ONE
TABLESPOON OF HONEY OR SUGAR, GO TO THE EMERGENCY ROOM IF
SYMPTOMS PERSIST.  INSTRUCTED ON MANAGEMENT OF DIABETES DURING
ILLNESSES SUCH AS TAKE YOUR INSULIN OR ORAL MEDICATIONS. TEST YOUR
BLOOD SUGAR BEFORE EACH MEAL AND AT BEDTIME.  FOLLOW YOUR MEAL
PLAN, IF YOU CAN EAT. IF YOU ARE NOT EATING, TAKE IN AT LEAST 4 OUNCES
OF SUGAR-CONTAINING BEVERAGE EVERY HOUR. ENCOURAGE FLUIDS TO
MAINTAIN HYDRATION. CONTACT YOUR PHYSICIAN IF YOU ARE UNABLE TO
KEEP DOWN FOOD, LIQUIDS OR MEDICATIONS. YOUR ILLNESS LASTS MORE
THAN 24 HOURS. YOU HAVE BLOOD SUGARS HIGHER THAN 240 MG/ML FOR
MORE THAN 1 DAY.

EDUCATION ON CORONA VIRUS

WEEKLY HEAD TO TOE ASSESSMENT PERFORMED. SKIN IS WARM AND
INTACT.  PATIENT WAS TAUGHT ON PRACTICING UNIVERSAL PRECAUTIONS
ESPECIALLY WITH THE OUTBREAK OF COVID-19. PATIENT WAS ENCOURAGED
TO  PRACTICE EVERYDAY PREVENTIVE BEHAVIORS. STAY HOME WHEN SICK.
COVER COUGHS AND SNEEZES. FREQUENTLY WASH HANDS WITH SOAP AND
WATER. CLEAN FREQUENTLY TOUCHED SURFACES. . REVIEWED WITH
PATIENT /PCG S/S OF DISEASE EXACERBATION THAT NEED TO BE REPORTED
TO HEALTH CARE PROVIDERS INCLUDING STEPS ON WHAT TO DO IN AN
EVENT OF AN EMERGENCY. MEDICATION PILL BOX SET UP CHECKED AND
EMPHASIZED THE IMPORTANCE OF TIMELY REFILL OF MEDICATIONS TO
PREVENT MISSING OR SKIPPING DOSES, PAIN MANAGEMENT, CONTINUE
FOLLOWING PRESCRIBED DIET REGIMEN. RE-INSTRUCTED ON INFECTION
CONTROL MEASURES AND PRACTICING STANDARD PRECAUTIONS, MOST
IMPORTANTLY, FREQUENT PROPER HAND WASHING TO PREVENT DISEASE
COMPLICATIONS.
EDUCATION ON DIABETIC NEUROPATHY
EDUCATED PT./PCG ON THE DISEASE PROCESS OF DIABETIC NEUROPATHY.
DIABETIC NEUROPATHY IS A TYPE OF NERVE DAMAGE THAT CAN OCCUR IF
YOU HAVE DIABETES. HIGH BLOOD SUGAR (GLUCOSE) CAN INJURE NERVES
THROUGHOUT YOUR BODY. DIABETIC NEUROPATHY MOST OFTEN DAMAGES
NERVES IN YOUR LEGS AND FEET. DEPENDING ON THE AFFECTED NERVES,
DIABETIC NEUROPATHY SYMPTOMS CAN RANGE FROM PAIN AND NUMBNESS
IN YOUR LEGS AND FEET TO PROBLEMS WITH YOUR DIGESTIVE SYSTEM,
URINARY TRACT, BLOOD VESSELS AND HEART. SOME PEOPLE HAVE MILD
SYMPTOMS. BUT FOR OTHERS, DIABETIC NEUROPATHY CAN BE QUITE
PAINFUL AND DISABLING. DIABETIC NEUROPATHY IS A SERIOUS DIABETES
COMPLICATION THAT MAY AFFECT AS MANY AS 50% OF PEOPLE WITH
DIABETES. BUT YOU CAN OFTEN PREVENT DIABETIC NEUROPATHY OR SLOW
ITS PROGRESS WITH CONSISTENT BLOOD SUGAR MANAGEMENT AND A
HEALTHY LIFESTYLE.

EDUCATION ON CAD
INSTRUCTED PT. ON DISEASE PROCESS OF CAD. CORONARY ARTERY
DISEASE (CAD) IS THE MOST COMMON TYPE OF HEART DISEASE IN THE
UNITED STATES. IT IS SOMETIMES CALLED CORONARY HEART DISEASE OR
ISCHEMIC HEART DISEASE. CAD IS CAUSED BY PLAQUE BUILDUP IN THE
WALLS OF THE ARTERIES THAT SUPPLY BLOOD TO THE HEART (CALLED
CORONARY ARTERIES) AND OTHER PARTS OF THE BODY. PLAQUE IS MADE UP
OF DEPOSITS OF CHOLESTEROL AND OTHER SUBSTANCES IN THE ARTERY.
PLAQUE BUILDUP CAUSES THE INSIDE OF THE ARTERIES TO NARROW OVER
TIME, WHICH CAN PARTIALLY OR TOTALLY BLOCK THE BLOOD FLOW. THIS
PROCESS IS CALLED ATHEROSCLEROSIS. OVERWEIGHT, PHYSICAL
INACTIVITY, UNHEALTHY EATING, AND SMOKING TOBACCO ARE RISK
FACTORS FOR CAD. A FAMILY HISTORY OF HEART DISEASE ALSO INCREASES
YOUR RISK FOR CAD, ESPECIALLY A FAMILY HISTORY OF HAVING HEART
DISEASE AT AN EARLY AGE (50 OR YOUNGER).

S&SX:
INSTRUCTED PT. ON SIGNS AND SYMPTOMS OF CAD. ANGINA, OR CHEST PAIN
AND DISCOMFORT, IS THE MOST COMMON SYMPTOM OF CAD. ANGINA CAN
HAPPEN WHEN TOO MUCH PLAQUE BUILDS UP INSIDE ARTERIES, CAUSING
THEM TO NARROW. NARROWED ARTERIES CAN CAUSE CHEST PAIN BECAUSE
THEY CAN BLOCK BLOOD FLOW TO YOUR HEART MUSCLE AND THE REST OF
YOUR BODY. FOR MANY PEOPLE, THE FIRST CLUE THAT THEY HAVE CAD IS A
HEART ATTACK. SYMPTOMS OF HEART ATTACK INCLUDE: CHEST PAIN OR
DISCOMFORT (ANGINA), WEAKNESS, LIGHT-HEADEDNESS, NAUSEA (FEELING
SICK TO YOUR STOMACH), OR A COLD SWEAT, PAIN OR DISCOMFORT IN THE
ARMS OR SHOULDER, SHORTNESS OF BREATH. OVER TIME, CAD CAN WEAKEN
THE HEART MUSCLE. THIS MAY LEAD TO HEART FAILURE, A SERIOUS
CONDITION WHERE THE HEART CAN’T PUMP BLOOD THE WAY IT SHOULD.

MANAGEMENT:
INSTRUCTED PT. ON MANAGEMENT OF CORONARY ARTERY DISEASE. IT
INVOLVES REDUCING YOUR RISK FACTORS, TAKING MEDICATIONS AS
PRESCRIBED, POSSIBLY UNDERGOING INVASIVE AND/OR SURGICAL
PROCEDURES, AND SEEING YOUR DOCTOR FOR REGULAR VISITS. TREATING
CORONARY ARTERY DISEASE IS IMPORTANT TO REDUCE YOUR RISK OF A
HEART ATTACK OR STROKE. REDUCING YOUR RISK FACTORS INVOLVES
MAKING LIFESTYLE CHANGES. IF YOU SMOKE, YOU SHOULD QUIT. MAKE
CHANGES IN YOUR DIET TO REDUCE YOUR CHOLESTEROL, CONTROL YOUR
BLOOD PRESSURE, AND MANAGE BLOOD SUGAR IF YOU HAVE DIABETES.
LOW-FAT, LOW-SODIUM AND LOW-CHOLESTEROL FOODS ARE
RECOMMENDED. LIMITING ALCOHOL TO NO MORE THAN ONE DRINK A DAY IS
ALSO IMPORTANT. A REGISTERED DIETITIAN CAN HELP YOU MAKE THE RIGHT
DIETARY CHANGES. CLEVELAND CLINIC OFFERS NUTRITION PROGRAMS AND
CLASSES TO HELP YOU REACH YOUR GOALS. INCREASE YOUR
EXERCISE/ACTIVITY LEVEL TO HELP ACHIEVE AND MAINTAIN A HEALTHY
WEIGHT AND REDUCE STRESS. BUT, CHECK WITH YOUR DOCTOR BEFORE
STARTING AN EXERCISE PROGRAM. ASK YOUR DOCTOR ABOUT
PARTICIPATING IN A CARDIAC REHABILITATION PROGRAM. TEST YOUR 10
YEAR RISK FOR HEART ATTACK.

EDUCATION ON CONSTIPATION
INSTRUCTED PT. ON CONSTIPATION. CONSTIPATION OCCURS WHEN BOWEL
MOVEMENTS BECOME LESS FREQUENT AND STOOLS BECOME DIFFICULT TO
PASS. IT HAPPENS MOST OFTEN DUE TO CHANGES IN DIET OR ROUTINE, OR
DUE TO INADEQUATE INTAKE OF FIBER. YOU SHOULD CALL YOUR DOCTOR IF
YOU HAVE SEVERE PAIN, BLOOD IN YOUR STOOLS, OR CONSTIPATION THAT
LASTS LONGER THAN THREE WEEKS. YOUR STOOLS ARE DRY AND HARD.
YOUR BOWEL MOVEMENT IS PAINFUL AND STOOLS ARE DIFFICULT TO PASS.
YOU HAVE A FEELING THAT YOU HAVE NOT FULLY EMPTIED YOUR BOWELS.

EDUCATION ON VENOUS INSUFFICIENCY

INSTRUCTED PT. ON DISEASE PROCESS OF VENOUS INSUFFICIENCY.
CHRONIC VENOUS INSUFFICIENCY (CVI) IS A CONDITION THAT OCCURS WHEN
THE VENOUS WALL AND/OR VALVES IN THE LEG VEINS ARE NOT WORKING
EFFECTIVELY, MAKING IT DIFFICULT FOR BLOOD TO RETURN TO THE HEART
FROM THE LEGS. CVI CAUSES BLOOD TO “POOL” OR COLLECT IN THESE
VEINS, AND THIS POOLING IS CALLED STASIS.
S&SX:
INSTRUCTED PT. ON SIGNS AND SYMPTOMS OF CVI. THE SERIOUSNESS OF
CVI, ALONG WITH THE COMPLEXITIES OF TREATMENT, INCREASE AS THE
DISEASE PROGRESSES. THAT’S WHY IT IS VERY IMPORTANT TO SEE YOUR
DOCTOR IF YOU HAVE ANY OF THE SYMPTOMS OF CVI. THE PROBLEM WILL
NOT GO AWAY IF YOU WAIT, AND THE EARLIER IT IS DIAGNOSED AND
TREATED, THE BETTER YOUR CHANCES OF PREVENTING SERIOUS
COMPLICATIONS.SYMPTOMS INCLUDE: SWELLING IN THE LOWER LEGS AND
ANKLES, ESPECIALLY AFTER EXTENDED PERIODS OF STANDING, ACHING OR
TIREDNESS IN THE LEGS, NEW VARICOSE VEINS, LEATHERY-LOOKING SKIN ON
THE LEGS, FLAKING OR ITCHING SKIN ON THE LEGS OR FEET, STASIS ULCERS
(OR VENOUS STASIS ULCERS). IF CVI IS NOT TREATED, THE PRESSURE AND
SWELLING INCREASE UNTIL THE TINIEST BLOOD VESSELS IN THE LEGS
(CAPILLARIES) BURST. WHEN THIS HAPPENS, THE OVERLYING SKIN TAKES ON
A REDDISH-BROWN COLOR AND IS VERY SENSITIVE TO BEING BROKEN IF
BUMPED OR SCRATCHED. AT THE LEAST, BURST CAPILLARIES CAN CAUSE
LOCAL TISSUE INFLAMMATION AND INTERNAL TISSUE DAMAGE. AT WORST,
THIS LEADS TO ULCERS, OPEN SORES ON THE SKIN SURFACE. THESE
VENOUS STASIS ULCERS CAN BE DIFFICULT TO HEAL AND CAN BECOME
INFECTED. WHEN THE INFECTION IS NOT CONTROLLED, IT CAN SPREAD TO
SURROUNDING TISSUE, A CONDITION KNOWN AS CELLULITIS. CVI IS OFTEN
ASSOCIATED WITH VARICOSE VEINS, WHICH ARE TWISTED, ENLARGED VEINS
CLOSE TO THE SURFACE OF THE SKIN. THEY CAN OCCUR ALMOST
ANYWHERE, BUT MOST COMMONLY OCCUR IN THE LEGS.

MANAGEMENT:
EDUCATED PT./PCG ON MANAGEMENT OF CVI. LIKE ANY DISEASE, CVI IS MOST
TREATABLE IN ITS EARLIEST STAGES. VASCULAR MEDICINE OR VASCULAR
SURGERY SPECIALISTS TYPICALLY RECOMMEND A COMBINATION OF
TREATMENTS FOR PEOPLE WITH CVI. SOME OF THE BASIC TREATMENT
STRATEGIES INCLUDE: AVOID LONG PERIODS OF STANDING OR SITTING: IF
YOU MUST TAKE A LONG TRIP AND WILL BE SITTING FOR A LONG TIME, FLEX
AND EXTEND YOUR LEGS, FEET, AND ANKLES ABOUT 10 TIMES EVERY 30
MINUTES TO KEEP THE BLOOD FLOWING IN THE LEG VEINS. IF YOU NEED TO
STAND FOR LONG PERIODS OF TIME, TAKE FREQUENT BREAKS TO SIT DOWN
AND ELEVATE YOUR FEET. EXERCISE REGULARLY. WALKING IS ESPECIALLY
BENEFICIAL. LOSE WEIGHT IF YOU ARE OVERWEIGHT. ELEVATE YOUR LEGS
WHILE SITTING AND LYING DOWN, WITH YOUR LEGS ELEVATED ABOVE THE
LEVEL OF YOUR HEART. WEAR COMPRESSION STOCKINGS. TAKE ANTIBIOTICS
AS NEEDED TO TREAT SKIN INFECTIONS. PRACTICE GOOD SKIN HYGIENE. THE
GOALS OF TREATMENT ARE TO REDUCE THE POOLING OF BLOOD AND
PREVENT LEG ULCERS.
EDUCATION ON UTI
INSTRUCTED ON DISEASE PROCESS OF UTI. A URINARY TRACT INFECTION
(UTI) IS AN INFECTION IN ANY PART OF YOUR URINARY SYSTEM — YOUR
KIDNEYS, URETERS, BLADDER AND URETHRA. MOST INFECTIONS INVOLVE
THE LOWER URINARY TRACT — THE BLADDER AND THE URETHRA. WOMEN
ARE AT GREATER RISK OF DEVELOPING A UTI THAN ARE MEN. INFECTION
LIMITED TO YOUR BLADDER CAN BE PAINFUL AND ANNOYING. HOWEVER,
SERIOUS CONSEQUENCES CAN OCCUR IF A UTI SPREADS TO YOUR KIDNEYS.
DOCTORS TYPICALLY TREAT URINARY TRACT INFECTIONS WITH ANTIBIOTICS.
BUT YOU CAN TAKE STEPS TO REDUCE YOUR CHANCES OF GETTING A UTI IN
THE FIRST PLACE.

S&SX:
INSTRUCTED ON SIGNS AND SYMPTOMS OF UTI. URINARY TRACT INFECTIONS
DON'T ALWAYS CAUSE SIGNS AND SYMPTOMS, BUT WHEN THEY DO THEY MAY
INCLUDE: A STRONG, PERSISTENT URGE TO URINAT, A BURNING SENSATION
WHEN URINATING, PASSING FREQUENT, SMALL AMOUNTS OF URINE, URINE
THAT APPEARS CLOUDY, URINE THAT APPEARS RED, BRIGHT PINK OR COLA-
COLORED — A SIGN OF BLOOD IN THE URINE, STRONG-SMELLING URINE,
PELVIC PAIN, IN WOMEN — ESPECIALLY IN THE CENTER OF THE PELVIS AND
AROUND THE AREA OF THE PUBIC BONE. UTIS MAY BE OVERLOOKED OR
MISTAKEN FOR OTHER CONDITIONS IN OLDER ADULTS.

MANAGEMENT:
INSTRUCTED ON MANAGEMENT OF UTI. YOU CAN TAKE THESE STEPS TO
REDUCE YOUR RISK OF URINARY TRACT INFECTIONS: DRINK PLENTY OF
LIQUIDS, ESPECIALLY WATER. DRINKING WATER HELPS DILUTE YOUR URINE
AND ENSURES THAT YOU'LL URINATE MORE FREQUENTLY — ALLOWING
BACTERIA TO BE FLUSHED FROM YOUR URINARY TRACT BEFORE AN
INFECTION CAN BEGIN. DRINK CRANBERRY JUICE. ALTHOUGH STUDIES ARE
NOT CONCLUSIVE THAT CRANBERRY JUICE PREVENTS UTIS, IT IS LIKELY NOT
HARMFUL. WIPE FROM FRONT TO BACK. DOING SO AFTER URINATING AND
AFTER A BOWEL MOVEMENT HELPS PREVENT BACTERIA IN THE ANAL REGION
FROM SPREADING TO THE VAGINA AND URETHRA. EMPTY YOUR BLADDER
SOON AFTER INTERCOURSE. ALSO, DRINK A FULL GLASS OF WATER TO HELP
FLUSH BACTERIA. AVOID POTENTIALLY IRRITATING FEMININE PRODUCTS.
USING DEODORANT SPRAYS OR OTHER FEMININE PRODUCTS, SUCH AS
DOUCHES AND POWDERS, IN THE GENITAL AREA CAN IRRITATE THE
URETHRA. CHANGE YOUR BIRTH CONTROL METHOD. DIAPHRAGMS, OR
UNLUBRICATED OR SPERMICIDE-TREATED CONDOMS, CAN ALL CONTRIBUTE
TO BACTERIAL GROWTH.
EDUCATION ON HYPERLIPIDEMIA
INSTRUCTED ON THE DISEASE PROCESS OF HYPERLIPIDEMIA. YOU CALL IT
HIGH CHOLESTEROL. YOUR DOCTOR CALLS IT HYPERLIPIDEMIA. EITHER WAY,
IT'S A COMMON PROBLEM. THE TERM COVERS SEVERAL DISORDERS THAT
RESULT IN EXTRA FATS, ALSO KNOWN AS LIPIDS, IN YOUR BLOOD. YOU CAN
CONTROL SOME OF ITS CAUSES; BUT NOT ALL OF THEM. HYPERLIPIDEMIA IS
TREATABLE, BUT IT'S OFTEN A LIFE-LONG CONDITION. YOU'LL NEED TO
WATCH WHAT YOU EAT AND ALSO EXERCISE REGULARLY. YOU MIGHT NEED
TO TAKE A PRESCRIPTION MEDICATION, TOO. THE GOAL IS TO LOWER THE
HARMFUL CHOLESTEROL LEVELS. DOING SO CAN REDUCE YOUR RISK OF
HEART DISEASE, HEART ATTACK, STROKE, AND OTHER PROBLEMS.

S&SX:
INSTRUCTED ON SIGNS AND SYMPTOMS OF HYPERLIPIDEMIA. MOST PEOPLE
WITH HYPERLIPIDEMIA CAN'T TELL THAT THEY HAVE IT AT FIRST. IT'S NOT
SOMETHING YOU CAN FEEL, BUT YOU MAY NOTICE THE EFFECTS OF IT
SOMEDAY. CHOLESTEROL, ALONG WITH TRIGLYCERIDES AND OTHER FATS,
CAN BUILD UP INSIDE YOUR ARTERIES. THIS MAKES THE BLOOD VESSELS
NARROWER AND MAKES IT MORE DIFFICULT FOR BLOOD TO GET THROUGH.
YOUR BLOOD PRESSURE COULD GO UP. THE BUILDUP CAN ALSO CAUSE A
BLOOD CLOT TO FORM. IF A BLOOD CLOT BREAKS OFF AND TRAVELS TO
YOUR HEART, IT CAN CAUSE A HEART ATTACK. IF IT GOES TO YOUR BRAIN, IT
CAN CAUSE A STROKE

MANAGEMENT:
INSTRUCTED ON MANAGEMENT OF HYPERLIPIDEMIA. LIFESTYLE CHANGES
THAT CAN LOWER YOUR CHOLESTEROL INCLUDE A HEALTHY DIET, WEIGHT
LOSS, AND EXERCISE. YOU SHOULD: CHOOSE FOODS LOW IN TRANS FATS
AND SATURATED FATS EAT MORE FIBER-RICH FOODS, SUCH AS OATMEAL,
APPLES, BANANAS, PEARS, PRUNES, KIDNEY BEANS, CHICKPEAS, LENTILS,
AND LIMA BEANS, HAVE FISH TWICE A WEEK, AVOID SUGARY DRINKS AND
ADDED SUGARS, AVOID FRIED AND PROCESSED MEATS, LIMIT YOUR
ALCOHOL, TOO. THAT MEANS NO MORE THAN ONE DRINK A DAY. STEP UP
YOUR EXERCISE HABITS. AIM FOR ABOUT 30 MINUTES OF MODERATE-
INTENSITY ACTIVITY, LIKE A BRISK WALK, MOST DAYS OF THE WEEK. YOU
DON'T HAVE TO DO IT ALL AT ONCE. EVEN 10 TO 15 MINUTES AT A TIME CAN
MAKE A DIFFERENCE.

EDUCATION ON OSTEOPOROSIS
INSTRUCTED ON DISEASE PROCESS OF OSTEOPOROSIS. OSTEOPOROSIS
CAUSES BONES TO BECOME WEAK AND BRITTLE — SO BRITTLE THAT A FALL
OR EVEN MILD STRESSES SUCH AS BENDING OVER OR COUGHING CAN
CAUSE A FRACTURE. OSTEOPOROSIS-RELATED FRACTURES MOST
COMMONLY OCCUR IN THE HIP, WRIST OR SPINE. BONE IS LIVING TISSUE
THAT IS CONSTANTLY BEING BROKEN DOWN AND REPLACED. OSTEOPOROSIS
OCCURS WHEN THE CREATION OF NEW BONE DOESN'T KEEP UP WITH THE
LOSS OF OLD BONE. OSTEOPOROSIS AFFECTS MEN AND WOMEN OF ALL
RACES. BUT WHITE AND ASIAN WOMEN — ESPECIALLY OLDER WOMEN WHO
ARE PAST MENOPAUSE — ARE AT HIGHEST RISK. MEDICATIONS, HEALTHY
DIET AND WEIGHT-BEARING EXERCISE CAN HELP PREVENT BONE LOSS OR
STRENGTHEN ALREADY WEAK BONES.

S&SX:
INSTRUCTED ON SIGNS AND SYMPTOMS OF OSTEOPOROSIS. THERE
TYPICALLY ARE NO SYMPTOMS IN THE EARLY STAGES OF BONE LOSS. BUT
ONCE YOUR BONES HAVE BEEN WEAKENED BY OSTEOPOROSIS, YOU MIGHT
HAVE SIGNS AND SYMPTOMS THAT INCLUDE: BACK PAIN, CAUSED BY A
FRACTURED OR COLLAPSED VERTEBRA, LOSS OF HEIGHT OVER TIME, A
STOOPED POSTURE, A BONE THAT BREAKS MUCH MORE EASILY THAN
EXPECTED.

MANAGEMENT:
INSTRUCTED ON MANAGEMENT OF OSTEOPOROSIS. TREATMENTS FOR
ESTABLISHED OSTEOPOROSIS MAY INCLUDE EXERCISE, VITAMIN AND
MINERAL SUPPLEMENTS, AND MEDICATIONS. EXERCISE AND
SUPPLEMENTATION ARE OFTEN SUGGESTED TO HELP YOU PREVENT
OSTEOPOROSIS. WEIGHT-BEARING, RESISTANCE AND BALANCE EXERCISES
ARE ALL IMPORTANT.

EDUCATION ON FIBROMYALGIA
INSTRUCTED ON DISEASE PROCESS OF FIBROMYALGIA. FIBROMYALGIA IS A
DISORDER CHARACTERIZED BY WIDESPREAD MUSCULOSKELETAL PAIN
ACCOMPANIED BY FATIGUE, SLEEP, MEMORY AND MOOD ISSUES.
RESEARCHERS BELIEVE THAT FIBROMYALGIA AMPLIFIES PAINFUL
SENSATIONS BY AFFECTING THE WAY YOUR BRAIN PROCESSES PAIN
SIGNALS. WOMEN ARE MORE LIKELY TO DEVELOP FIBROMYALGIA THAN ARE
MEN. MANY PEOPLE WHO HAVE FIBROMYALGIA ALSO HAVE TENSION
HEADACHES, TEMPOROMANDIBULAR JOINT (TMJ) DISORDERS, IRRITABLE
BOWEL SYNDROME, ANXIETY AND DEPRESSION.

S&SX:
INSTRUCTED PT. ON SIGNS AND SYMPTOMS OF FIBROMYALGIA. SYMPTOMS
SOMETIMES BEGIN AFTER A PHYSICAL TRAUMA, SURGERY, INFECTION OR
SIGNIFICANT PSYCHOLOGICAL STRESS. IN OTHER CASES, SYMPTOMS
GRADUALLY ACCUMULATE OVER TIME WITH NO SINGLE TRIGGERING EVENT.
SYMPTOMS OF FIBROMYALGIA INCLUDE: WIDESPREAD PAIN. THE PAIN
ASSOCIATED WITH FIBROMYALGIA OFTEN IS DESCRIBED AS A CONSTANT
DULL ACHE THAT HAS LASTED FOR AT LEAST THREE MONTHS. TO BE
CONSIDERED WIDESPREAD, THE PAIN MUST OCCUR ON BOTH SIDES OF YOUR
BODY AND ABOVE AND BELOW YOUR WAIST. FATIGUE. PEOPLE WITH
FIBROMYALGIA OFTEN AWAKEN TIRED, EVEN THOUGH THEY REPORT
SLEEPING FOR LONG PERIODS OF TIME. SLEEP IS OFTEN DISRUPTED BY PAIN,
AND MANY PATIENTS WITH FIBROMYALGIA HAVE OTHER SLEEP DISORDERS,
SUCH AS RESTLESS LEGS SYNDROME AND SLEEP APNEA. COGNITIVE
DIFFICULTIES. A SYMPTOM COMMONLY REFERRED TO AS "FIBRO FOG"
IMPAIRS THE ABILITY TO FOCUS, PAY ATTENTION AND CONCENTRATE ON
MENTAL TASKS. FIBROMYALGIA OFTEN CO-EXISTS WITH OTHER PAINFUL
CONDITIONS, SUCH AS: IRRITABLE BOWEL SYNDROME, MIGRAINE AND HER
TYPES OF HEADACHES, INTERSTITIAL CYSTITIS OR PAINFUL BLADDER
SYNDROME,TEMPOROMANDIBULAR JOINT DISORDERS.

MANAGEMENT:
INSTRUCTED ON MANAGEMENT OF FIBROMYALGIA. MANAGEMENTS AND
TREATMENTS FOR FIBROMYALGIA INCLUDE BOTH MEDICATION AND SELF-
CARE. THE EMPHASIS IS ON MINIMIZING SYMPTOMS AND IMPROVING
GENERAL HEALTH. NO ONE TREATMENT WORKS FOR ALL SYMPTOMS.
MEDICATIONS CAN HELP REDUCE THE PAIN OF FIBROMYALGIA AND IMPROVE
SLEEP. COMMON CHOICES INCLUDE: PAIN RELIEVERS. OVER-THE-COUNTER
PAIN RELIEVERS SUCH AS ACETAMINOPHEN (TYLENOL, OTHERS), IBUPROFEN
(ADVIL, MOTRIN IB, OTHERS) OR NAPROXEN SODIUM (ALEVE, OTHERS) MAY BE
HELPFUL. YOUR DOCTOR MIGHT SUGGEST A PRESCRIPTION PAIN RELIEVER
SUCH AS TRAMADOL (ULTRAM). NARCOTICS ARE NOT ADVISED, BECAUSE
THEY CAN LEAD TO DEPENDENCE AND MAY EVEN WORSEN THE PAIN OVER
TIME. ANTIDEPRESSANTS. DULOXETINE (CYMBALTA) AND MILNACIPRAN
(SAVELLA) MAY HELP EASE THE PAIN AND FATIGUE ASSOCIATED WITH
FIBROMYALGIA. YOUR DOCTOR MAY PRESCRIBE AMITRIPTYLINE OR THE
MUSCLE RELAXANT CYCLOBENZAPRINE TO HELP PROMOTE SLEEP. ANTI-
SEIZURE DRUGS. MEDICATIONS DESIGNED TO TREAT EPILEPSY ARE OFTEN
USEFUL IN REDUCING CERTAIN TYPES OF PAIN. GABAPENTIN (NEURONTIN) IS
SOMETIMES HELPFUL IN REDUCING FIBROMYALGIA SYMPTOMS, WHILE
PREGABALIN (LYRICA) WAS THE FIRST DRUG APPROVED BY THE FOOD AND
DRUG ADMINISTRATION TO TREAT FIBROMYALGIA. THERAPY, A VARIETY OF
DIFFERENT THERAPIES CAN HELP REDUCE THE EFFECT THAT FIBROMYALGIA
HAS ON YOUR BODY AND YOUR LIFE. EXAMPLES INCLUDE: PHYSICAL
THERAPY. A PHYSICAL THERAPIST CAN TEACH YOU EXERCISES THAT WILL
IMPROVE YOUR STRENGTH, FLEXIBILITY AND STAMINA. WATER-BASED
EXERCISES MIGHT BE PARTICULARLY HELPFUL. OCCUPATIONAL THERAPY. AN
OCCUPATIONAL THERAPIST CAN HELP YOU MAKE ADJUSTMENTS TO YOUR
WORK AREA OR THE WAY YOU PERFORM CERTAIN TASKS THAT WILL CAUSE
LESS STRESS ON YOUR BODY. COUNSELING. TALKING WITH A COUNSELOR
CAN HELP STRENGTHEN YOUR BELIEF IN YOUR ABILITIES AND TEACH YOU
STRATEGIES FOR DEALING WITH STRESSFUL SITUATIONS.
EDUCATION ON CHF
INSTRUCTED PATIENT/CAREGIVER ON THE DISEASE PROCESS OF HEART
FAILURE THAT HEART FAILURE, ALSO CALLED CONGESTIVE HEART FAILURE
(CHF), MEANS YOUR HEART DOES NOT PUMP BLOOD AS WELL AS IT SHOULD.
THIS DOES NOT MEAN YOUR HEART HAS STOPPED WORKING, BUT THAT IT IS
NOT AS STRONG AS IT USED TO BE AND FLUID BUILDS UP IN THE LUNGS AND
OTHER PARTS OF YOUR BODY. THIS CAN CAUSE SHORTNESS OF BREATH,
SWELLING IN THE LEGS, FEET, AND STOMACH. HEART FAILURE STARTS
SLOWLY AND CAN GET WORSE OVER TIME.  VERBALIZED UNDERSTANDING.
PATIENT IS ON METOPROLOL MEDICATION.  INSTRUCTED PATIENT/CAREGIVER
THAT METOPROLOL IS USED FOR TREATING HIGH BLOOD PRESSURE, HEART
PAIN, ABNORMAL RHYTHMS OF THE HEART, AND SOME NEUROLOGIC
CONDITIONS; IT REDUCES THE FORCE OF CONTRACTION OF HEART MUSCLE
AND THEREBY LOWERS BLOOD PRESSURE. SIDE EFFECTS TO REPORT TO
PHYSICIAN ( MD ) WHEN TAKING METOPROLOL INCLUDING DIARRHEA,
CONSTIPATION, FATIGUE, INSOMNIA, NAUSEA, DEPRESSION, MEMORY LOSS,
FEVER, LIGHTHEADEDNESS, SLOW HEART RATE, LOW BLOOD PRESSURE,
COLD EXTREMITIES, SORE THROAT, AND SHORTNESS OF BREATH OR
WHEEZING. IF EXPERIENCING ANY OF THESE SIDE EFFECTS OR WHEN
SYSTOLIC BP IS >160 OR < 90 AND / OR DIASTOLIC BP IS > 90 OR < 60 NOTIFY
PHYSICIAN (MD).  VERBALIZED UNDERSTANDING.

S&SX:
INSTRUCTED PATIENT/CAREGIVER ON HEART FAILURE SIGNS AND SYMPTOMS
MAY INCLUDE:  SHORTNESS OF BREATH (DYSPNEA) WHEN YOU EXERT
YOURSELF OR WHEN YOU LIE DOWN, FATIGUE AND WEAKNESS, SWELLING
(EDEMA) IN YOUR LEGS, ANKLES AND FEET, RAPID OR IRREGULAR
HEARTBEAT, REDUCED ABILITY TO EXERCISE, PERSISTENT COUGH OR
WHEEZING WITH WHITE OR PINK BLOOD-TINGED PHLEGM, INCREASED NEED
TO URINATE AT NIGHT,
SWELLING OF YOUR ABDOMEN (ASCITES), VERY RAPID WEIGHT GAIN FROM
FLUID RETENTION, LACK OF APPETITE AND NAUSEA, DIFFICULTY
CONCENTRATING OR DECREASED ALERTNESS, SUDDEN, SEVERE
SHORTNESS OF BREATH AND COUGHING UP PINK, FOAMY MUCUS, AND
CHEST PAIN IF YOUR HEART FAILURE IS CAUSED BY A HEART ATTACK. 
INSTRUCTED PATIENT/CAREGIVER TO SEE YOUR DOCTOR IF YOU THINK YOU
MIGHT BE EXPERIENCING SIGNS OR SYMPTOMS OF HEART FAILURE.
VERBALIZED UNDERSTANDING.
EDUCATION ON COPD
INSTRUCTED PT. ON THE DISEASE PROCESS OF COPD. CHRONIC
OBSTRUCTIVE PULMONARY DISEASE (COPD) IS THE NAME FOR A GROUP OF
LUNG CONDITIONS THAT CAUSE BREATHING DIFFICULTIES. IT INCLUDES:
EMPHYSEMA – DAMAGE TO THE AIR SACS IN THE LUNGS, CHRONIC
BRONCHITIS – LONG-TERM INFLAMMATION OF THE AIRWAYS. COPD IS A
COMMON CONDITION THAT MAINLY AFFECTS MIDDLE-AGED OR OLDER
ADULTS WHO SMOKE. MANY PEOPLE DO NOT REALISE THEY HAVE IT. THE
BREATHING PROBLEMS TEND TO GET GRADUALLY WORSE OVER TIME AND
CAN LIMIT YOUR NORMAL ACTIVITIES, ALTHOUGH TREATMENT CAN HELP
KEEP THE CONDITION UNDER CONTROL.
COPD HAPPENS WHEN THE LUNGS BECOME INFLAMED, DAMAGED AND
NARROWED. THE MAIN CAUSE IS SMOKING, ALTHOUGH THE CONDITION CAN
SOMETIMES AFFECT PEOPLE WHO HAVE NEVER SMOKED. THE LIKELIHOOD
OF DEVELOPING COPD INCREASES THE MORE YOU SMOKE AND THE LONGER
YOU'VE SMOKED. SOME CASES OF COPD ARE CAUSED BY LONG-TERM
EXPOSURE TO HARMFUL FUMES OR DUST. OTHERS ARE THE RESULT OF A
RARE GENETIC PROBLEM WHICH MEANS THE LUNGS ARE MORE VULNERABLE
TO DAMAGE.

S&SX:
INSTRUCTED PT. ON SIGNS AND SYMPTOMS OF COPD. COMMON SYMPTOMS
OF COPD INCLUDE: INCREASING BREATHLESSNESS – THIS MAY ONLY HAPPEN
WHEN EXERCISING AT FIRST, AND YOU MAY SOMETIMES WAKE UP AT NIGHT
FEELING BREATHLESS, A PERSISTENT CHESTY COUGH WITH PHLEGM THAT
DOES NOT GO AWAY, FREQUENT CHEST INFECTIONS, PERSISTENT
WHEEZING. THE SYMPTOMS WILL USUALLY GET GRADUALLY WORSE OVER
TIME AND MAKE DAILY ACTIVITIES INCREASINGLY DIFFICULT, ALTHOUGH
TREATMENT CAN HELP SLOW THE PROGRESSION. SOMETIMES THERE MAY BE
PERIODS WHEN YOUR SYMPTOMS GET SUDDENLY WORSE – KNOWN AS A
FLARE-UP OR EXACERBATION. IT'S COMMON TO HAVE A FEW FLARE-UPS A
YEAR, PARTICULARLY DURING THE WINTER. LESS COMMON SYMPTOMS OF
COPD INCLUDE: WEIGHT LOSS, TIREDNESS, SWOLLEN ANKLES FROM A BUILD-
UP OF FLUID (EDEMA), CHEST PAIN AND COUGHING UP BLOOD – ALTHOUGH
THESE ARE USUALLY SIGNS OF ANOTHER CONDITION, SUCH AS A CHEST
INFECTION OR POSSIBLY LUNG CANCER. THESE ADDITIONAL SYMPTOMS
ONLY TEND TO HAPPEN WHEN COPD REACHES AN ADVANCED STAGE.

MANAGEMENT:
INSTRUCTED PT. ON MANAGEMENT OF COPD. AN EFFECTIVE COPD
MANAGEMENT PLAN INCLUDES FOUR COMPONENTS: (1) ASSESS AND
MONITOR DISEASE; (2) REDUCE RISK FACTORS; (3) MANAGE STABLE COPD; (4)
MANAGE EXACERBATIONS. THE GOALS OF EFFECTIVE COPD MANAGEMENT
ARE TO: PREVENT DISEASE PROGRESSION, RELIEVE SYMPTOMS, IMPROVE
EXERCISE TOLERANCE, IMPROVE HEALTH STATUS, PREVENT AND TREAT
COMPLICATIONS, PREVENT AND TREAT EXACERBATIONS, REDUCE
MORTALITY.  THESE GOALS SHOULD BE REACHED WITH A MINIMUM OF SIDE
EFFECTS FROM TREATMENT, A PARTICULAR CHALLENGE IN PATIENTS WITH
COPD WHERE COMORBIDITIES ARE COMMON. THE EXTENT TO WHICH THESE
GOALS CAN BE REALIZED VARIES WITH EACH INDIVIDUAL, AND SOME
TREATMENTS WILL PRODUCE BENEFITS IN MORE THAN ONE AREA. IN
SELECTING A TREATMENT PLAN, THE BENEFITS AND RISKS TO THE
INDIVIDUAL AND THE COSTS, DIRECT AND INDIRECT, TO THE COMMUNITY
MUST BE CONSIDERED. PATIENTS SHOULD BE IDENTIFIED BEFORE THE END
STAGE OF THE ILLNESS, WHEN DISABILITY IS SUBSTANTIAL. HOWEVER, THE
BENEFITS OF SPIROMETRIC SCREENING, OF EITHER THE GENERAL
POPULATION OR SMOKERS, ARE STILL UNCLEAR. EDUCATING PATIENTS AND
PHYSICIANS TO RECOGNIZE THAT COUGH, SPUTUM PRODUCTION, AND
ESPECIALLY BREATHLESSNESS ARE NOT TRIVIAL SYMPTOMS IS AN
ESSENTIAL ASPECT OF THE PUBLIC HEALTH CARE OF THIS DISEASE.
REDUCTION OF THERAPY ONCE SYMPTOM CONTROL HAS BEEN ACHIEVED IS
NOT NORMALLY POSSIBLE IN COPD. FURTHER DETERIORATION OF LUNG
FUNCTION USUALLY REQUIRES THE PROGRESSIVE INTRODUCTION OF MORE
TREATMENTS, BOTH PHARMACOLOGIC AND NONPHARMACOLOGIC, TO
ATTEMPT TO LIMIT THE IMPACT OF THESE CHANGES. ACUTE EXACERBATIONS
OF SIGNS AND SYMPTOMS, A HALLMARK OF COPD, IMPAIR PATIENTS' QUALITY
OF LIFE AND DECREASE THEIR HEALTH STATUS. APPROPRIATE TREATMENT
AND MEASURES TO PREVENT FURTHER EXACERBATIONS SHOULD BE
IMPLEMENTED AS QUICKLY AS POSSIBLE.

EDUCATION ON INTESTINAL ADHESIONS

INSTRUCTED PT. ON DISEASE PROCESS OF INTESTINAL ADHESIONS.
ABDOMINAL ADHESIONS ARE BANDS OF SCAR-LIKE TISSUE THAT FORM INSIDE
YOUR ABDOMEN. THE BANDS FORM BETWEEN TWO OR MORE ORGANS OR
BETWEEN ORGANS AND THE ABDOMINAL WALL. NORMALLY, THE SURFACES
OF ORGANS AND YOUR ABDOMINAL WALL DO NOT STICK TOGETHER WHEN
YOU MOVE. HOWEVER, ABDOMINAL ADHESIONS MAY CAUSE THESE
SURFACES TO BECOME ADHERENT, OR STICK TOGETHER. ABDOMINAL
ADHESIONS CAN KINK, TWIST, PULL, OR COMPRESS THE INTESTINES AND
OTHER ORGANS IN THE ABDOMEN, CAUSING SYMPTOMS AND
COMPLICATIONS, SUCH AS INTESTINAL OBSTRUCTION OR BLOCKAGE.
ABDOMINAL ADHESIONS ARE COMMON AND OFTEN DEVELOP AFTER
ABDOMINAL SURGERY. IN ABDOMINAL SURGERY, SURGEONS ENTER A
PATIENT’S ABDOMEN THROUGH AN INCISION, OR CUT. ABDOMINAL SURGERY
MAY BE LAPAROSCOPIC OR OPEN. IN LAPAROSCOPIC SURGERY, WHICH IS
INCREASINGLY COMMON, SURGEONS MAKE SMALL CUTS IN THE ABDOMEN
AND INSERT SPECIAL TOOLS TO VIEW, REMOVE, OR REPAIR ORGANS AND
TISSUES. IN OPEN SURGERY, SURGEONS MAKE A LARGER CUT TO OPEN THE
ABDOMEN. ABDOMINAL ADHESIONS DEVELOP IN MORE THAN 9 OUT OF EVERY
10 PEOPLE WHO HAVE SURGERY THAT OPENS THE ABDOMEN.HOWEVER, A
MAJORITY OF PEOPLE WITH ABDOMINAL ADHESIONS DO NOT DEVELOP
SYMPTOMS OR COMPLICATIONS.1 ABDOMINAL ADHESIONS ARE LESS
COMMON AFTER LAPAROSCOPIC SURGERY THAN AFTER OPEN SURGERY.

S&SX:
EDUCATED ON SIGNS AND SYMPTOMS OF INTESTINAL ADHESIONS. IN MANY
CASES, ABDOMINAL ADHESIONS DO NOT CAUSE SYMPTOMS. IF THEY DO
CAUSE SYMPTOMS, CHRONIC ABDOMINAL PAIN IS THE MOST COMMON
SYMPTOM. ABDOMINAL ADHESIONS MAY CAUSE INTESTINAL OBSTRUCTION,
WHICH CAN BE LIFE-THREATENING. IF YOU HAVE SYMPTOMS OF INTESTINAL
OBSTRUCTION, SEEK MEDICAL HELP RIGHT AWAY. SYMPTOMS OF INTESTINAL
OBSTRUCTION MAY INCLUDE ABDOMINAL PAIN, BLOATING, CONSTIPATION,
NOT PASSING GAS, NAUSEA, VOMITING. IF INTESTINAL OBSTRUCTION CUTS
OFF THE BLOOD FLOW TO THE BLOCKED PART OF THE INTESTINES OR LEADS
TO PERITONITIS, YOU MAY DEVELOP ADDITIONAL SYMPTOMS SUCH A FAST
HEART RATE OR FEVER.
ABDOMINAL SURGERY IS THE MOST COMMON CAUSE OF ABDOMINAL
ADHESIONS. ADHESIONS CAUSED BY SURGERY ARE MORE LIKELY TO CAUSE
SYMPTOMS AND COMPLICATIONS THAN ADHESIONS RELATED TO OTHER
CAUSES. SYMPTOMS AND COMPLICATIONS MAY START ANY TIME AFTER
SURGERY, EVEN MANY YEARS LATER. CONDITIONS THAT INVOLVE
INFLAMMATION OR INFECTION IN THE ABDOMEN MAY ALSO CAUSE
ADHESIONS. THESE CONDITIONS INCLUDE CROHN’S DISEASE, DIVERTICULAR
DISEASE, ENDOMETRIOSIS NIH EXTERNAL LINK, PELVIC INFLAMMATORY
DISEASE NIH EXTERNAL LINK, AND PERITONITIS. OTHER CAUSES OF
ABDOMINAL ADHESIONS INCLUDE LONG-TERM PERITONEAL DIALYSIS TO
TREAT KIDNEY FAILURE AND RADIATION THERAPY NIH EXTERNAL LINK TO
TREAT CANCER NIH EXTERNAL LINK. IN SOME CASES, ABDOMINAL ADHESIONS
ARE PRESENT AT BIRTH.

MANAGEMENT:
INSTRUCTED ON MANAGEMENT OF INTESTINAL ADHESIONS. IF ABDOMINAL
ADHESIONS DON’T CAUSE SYMPTOMS OR COMPLICATIONS, THEY TYPICALLY
DON’T NEED TREATMENT. IF ABDOMINAL ADHESIONS CAUSE SYMPTOMS OR
COMPLICATIONS, DOCTORS CAN RELEASE THE ADHESIONS WITH
LAPAROSCOPIC OR OPEN SURGERY. HOWEVER, SURGERY TO TREAT
ADHESIONS MAY CAUSE NEW ADHESIONS TO FORM. IF YOU HAVE ABDOMINAL
ADHESIONS, TALK WITH YOUR DOCTOR ABOUT THE POSSIBLE BENEFITS AND
RISKS OF SURGERY. IF ABDOMINAL ADHESIONS CAUSE AN INTESTINAL
OBSTRUCTION, YOU WILL NEED TREATMENT AT A HOSPITAL RIGHT AWAY.
DOCTORS WILL EXAMINE YOU AND MAY ORDER TESTS TO FIND OUT IF YOU
NEED EMERGENCY SURGERY. IF YOU DO, SURGEONS WILL RELEASE THE
ADHESIONS, RELIEVING THE INTESTINAL OBSTRUCTION. IF YOU DON’T NEED
EMERGENCY SURGERY, DOCTORS MAY TRY TO TREAT THE OBSTRUCTION
WITHOUT SURGERY. HEALTH CARE PROFESSIONALS WILL GIVE YOU
INTRAVENOUS (IV) FLUIDS AND INSERT A TUBE THROUGH YOUR NOSE AND
INTO YOUR STOMACH TO REMOVE THE CONTENTS OF YOUR DIGESTIVE
TRACT ABOVE THE OBSTRUCTION. IN SOME CASES, THE OBSTRUCTION MAY
GO AWAY. IF THE OBSTRUCTION DOES NOT GO AWAY, SURGEONS WILL
PERFORM SURGERY TO RELEASE THE ADHESIONS, RELIEVING THE
INTESTINAL OBSTRUCTION.

EDUCATION ON GERD
EDUCATED PT. ON DISEASE PROCESS OF GERD. GASTROESOPHAGEAL
REFLUX DISEASE (GERD) IS A DIGESTIVE DISORDER THAT OCCURS WHEN
ACIDIC STOMACH JUICES, OR FOOD AND FLUIDS BACK UP FROM THE
STOMACH INTO THE ESOPHAGUS. GERD AFFECTS PEOPLE OF ALL AGES—
FROM INFANTS TO OLDER ADULTS. PEOPLE WITH ASTHMA ARE AT HIGHER
RISK OF DEVELOPING GERD. ASTHMA FLARE-UPS CAN CAUSE THE LOWER
ESOPHAGEAL SPHINCTER TO RELAX, ALLOWING STOMACH CONTENTS TO
FLOW BACK, OR REFLUX, INTO THE ESOPHAGUS. SOME ASTHMA
MEDICATIONS (ESPECIALLY THEOPHYLLINE) MAY WORSEN REFLUX
SYMPTOMS. ON THE OTHER HAND, ACID REFLUX CAN MAKE ASTHMA
SYMPTOMS WORSE BY IRRITATING THE AIRWAYS AND LUNGS. THIS, IN TURN,
CAN LEAD TO PROGRESSIVELY MORE SERIOUS ASTHMA. ALSO, THIS
IRRITATION CAN TRIGGER ALLERGIC REACTIONS AND MAKE THE AIRWAYS
MORE SENSITIVE TO ENVIRONMENTAL CONDITIONS SUCH AS SMOKE OR
COLD AIR.

S&SX:
INSTRUCTED ON SIGNS AND SYMPTOMS OF GERD. EVERYONE HAS
EXPERIENCED GASTROESOPHAGEAL REFLUX. IT HAPPENS WHEN YOU BURP,
HAVE AN ACID TASTE IN YOUR MOUTH OR HAVE HEARTBURN. HOWEVER, IF
THESE SYMPTOMS INTERFERE WITH YOUR DAILY LIFE IT IS TIME TO SEE
YOUR PHYSICIAN. OTHER SYMPTOMS THAT OCCUR LESS FREQUENTLY BUT
CAN INDICATE THAT YOU COULD HAVE GERD ARE: ACID REGURGITATION
(RETASTING YOUR FOOD AFTER EATING), DIFFICULTY OR PAIN WHEN
SWALLOWING, SUDDEN EXCESS OF SALIVA, CHRONIC SORE THROAT,
LARYNGITIS OR HOARSENESS, INFLAMMATION OF THE GUMS, CAVITIES, BAD
BREATH, CHEST PAIN (SEEK IMMEDIATE MEDICAL HELP).

MANAGEMENT:
EDUCATED ON MANAGEMENT OF GERD. IF YOU HAVE BOTH GERD AND
ASTHMA, MANAGING YOUR GERD WILL HELP CONTROL YOUR ASTHMA
SYMPTOMS. STUDIES HAVE SHOWN THAT PEOPLE WITH ASTHMA AND GERD
SAW A DECREASE IN ASTHMA SYMPTOMS (AND ASTHMA MEDICATION USE)
AFTER TREATING THEIR REFLUX DISEASE. LIFESTYLE CHANGES TO TREAT
GERD INCLUDE: ELEVATE THE HEAD OF THE BED 6-8 INCHES, LOSE WEIGHT,
STOP SMOKING, DECREASE ALCOHOL INTAKE, LIMIT MEAL SIZE AND AVOID
HEAVY EVENING MEALS, DO NOT LIE DOWN WITHIN TWO TO THREE HOURS OF
EATING, DECREASE CAFFEINE INTAKE, AVOID THEOPHYLLINE (IF POSSIBLE).
YOUR PHYSICIAN MAY ALSO RECOMMEND MEDICATIONS TO TREAT REFLUX
OR RELIEVE SYMPTOMS. OVER-THE-COUNTER ANTACIDS AND H2 BLOCKERS
MAY HELP DECREASE THE EFFECTS OF STOMACH ACID. PROTON PUMP
INHIBITORS BLOCK ACID PRODUCTION AND ALSO MAY BE EFFECTIVE. IN
SEVERE AND MEDICATION INTOLERANT CASES, SURGERY MAY BE
RECOMMENDED.

EDUCATION ON END STAGE RENAL DISEASE

INSTRUCTED PT. ON DISEASE PROCESS OF END STAGE RENAL DISEASE. END-
STAGE RENAL DISEASE, ALSO CALLED END-STAGE KIDNEY DISEASE, OCCURS
WHEN CHRONIC KIDNEY DISEASE — THE GRADUAL LOSS OF KIDNEY
FUNCTION — REACHES AN ADVANCED STATE. IN END-STAGE RENAL DISEASE,
YOUR KIDNEYS ARE NO LONGER ABLE TO WORK AS THEY SHOULD TO MEET
YOUR BODY'S NEEDS. YOUR KIDNEYS FILTER WASTES AND EXCESS FLUIDS
FROM YOUR BLOOD, WHICH ARE THEN EXCRETED IN YOUR URINE. WHEN
YOUR KIDNEYS LOSE THEIR FILTERING CAPABILITIES, DANGEROUS LEVELS
OF FLUID, ELECTROLYTES AND WASTES CAN BUILD UP IN YOUR BODY. WITH
END-STAGE RENAL DISEASE, YOU NEED DIALYSIS OR A KIDNEY TRANSPLANT
TO STAY ALIVE. BUT YOU MAY ALSO CHOOSE TO FORGO DIALYSIS OR
TRANSPLANT AND OPT FOR CONSERVATIVE CARE TO MANAGE YOUR
SYMPTOMS — AIMING FOR THE BEST QUALITY OF LIFE POSSIBLE DURING
YOUR REMAINING TIME.

S&SX:
INSTRUCTED ON SIGNS AND SYMPTOMS OF END STAGE RENAL DISEASE.
EARLY IN CHRONIC KIDNEY DISEASE, YOU MAY HAVE NO SIGNS OR
SYMPTOMS. AS CHRONIC KIDNEY DISEASE PROGRESSES TO END-STAGE
RENAL DISEASE, SIGNS AND SYMPTOMS MIGHT INCLUDE: NAUSEA, VOMITING,
LOSS OF APPETITE, FATIGUE AND WEAKNESS, SLEEP PROBLEMS, CHANGES
IN HOW MUCH YOU URINATE, DECREASED MENTAL SHARPNESS, MUSCLE
TWITCHES AND CRAMPS, SWELLING OF FEET AND ANKLES, PERSISTENT
ITCHING, CHEST PAIN, IF FLUID BUILDS UP AROUND THE LINING OF THE
HEART, SHORTNESS OF BREATH, IF FLUID BUILDS UP IN THE LUNGS, HIGH
BLOOD PRESSURE (HYPERTENSION) THAT'S DIFFICULT TO CONTROL. SIGNS
AND SYMPTOMS OF KIDNEY DISEASE ARE OFTEN NONSPECIFIC, MEANING
THEY CAN ALSO BE CAUSED BY OTHER ILLNESSES. BECAUSE YOUR KIDNEYS
ARE HIGHLY ADAPTABLE AND ABLE TO COMPENSATE FOR LOST FUNCTION,
SIGNS AND SYMPTOMS MAY NOT APPEAR UNTIL IRREVERSIBLE DAMAGE HAS
OCCURRED.

MANAGEMENT:
MANAGEMENT OF RENAL DISEASE. IF YOU HAVE KIDNEY DISEASE, YOU MAY
BE ABLE TO SLOW ITS PROGRESS BY MAKING HEALTHY LIFESTYLE CHOICES:
LOSE WEIGHT IF YOU NEED TO, BE ACTIVE MOST DAYS, EAT A BALANCED DIET
OF NUTRITIOUS, LOW-SODIUM FOODS, CONTROL YOUR BLOOD PRESSURE,
TAKE YOUR MEDICATIONS AS PRESCRIBED, HAVE YOUR CHOLESTEROL
LEVELS CHECKED EVERY YEAR, CONTROL YOUR BLOOD SUGAR LEVEL, DON'T
SMOKE OR USE TOBACCO PRODUCTS, GET REGULAR CHECKUPS.

COVID 19
SN COMPLETED COV-19 SCREENING PRIOR TO HOME VISIT. PATIENT HAS NO SIGN
AND SYMPTOMS OF COV-19, NO RECENT TRAVEL AND NO KNOWN EXPOSURE AT THIS
TIME, COV-19 TEACHING CONTINUED.

EDUCATION ON SARCOIDOSIS

SN INSTRUCTED PATIENT THAT SARCOIDOSIS IS A CONDITION IN WHICH THERE IS AN

ABNORMAL COLLECTION OF INFLAMMATORY CELLS THAT FORM AGGREGATES IN
THE LUNGS, SKIN OR LYMPH NODES. TREATMENTS CAN HELP MANAGE CONDITION,
NO KNOWN CURE. ALSO INSTRUCTED A NUMBER OF NATURAL REMEDIES ARE
AVAILABLE TO GET RID OF SARCOIDOSIS. JUST ADOPT SIMPLE LIFESTYLE
MODIFICATIONS, GOOD DIETARY HABITS AND REGULAR EXERCISING; THEN YOU CAN
CURE THIS DISORDER WITHOUT GOING TO DOCTOR OR TAKING MEDICATIONS.

S&SX:
INSTRUCTED PT. ON THE SIGNS AND SYMPTOMS OF SARCOIDOSIS. THE SYMPTOMS
OF SARCOIDOSIS CAN VARY GREATLY FROM INDIVIDUAL TO INDIVIDUAL, AND
DEPEND ON WHICH TISSUES AND ORGANS ARE AFFECTED. IN SOME PEOPLE,
SYMPTOMS MAY BEGIN SUDDENLY AND/OR SEVERELY AND SUBSIDE IN A SHORT
PERIOD OF TIME. OTHERS MAY HAVE NO OUTWARD SYMPTOMS AT ALL, EVEN
THOUGH ORGANS ARE AFFECTED. STILL OTHERS MAY HAVE SYMPTOMS THAT
APPEAR SLOWLY AND SUBTLY, BUT LAST OR RECUR OVER A LONG TIME SPAN. MOST
COMMON INITIAL SYMPTOMS: SHORTNESS OF BREATH (DYSPNEA). COUGH THAT
WON’T GO AWAY. REDDISH BUMPS OR PATCHES ON THE SKIN OR UNDER THE SKIN.
ENLARGED LYMPH GLANDS IN THE CHEST AND AROUND THE LUNGS THAT
PRODUCES COUGH AND SHORTNESS OF BREATH. FEVER, WEIGHT LOSS, FATIGUE,
NIGHT SWEATS, GENERAL FEELING OF ILL HEALTH.
OTHER DISEASE CHARACTERISTICS INCLUDE: RED AND TEARY EYES OR BLURRED
VISION. SWOLLEN AND PAINFUL JOINTS. ENLARGED LYMPH GLANDS IN THE NECK,
ARMPITS AND GROIN. NASAL STUFFINESS AND HOARSE VOICE. PAIN IN THE HANDS,
FEET, OR OTHER BONY AREAS DUE TO THE FORMATION OF CYSTS (AN ABNORMAL
SAC-LIKE GROWTH) IN BONES. KIDNEY STONE FORMATION. DEVELOPMENT OF
ABNORMAL OR MISSED BEATS (ARRHYTHMIAS), INFLAMMATION OF THE COVERING
OF THE HEART (PERICARDITIS), OR HEART FAILURE. NERVOUS SYSTEM EFFECTS
INCLUDE HEARING LOSS, MENINGITIS, SEIZURES OR PSYCHIATRIC DISORDERS (FOR
EXAMPLE, DEMENTIA, DEPRESSION, PSYCHOSIS).

MANAGEMENT:
INSTRUCTED PT. ON MANAGEMENT AND TREATMENT OF SARCOIDOSIS. THERE IS NO
CURE FOR SARCOIDOSIS, BUT THE DISEASE MAY GET BETTER ON ITS OWN OVER
TIME. MANY PEOPLE WITH SARCOIDOSIS HAVE MILD SYMPTOMS AND DO NOT
REQUIRE ANY TREATMENT AT ALL. TREATMENT, WHEN IT IS NEEDED, GENERALLY
FALLS INTO TWO CATEGORIES—MAINTENANCE OF GOOD HEALTH PRACTICES AND
DRUG TREATMENT. GOOD HEALTH PRACTICES INCLUDE: GETTING REGULAR CHECK-
UPS WITH YOUR HEALTH CARE PROVIDER. EATING A WELL-BALANCED DIET WITH A
VARIETY OF FRESH FRUITS AND VEGETABLES. DRINKING 8 TO 10 8-OUNCE GLASSES
OF WATER A DAY. GETTING 6 TO 8 HOURS OF SLEEP EACH NIGHT. EXERCISING
REGULARLY, AND MANAGING AND MAINTAINING YOUR WEIGHT. QUITTING SMOKING.
AVOIDING EXPOSURE TO DUST, CHEMICALS, FUMES, GASES, TOXIC INHALANTS AND
OTHER SUBSTANCES THAT CAN HARM YOUR LUNGS. AVOIDING EXCESSIVE
AMOUNTS OF CALCIUM-RICH FOODS (SUCH AS DAIRY PRODUCTS, ORANGES,
CANNED SALMON WITH BONES), VITAMIN D AND SUNLIGHT. DAILY SUNBATHING IS AN
EXAMPLE OF EXCESSIVE SUNLIGHT AND SHOULD BE AVOIDED; SUNLIGHT RECEIVED
FROM ACTIVITIES OF EVERYDAY LIVING IS ACCEPTABLE. (THE ADVICE IN THIS BULLET
POINT IS LIMITED TO PATIENTS WITH HIGH BLOOD OR URINE LEVELS OF CALCIUM.)
DRUG TREATMENTS ARE USED TO RELIEVE SYMPTOMS, REDUCE THE INFLAMMATION
OF THE AFFECTED TISSUES, REDUCE THE IMPACT OF GRANULOMA DEVELOPMENT,
AND PREVENT THE DEVELOPMENT OF LUNG FIBROSIS AND OTHER IRREVERSIBLE
ORGAN DAMAGE.
CORTICOSTEROIDS ARE PARTICULARLY EFFECTIVE IN REDUCING INFLAMMATION,
AND ARE TYPICALLY THE FIRST DRUGS USED IN TREATING SARCOIDOSIS. THE ORAL
CORTICOSTEROID PREDNISONE IS THE MOST COMMONLY USED CORTICOSTEROID.
FOR PATIENTS WITH NO SYMPTOMS OR VERY MILD SYMPTOMS, THE SIDE EFFECTS
OF PREDNISONE THERAPY MAY OUTWEIGH POSSIBLE BENEFITS, SO TREATMENT IS
USUALLY NOT RECOMMENDED FOR THIS DISEASE STAGE. CORTICOSTEROIDS ARE
MORE TYPICALLY RESERVED FOR PATIENTS WITH DISEASE THAT IS OF MODERATE
SEVERITY. SYMPTOMS, ESPECIALLY COUGH AND SHORTNESS OF BREATH,
GENERALLY IMPROVE WITH STEROID THERAPY.
CORTICOSTEROID TREATMENT CONTROLS THE DISEASE RATHER THAN CURES IT.
THE SYMPTOMS RESPOND TO TREATMENT IN THE MAJORITY OF PATIENTS. A
RELATIVELY HIGH DOSE IS USUALLY PRESCRIBED AT FIRST, FOLLOWED BY A SLOW
TAPER TO THE LOWEST EFFECTIVE DOSE. FORTUNATELY, DISEASE RELAPSES
--WHEN THEY OCCUR -- USUALLY RESPOND TO RETREATMENT WITH STEROIDS.
PATIENTS WHO IMPROVE AND REMAIN STABLE FOR MORE THAN ONE YEAR AFTER
STOPPING TREATMENT HAVE A LOW RATE OF RELAPSE.
RESULTS OF SOME LONG-TERM STUDIES INDICATE PATIENTS CAN EXPECT ABOUT A
10% IMPROVEMENT IN SYMPTOMS UP TO FIVE YEARS AFTER QUITTING
CORTICOSTEROID TREATMENT. WHETHER OR NOT THIS IS A LARGE ENOUGH
BENEFIT TO OUTWEIGH THE RISKS OF CORTICOSTEROID TREATMENT REMAINS AN
ISSUE DEBATED BY DOCTORS. IF STEROIDS ARE PRESCRIBED, THE PATIENT SHOULD
SEE HIS OR HER DOCTOR AT REGULAR INTERVALS SO THAT THE DISEASE AND SIDE
EFFECTS OF TREATMENT CAN BE MONITORED. THE COMMON SIDE EFFECTS OF
CORTICOSTEROIDS INCLUDE: EXCESSIVE WEIGHT GAIN. INSOMNIA. ACNE. DIABETES
IN SUSCEPTIBLE PEOPLE. HIGH BLOOD PRESSURE. GLAUCOMA. CATARACTS.
OSTEOPOROSIS. DEPRESSION AND EMOTIONAL IRRITABILITY. SKIN BRUISING.
INCREASED RISK OF INFECTIONS.

EDUCATION ON DIABETIC FOOT CARE

SN INSTRUCTED PATIENT ON DIABETIC FOOT CARE THAT TO TAKE GOOD CARE OF

YOUR FEET, YOU CAN PREVENT MOST SERIOUS PROBLEMS RELATED TO DIABETES.
USE MILD SOAPS AND WARM WATER. PAT YOUR SKIN DRY; DO NOT RUB.
THOROUGHLY DRY YOUR FEET. AFTER WASHING, PUT LOTION ON THEM TO PREVENT
CRACKING. BUT NOT BETWEEN YOUR TOES. ALSO INSTRUCTED TO REPORT OY ANY
SKIN IRRITATION OR CUTS. SN ASSESSED SKIN INTEGRITY NO CUTS OR SKIN
IRRITATION NOTED.

EDUCATE ON DIABETIC NEUROPATHY

INSTRUCTED PT. ON DISAESE PROCESS OF DIABETIC NEUROPATHY. DIABETIC

NEUROPATHY IS A TYPE OF NERVE DAMAGE THAT CAN OCCUR IF YOU HAVE
DIABETES. HIGH BLOOD SUGAR (GLUCOSE) CAN INJURE NERVES THROUGHOUT
YOUR BODY. DIABETIC NEUROPATHY MOST OFTEN DAMAGES NERVES IN YOUR LEGS
AND FEET. DEPENDING ON THE AFFECTED NERVES, DIABETIC NEUROPATHY
SYMPTOMS CAN RANGE FROM PAIN AND NUMBNESS IN YOUR LEGS AND FEET TO
PROBLEMS WITH YOUR DIGESTIVE SYSTEM, URINARY TRACT, BLOOD VESSELS AND
HEART. SOME PEOPLE HAVE MILD SYMPTOMS. BUT FOR OTHERS, DIABETIC
NEUROPATHY CAN BE QUITE PAINFUL AND DISABLING. DIABETIC NEUROPATHY IS A
SERIOUS DIABETES COMPLICATION THAT MAY AFFECT AS MANY AS 50% OF PEOPLE
WITH DIABETES. BUT YOU CAN OFTEN PREVENT DIABETIC NEUROPATHY OR SLOW
ITS PROGRESS WITH CONSISTENT BLOOD SUGAR MANAGEMENT AND A HEALTHY
LIFESTYLE.
S&SX:
EDUCATED PT. ON SIGNS AND SYMPTOMS OF NEUROPATHY. THERE ARE FOUR MAIN
TYPES OF DIABETIC NEUROPATHY. YOU CAN HAVE ONE TYPE OR MORE THAN ONE
TYPE OF NEUROPATHY. YOUR SYMPTOMS WILL DEPEND ON THE TYPE YOU HAVE
AND WHICH NERVES ARE AFFECTED. USUALLY, SYMPTOMS DEVELOP GRADUALLY.
YOU MAY NOT NOTICE ANYTHING IS WRONG UNTIL CONSIDERABLE NERVE DAMAGE
HAS OCCURRED.
PERIPHERAL NEUROPATHY THIS TYPE OF NEUROPATHY MAY ALSO BE CALLED
DISTAL SYMMETRIC PERIPHERAL NEUROPATHY. IT'S THE MOST COMMON TYPE OF
DIABETIC NEUROPATHY. IT AFFECTS THE FEET AND LEGS FIRST, FOLLOWED BY THE
HANDS AND ARMS. SIGNS AND SYMPTOMS OF PERIPHERAL NEUROPATHY ARE
OFTEN WORSE AT NIGHT, AND MAY INCLUDE: NUMBNESS OR REDUCED ABILITY TO
FEEL PAIN OR TEMPERATURE CHANGES, TINGLING OR BURNING SENSATION, SHARP
PAINS OR CRAMPS, INCREASED SENSITIVITY TO TOUCH — FOR SOME PEOPLE, EVEN
A BEDSHEET'S WEIGHT CAN BE PAINFUL, SERIOUS FOOT PROBLEMS, SUCH AS
ULCERS, INFECTIONS, AND BONE AND JOINT PAIN
AUTONOMIC NEUROPATHY THE AUTONOMIC NERVOUS SYSTEM CONTROLS YOUR
HEART, BLADDER, STOMACH, INTESTINES, SEX ORGANS AND EYES. DIABETES CAN
AFFECT NERVES IN ANY OF THESE AREAS, POSSIBLY CAUSING: A LACK OF
AWARENESS THAT BLOOD SUGAR LEVELS ARE LOW (HYPOGLYCEMIA
UNAWARENESS), BLADDER OR BOWEL PROBLEMS, SLOW STOMACH EMPTYING
(GASTROPARESIS), CAUSING NAUSEA, VOMITING AND LOSS OF APPETITE, CHANGES
IN THE WAY YOUR EYES ADJUST FROM LIGHT TO DARK, DECREASED SEXUAL
RESPONSE
PROXIMAL NEUROPATHY (DIABETIC POLYRADICULOPATHY) THIS TYPE OF
NEUROPATHY — ALSO CALLED DIABETIC AMYOTROPHY — OFTEN AFFECTS NERVES
IN THE THIGHS, HIPS, BUTTOCKS OR LEGS. IT CAN ALSO AFFECT THE ABDOMINAL
AND CHEST AREA. SYMPTOMS ARE USUALLY ON ONE SIDE OF THE BODY, BUT MAY
SPREAD TO THE OTHER SIDE. YOU MAY HAVE: SEVERE PAIN IN A HIP AND THIGH OR
BUTTOCK, EVENTUAL WEAK AND SHRINKING THIGH MUSCLES, DIFFICULTY RISING
FROM A SITTING POSITION, SEVERE STOMACH PAIN
MONONEUROPATHY (FOCAL NEUROPATHY) THERE ARE TWO TYPES OF
MONONEUROPATHY — CRANIAL AND PERIPHERAL. MONONEUROPATHY REFERS TO
DAMAGE TO A SPECIFIC NERVE. MONONEUROPATHY MAY ALSO LEAD TO: DIFFICULTY
FOCUSING OR DOUBLE VISION, ACHING BEHIND ONE EYE, PARALYSIS ON ONE SIDE
OF YOUR FACE (BELL'S PALSY), NUMBNESS OR TINGLING IN YOUR HAND OR
FINGERS, EXCEPT YOUR PINKIE (LITTLE FINGER), WEAKNESS IN YOUR HAND THAT
MAY CAUSE YOU TO DROP THINGS.

MANAGEMENT:
INSTRUCTED PT. ON MANAGEMENT OF NEUROPATHY. YOU CAN PREVENT OR DELAY
DIABETIC NEUROPATHY AND ITS COMPLICATIONS BY CLOSELY MANAGING YOUR
BLOOD SUGAR AND TAKING GOOD CARE OF YOUR FEET.
BLOOD SUGAR MANAGEMENT. THE AMERICAN DIABETES ASSOCIATION
RECOMMENDS THAT PEOPLE WITH DIABETES HAVE AN A1C TEST AT LEAST TWICE A
YEAR. THIS TEST ESTIMATES YOUR AVERAGE BLOOD SUGAR LEVEL FOR THE PAST
TWO TO THREE MONTHS. A1C GOALS MAY NEED TO BE INDIVIDUALIZED, BUT FOR
MANY ADULTS, THE AMERICAN DIABETES ASSOCIATION RECOMMENDS AN A1C OF
LESS THAN 7%. IF YOUR BLOOD SUGAR LEVELS ARE HIGHER THAN YOUR GOAL, YOU
MAY NEED CHANGES IN YOUR DAILY MANAGEMENT, SUCH AS ADDING OR ADJUSTING
YOUR MEDICATIONS OR CHANGING YOUR DIET.
FOOT CARE. FOOT PROBLEMS, INCLUDING SORES THAT DON'T HEAL, ULCERS AND
EVEN AMPUTATION, ARE COMMON COMPLICATIONS OF DIABETIC NEUROPATHY. BUT
YOU CAN PREVENT MANY OF THESE PROBLEMS BY HAVING A THOROUGH FOOT
EXAM AT LEAST ONCE A YEAR, HAVING YOUR DOCTOR CHECK YOUR FEET AT EACH
OFFICE VISIT AND TAKING GOOD CARE OF YOUR FEET AT HOME. FOLLOW YOUR
DOCTOR'S RECOMMENDATIONS FOR GOOD FOOT CARE. TO PROTECT THE HEALTH
OF YOUR FEET: CHECK YOUR FEET EVERY DAY. LOOK FOR BLISTERS, CUTS,
BRUISES, CRACKED AND PEELING SKIN, REDNESS, AND SWELLING. USE A MIRROR
OR ASK A FRIEND OR FAMILY MEMBER TO HELP EXAMINE PARTS OF YOUR FEET
THAT ARE HARD TO SEE. KEEP YOUR FEET CLEAN AND DRY. WASH YOUR FEET
EVERY DAY WITH LUKEWARM WATER AND MILD SOAP. AVOID SOAKING YOUR FEET.
DRY YOUR FEET AND BETWEEN YOUR TOES CAREFULLY. MOISTURIZE YOUR FEET.
THIS HELPS PREVENT CRACKING. BUT DON'T GET LOTION BETWEEN YOUR TOES,
BECAUSE IT MIGHT ENCOURAGE FUNGAL GROWTH. TRIM YOUR TOENAILS
CAREFULLY. CUT YOUR TOENAILS STRAIGHT ACROSS. FILE THE EDGES CAREFULLY
TO AVOID SHARP EDGES. WEAR CLEAN, DRY SOCKS. LOOK FOR SOCKS MADE OF
COTTON OR MOISTURE-WICKING FIBERS THAT DON'T HAVE TIGHT BANDS OR THICK
SEAMS. WEAR CUSHIONED SHOES THAT FIT WELL. ALWAYS WEAR SHOES OR
SLIPPERS TO PROTECT YOUR FEET. MAKE SURE YOUR SHOES FIT PROPERLY AND
ALLOW YOUR TOES TO MOVE. A FOOT DOCTOR CAN TEACH YOU HOW TO BUY
PROPERLY FITTED SHOES AND TO PREVENT PROBLEMS SUCH AS CORNS AND
CALLUSES. IF YOU QUALIFY FOR MEDICARE, YOUR PLAN MAY COVER THE COST OF
AT LEAST ONE PAIR OF SHOES EACH YEAR.

EDUCATION ON POLYNEUROPATHY
POLYNEUROPATHY IS WHEN MULTIPLE PERIPHERAL NERVES BECOME
DAMAGED, WHICH IS ALSO COMMONLY CALLED PERIPHERAL NEUROPATHY.
PERIPHERAL NERVES ARE THE NERVES OUTSIDE OF THE BRAIN AND SPINAL
CORD. THEY RELAY INFORMATION BETWEEN THE CENTRAL NERVOUS
SYSTEM (CNS), AND ALL OTHER PARTS OF THE BODY. THE BRAIN AND SPINAL
CORD ARE PART OF THE CNS. POLYNEUROPATHY AFFECTS SEVERAL NERVES
IN DIFFERENT PARTS OF THE BODY AT THE SAME TIME. IN CASES OF
MONONEUROPATHY, JUST ONE NERVE IS AFFECTED. POLYNEUROPATHY CAN
AFFECT NERVES RESPONSIBLE FOR FEELING (SENSORY NEUROPATHY),
MOVEMENT (MOTOR NEUROPATHY), OR BOTH (SENSORIMOTOR
NEUROPATHY). IT MAY ALSO AFFECT THE AUTONOMIC NERVES RESPONSIBLE
FOR CONTROLLING FUNCTIONS SUCH AS DIGESTION, THE BLADDER, BLOOD
PRESSURE, AND HEART RATE.

LUMBAR SPONDYLOSIS

SN INSTRUCTED PATIENT ON LUMBAR SPONDYLOSIS, THE LOWER SPINE IS

COMPOSED OF DISC-LIKE STRUCTURES THAT ARE CUSHIONED BY SOFT GEL-
LIKE SECTIONS IN BETWEEN THEM. THE PURPOSE OF THESE SECTIONS IS TO
PROMOTE FLEXIBILITY AND ABSORB THE LOAD OF STRESS APPLIED TO THE
VERTEBRA. DEGENERATION OF THESE AREAS CAUSES A LOSS OF ELASTICITY
AND A PROPENSITY TO BE TORN OR DAMAGED. IF THIS TYPE OF DAMAGE
WERE TO OCCUR, IT MAY LEAD TO A CONDITION CALLED DISC PROLAPSE,
DISC HERNIATION, OR A SLIPPED DISC—A COMMON FEATURE OF LUMBAR
SPONDYLOSIS.

S&SX:

SN INSTRUCTED PATIENT WHILE JUST THINKING OF INJURING THE BONES IN

THE LOWER BACK CAN INDUCE WINCING, 37 PERCENT OF PATIENTS
SUFFERING FROM LUMBAR SPONDYLOSIS DO NOT HAVE SYMPTOMS
INITIALLY. BUT WHEN SYMPTOMS DO APPEAR, THEY CAN PRESENT AS PAIN
RANGING FROM MILD TO SEVERE, INITIALLY PRESENTING AS STIFFNESS IN
THE MORNINGS LASTING FOR MORE THAN 30 MINUTES. ADDITIONS
SYMPTOMS OF LUMBAR SPONDYLOSIS INCLUDE:
LOCALIZED PAIN, PAIN AFTER PROLONGED SITTING, WORSENING PAIN AFTER
REPEATED MOVEMENT, MUSCLE SPASMS, REGIONAL TENDERNESS,
TINGLING, NUMBNESS IN THE LIMBS, WEAKNESS OF AFFECTED LIMB DUE TO
POSSIBLE NERVE COMPRESSION
CAUSES OF SPONDYLOSIS:

SN INSTRUCTED ON CAUSES AND RISK FACTOR OF LUMBAR SPONDYLOSIS.

BEING A DEGENERATIVE CONDITION MEANS THAT IT IS CLOSELY RELATED TO
THE PASSAGE OF TIME. THE IMPACT THAT MINOR TRAUMA OCCURRING
THROUGHOUT ONE’S LIFE CAN ACCUMULATE UNTIL ONE DAY THE SYMPTOMS
OF LUMBAR SPONDYLOSIS PRESENT THEMSELVES. THE FOLLOWING ARE THE
VARIOUS CAUSES AND RISK FACTORS OF THE CONDITION.
CAUSES AND RISK FACTORS:
AGING: THE MOST COMMON CAUSE AS THE PASSAGE OF TIME CAN LEAD TO
CHANGES IN THE BONES OF THE SPINE AND OTHER PROBLEMS.
UNFORTUNATELY, THIS OFTEN MEANS THAT THE DISEASE IS PROGRESSIVE
AND IRREVERSIBLE. BEING OVER THE AGE OF 40 INCREASES ONE’S RISK FOR
LUMBAR SPONDYLOSIS.
ABNORMAL SPINAL MOVEMENT: FREQUENT OVERUSE OF THE BACK AS SEEN
DURING SPORTS OR OTHER PHYSICALLY STRENUOUS ACTIVITY CAN PUT
INCREASED AMOUNTS OF STRESS ON THE LUMBAR VERTEBRAE, LEADING TO
INJURY.
GENERICS: THOSE GENETICALLY PREDISPOSED TO WEAK BONES AND
LIGAMENTS MAY BE AT INCREASED RISK FOR INJURY TO THE LUMBAR SPINE.
LIFESTYLE: CERTAIN LIFESTYLE HABITS AFFECT THE INTEGRITY OF BONES.
SMOKING, FOR EXAMPLE, DECREASES THE AMOUNT OF WATER IN YOUR
DISCS, WHICH ARE NEEDED TO ABSORB IMPACT.
OBESITY: EXCESS WEIGHT PUT EXTRA LOAD ON THE JOINTS OF THE LUMBAR
REGION, ACCELERATING WEAR-AND-TEAR OF THE LUMBAR JOINTS.
PROLONGED SITTING: PUTS PRESSURE ON THE LUMBAR VERTEBRAE.
PRIOR INJURY: MAKES ONE MORE SUSCEPTIBLE FOR LUMBAR SPONDYLOSIS
DEVELOPMENT.

MANAGEMENT OF SPONDYLOSIS:

SN INSTRUCTED ON TREATING LUMBAR SPONDYLOSIS. HAVING CHRONIC LOWER

BACK PAIN CAN CAUSE A LOT OF DIFFICULTY STANDING OR EVEN SITTING, SO MANY
TREATMENT OPTIONS FOCUS ON RELIEVING THIS ASPECT OF LUMBAR
SPONDYLOSIS. IN THE CASE OF SEVERE DISC PROLAPSE, SURGERY MAY BE
REQUIRED. GENERALLY, MOST CASES OF LUMBAR SPONDYLOSIS ARE CONSIDERED
MILD, AND THE FOLLOWING TREATMENT OPTIONS ARE CONVENTIONALLY USED:

CHIROPRACTIC CARE
PHYSIOTHERAPY
ANTI-INFLAMMATORY/PAIN MEDICATION
LIGHT EXERCISES, SUCH AS YOGA OR WATER AEROBICS
THERE ARE ALSO UNCONVENTIONAL TREATMENTS FOR LUMBAR SPONDYLOSIS THAT
INCLUDE:

STEROID EPIDURALS
OSTEOPATHIC MANUAL THERAPY
ACUPUNCTURE
IT IS IMPORTANT TO UNDERSTAND THAT SPINAL DISC DEGENERATION IS A NORMAL
PART OF AGING, BUT NOT ALL CAUSES OF BACK PAIN ARE THE RESULT OF THIS. BY
SPEAKING TO YOU DOCTOR AND GOING THROUGH SOME TESTS, YOU CAN GET BACK
ON YOUR FEET IN NO TIME.

SPINAL STENOSIS
INSTRUCTED PT. ON THE DISEASE PROCESS OF SPINAL STENOSIS. SPINAL STENOSIS
IS A NARROWING OF THE SPACES WITHIN YOUR SPINE, WHICH CAN PUT PRESSURE
ON THE NERVES THAT TRAVEL THROUGH THE SPINE. SPINAL STENOSIS OCCURS
MOST OFTEN IN THE LOWER BACK AND THE NECK. SOME PEOPLE WITH SPINAL
STENOSIS MAY NOT HAVE SYMPTOMS. OTHERS MAY EXPERIENCE PAIN, TINGLING,
NUMBNESS AND MUSCLE WEAKNESS. SYMPTOMS CAN WORSEN OVER TIME.SPINAL
STENOSIS IS MOST COMMONLY CAUSED BY WEAR-AND-TEAR CHANGES IN THE SPINE
RELATED TO OSTEOARTHRITIS. IN SEVERE CASES OF SPINAL STENOSIS, DOCTORS
MAY RECOMMEND SURGERY TO CREATE ADDITIONAL SPACE FOR THE SPINAL CORD
OR NERVES.

S&SX:

INSTRUCTED PT. ON SIGNS AND SYMPTOMS OF SPINAL STENOSIS. MANY PEOPLE

HAVE EVIDENCE OF SPINAL STENOSIS ON AN MRI OR CT SCAN BUT MAY NOT HAVE
SYMPTOMS. WHEN THEY DO OCCUR, THEY OFTEN START GRADUALLY AND WORSEN
OVER TIME. SYMPTOMS VARY DEPENDING ON THE LOCATION OF THE STENOSIS AND
WHICH NERVES ARE AFFECTED.
IN THE NECK (CERVICAL SPINE) SUCH AS NUMBNESS OR TINGLING IN A HAND, ARM,
FOOT OR LEG, WEAKNESS IN A HAND, ARM, FOOT OR LEG, PROBLEMS WITH WALKING
AND BALANCE, NECK PAIN. IN SEVERE CASES, BOWEL OR BLADDER DYSFUNCTION
(URINARY URGENCY AND INCONTINENCE)
IN THE LOWER BACK (LUMBAR SPINE)SUCH AS NUMBNESS OR TINGLING IN A FOOT
OR LEG, WEAKNESS IN A FOOT OR LEG, PAIN OR CRAMPING IN ONE OR BOTH LEGS
WHEN YOU STAND FOR LONG PERIODS OF TIME OR WHEN YOU WALK, WHICH
USUALLY EASES WHEN YOU BEND FORWARD OR SIT, BACK PAIN.

CAUSES:

EDUCATED PT. ON CAUSES OF SPINAL STENOSIS.

HERNIATED DISK AND BONE SPURS ON SPINE
THE BACKBONE (SPINE) RUNS FROM YOUR NECK TO YOUR LOWER BACK. THE BONES
OF YOUR SPINE FORM A SPINAL CANAL, WHICH PROTECTS YOUR SPINAL CORD
(NERVES).
SOME PEOPLE ARE BORN WITH A SMALL SPINAL CANAL. BUT MOST SPINAL STENOSIS
OCCURS WHEN SOMETHING HAPPENS TO NARROW THE OPEN SPACE WITHIN THE
SPINE. CAUSES OF SPINAL STENOSIS MAY INCLUDE:

 OVERGROWTH OF BONE. WEAR AND TEAR DAMAGE FROM

OSTEOARTHRITIS ON YOUR SPINAL BONES CAN PROMPT THE
FORMATION OF BONE SPURS, WHICH CAN GROW INTO THE SPINAL
CANAL. PAGET'S DISEASE, A BONE DISEASE THAT USUALLY AFFECTS
ADULTS, ALSO CAN CAUSE BONE OVERGROWTH IN THE SPINE.
 HERNIATED DISKS. THE SOFT CUSHIONS THAT ACT AS SHOCK
ABSORBERS BETWEEN YOUR VERTEBRAE TEND TO DRY OUT WITH AGE.
CRACKS IN A DISK'S EXTERIOR MAY ALLOW SOME OF THE SOFT INNER
MATERIAL TO ESCAPE AND PRESS ON THE SPINAL CORD OR NERVES.
 THICKENED LIGAMENTS. THE TOUGH CORDS THAT HELP HOLD THE
BONES OF YOUR SPINE TOGETHER CAN BECOME STIFF AND THICKENED
OVER TIME. THESE THICKENED LIGAMENTS CAN BULGE INTO THE SPINAL
CANAL.
  TUMORS. ABNORMAL GROWTHS CAN FORM INSIDE THE SPINAL CORD,
WITHIN THE MEMBRANES THAT COVER THE SPINAL CORD OR IN THE
SPACE BETWEEN THE SPINAL CORD AND VERTEBRAE. THESE ARE
UNCOMMON AND IDENTIFIABLE ON SPINE IMAGING WITH AN MRI OR CT.
 SPINAL INJURIES. CAR ACCIDENTS AND OTHER TRAUMA CAN CAUSE
DISLOCATIONS OR FRACTURES OF ONE OR MORE VERTEBRAE.
DISPLACED BONE FROM A SPINAL FRACTURE MAY DAMAGE THE
CONTENTS OF THE SPINAL CANAL. SWELLING OF NEARBY TISSUE
IMMEDIATELY AFTER BACK SURGERY ALSO CAN PUT PRESSURE ON THE
SPINAL CORD OR NERVES.

MANAGEMENT:

EDUCATED PT. ON MANAGEMENT OF SPINAL STENOSIS. TO DIAGNOSE SPINAL

STENOSIS, YOUR DOCTOR MAY ASK YOU ABOUT SIGNS AND SYMPTOMS, DISCUSS
YOUR MEDICAL HISTORY, AND CONDUCT A PHYSICAL EXAMINATION. HE OR SHE MAY
ORDER SEVERAL IMAGING TESTS TO HELP PINPOINT THE CAUSE OF YOUR SIGNS
AND SYMPTOMS.
IMAGING TESTS
THESE TESTS MAY INCLUDE:

 X-RAYS. AN X-RAY OF YOUR BACK CAN REVEAL BONY CHANGES, SUCH AS

BONE SPURS THAT MAY BE NARROWING THE SPACE WITHIN THE SPINAL
CANAL. EACH X-RAY INVOLVES A SMALL EXPOSURE TO RADIATION.
 MAGNETIC RESONANCE IMAGING (MRI). AN MRI USES A POWERFUL
MAGNET AND RADIO WAVES TO PRODUCE CROSS-SECTIONAL IMAGES OF
YOUR SPINE. THE TEST CAN DETECT DAMAGE TO YOUR DISKS AND
LIGAMENTS, AS WELL AS THE PRESENCE OF TUMORS. MOST IMPORTANT,
IT CAN SHOW WHERE THE NERVES IN THE SPINAL CORD ARE BEING
PRESSURED.
 CT OR CT MYELOGRAM. IF YOU CAN'T HAVE AN MRI, YOUR DOCTOR MAY
RECOMMEND COMPUTERIZED TOMOGRAPHY (CT), A TEST THAT
COMBINES X-RAY IMAGES TAKEN FROM MANY DIFFERENT ANGLES TO
PRODUCE DETAILED, CROSS-SECTIONAL IMAGES OF YOUR BODY. IN
A CT MYELOGRAM, THE CT SCAN IS CONDUCTED AFTER A CONTRAST DYE
IS INJECTED. THE DYE OUTLINES THE SPINAL CORD AND NERVES, AND IT
CAN REVEAL HERNIATED DISKS, BONE SPURS AND TUMORS.

OBSTRUCTIVE SLEEP APNEA

INSTRUCTED PT. ON DISEASE PROCESS OF OBSTRUCTIVE SLEEP APNEA.
OBSTRUCTIVE SLEEP APNEA IS A POTENTIALLY SERIOUS SLEEP DISORDER. IT
CAUSES BREATHING TO REPEATEDLY STOP AND START DURING SLEEP.
THERE ARE SEVERAL TYPES OF SLEEP APNEA, BUT THE MOST COMMON IS
OBSTRUCTIVE SLEEP APNEA. THIS TYPE OF APNEA OCCURS WHEN YOUR THROAT
MUSCLES INTERMITTENTLY RELAX AND BLOCK YOUR AIRWAY DURING SLEEP. A
NOTICEABLE SIGN OF OBSTRUCTIVE SLEEP APNEA IS SNORING.
TREATMENTS FOR OBSTRUCTIVE SLEEP APNEA ARE AVAILABLE. ONE TREATMENT
INVOLVES USING A DEVICE THAT USES POSITIVE PRESSURE TO KEEP YOUR AIRWAY
OPEN WHILE YOU SLEEP. ANOTHER OPTION IS A MOUTHPIECE TO THRUST YOUR
LOWER JAW FORWARD DURING SLEEP. IN SOME CASES, SURGERY MAY BE AN
OPTION TOO.

S&SX:

EDUCATED PT ON SIGNS AND SYMPTOMS OF OBSTRUCTIVE SLEEP APNEA. SIGNS

AND SYMPTOMS OF OBSTRUCTIVE SLEEP APNEA INCLUDE: EXCESSIVE DAYTIME
SLEEPINESS, LOUD SNORING, OBSERVED EPISODES OF STOPPED BREATHING
DURING SLEEP, ABRUPT AWAKENINGS ACCOMPANIED BY GASPING OR CHOKING,
AWAKENING WITH A DRY MOUTH OR SORE THROAT, MORNING HEADACHE,
DIFFICULTY CONCENTRATING DURING THE DAY, EXPERIENCING MOOD CHANGES,
SUCH AS DEPRESSION OR IRRITABILITY, HIGH BLOOD PRESSURE, NIGHTTIME
SWEATING, DECREASED LIBIDO.
CAUSES:

OBSTRUCTIVE SLEEP APNEA OCCURS WHEN THE MUSCLES IN THE BACK OF YOUR
THROAT RELAX TOO MUCH TO ALLOW NORMAL BREATHING. THESE MUSCLES
SUPPORT STRUCTURES INCLUDING THE BACK OF THE ROOF OF YOUR MOUTH (SOFT
PALATE), THE TRIANGULAR PIECE OF TISSUE HANGING FROM THE SOFT PALATE
(UVULA), THE TONSILS AND THE TONGUE.
WHEN THE MUSCLES RELAX, YOUR AIRWAY NARROWS OR CLOSES AS YOU BREATHE
IN AND BREATHING MAY BE INADEQUATE FOR 10 SECONDS OR LONGER. THIS MAY
LOWER THE LEVEL OF OXYGEN IN YOUR BLOOD AND CAUSE A BUILDUP OF CARBON
DIOXIDE.
YOUR BRAIN SENSES THIS IMPAIRED BREATHING AND BRIEFLY ROUSES YOU FROM
SLEEP SO THAT YOU CAN REOPEN YOUR AIRWAY. THIS AWAKENING IS USUALLY SO
BRIEF THAT YOU DON'T REMEMBER IT.
YOU CAN AWAKEN WITH SHORTNESS OF BREATH THAT CORRECTS ITSELF QUICKLY,
WITHIN ONE OR TWO DEEP BREATHS. YOU MAY MAKE A SNORTING, CHOKING OR
GASPING SOUND.
THIS PATTERN CAN REPEAT ITSELF FIVE TO 30 TIMES OR MORE EACH HOUR, ALL
NIGHT LONG. THESE DISRUPTIONS IMPAIR YOUR ABILITY TO REACH THE DESIRED
DEEP, RESTFUL PHASES OF SLEEP, AND YOU'LL PROBABLY FEEL SLEEPY DURING
YOUR WAKING HOURS.
PEOPLE WITH OBSTRUCTIVE SLEEP APNEA MAY NOT BE AWARE THAT THEIR SLEEP
WAS INTERRUPTED. IN FACT, MANY PEOPLE WITH THIS TYPE OF SLEEP APNEA THINK
THEY SLEPT WELL ALL NIGHT.

MANAGEMENT:

EDUCATED PT ON MANAGEMENT OF OBSTRUCTIVE SLEEP APNEA, LIFESTYLE

CHANGES: FOR MILDER CASES OF OBSTRUCTIVE SLEEP APNEA, YOUR DOCTOR MAY
RECOMMEND LIFESTYLE CHANGES:

 LOSE WEIGHT IF YOU'RE OVERWEIGHT.

  EXERCISE REGULARLY.
 DRINK ALCOHOL MODERATELY, IF AT ALL, AND DON'T DRINK SEVERAL
HOURS BEFORE BEDTIME.
 QUIT SMOKING.
 USE A NASAL DECONGESTANT OR ALLERGY MEDICATIONS.
 DON'T SLEEP ON YOUR BACK.
 AVOID TAKING SEDATIVE MEDICATIONS SUCH AS ANTI-ANXIETY DRUGS
OR SLEEPING PILLS.
IF THESE MEASURES DON'T IMPROVE YOUR SLEEP OR IF YOUR APNEA IS MODERATE
TO SEVERE, THEN YOUR DOCTOR MAY RECOMMEND OTHER TREATMENTS. CERTAIN
DEVICES CAN HELP OPEN UP A BLOCKED AIRWAY. IN OTHER CASES, SURGERY MAY
BE NECESSARY.
THERAPIES: CONTINUOUS POSITIVE AIRWAY PRESSURE (CPAP)OPEN POP-UP DIALOG
BOX
ORAL DEVICEOPEN POP-UP DIALOG BOX
 POSITIVE AIRWAY PRESSURE. IF YOU HAVE OBSTRUCTIVE SLEEP APNEA,
YOU MAY BENEFIT FROM POSITIVE AIRWAY PRESSURE. IN THIS
TREATMENT, A MACHINE DELIVERS AIR PRESSURE THROUGH A PIECE
THAT FITS INTO YOUR NOSE OR IS PLACED OVER YOUR NOSE AND
MOUTH WHILE YOU SLEEP.
POSITIVE AIRWAY PRESSURE REDUCES THE NUMBER OF RESPIRATORY
EVENTS THAT OCCUR AS YOU SLEEP, REDUCES DAYTIME SLEEPINESS
AND IMPROVES YOUR QUALITY OF LIFE.
THE MOST COMMON TYPE IS CALLED CONTINUOUS POSITIVE AIRWAY
PRESSURE, OR CPAP (SEE-PAP). WITH THIS TREATMENT, THE PRESSURE
OF THE AIR BREATHED IS CONTINUOUS, CONSTANT AND SOMEWHAT
GREATER THAN THAT OF THE SURROUNDING AIR, WHICH IS JUST
ENOUGH TO KEEP YOUR UPPER AIRWAY PASSAGES OPEN. THIS AIR
PRESSURE PREVENTS OBSTRUCTIVE SLEEP APNEA AND SNORING.
ALTHOUGH CPAP IS THE MOST CONSISTENTLY SUCCESSFUL AND MOST
COMMONLY USED METHOD OF TREATING OBSTRUCTIVE SLEEP APNEA,
SOME PEOPLE FIND THE MASK CUMBERSOME, UNCOMFORTABLE OR
LOUD. HOWEVER, NEWER MACHINES ARE SMALLER AND LESS NOISY
THAN OLDER MACHINES AND THERE ARE A VARIETY OF MASK DESIGNS
FOR INDIVIDUAL COMFORT.
ALSO, WITH SOME PRACTICE, MOST PEOPLE LEARN TO ADJUST THE
MASK TO OBTAIN A COMFORTABLE AND SECURE FIT. YOU MAY NEED TO
TRY DIFFERENT TYPES TO FIND A SUITABLE MASK. SEVERAL OPTIONS
ARE AVAILABLE, SUCH AS NASAL MASKS, NASAL PILLOWS OR FACE
MASKS.
IF YOU'RE HAVING PARTICULAR DIFFICULTIES TOLERATING PRESSURE,
SOME MACHINES HAVE SPECIAL ADAPTIVE PRESSURE FUNCTIONS TO
IMPROVE COMFORT. YOU ALSO MAY BENEFIT FROM USING A HUMIDIFIER
ALONG WITH YOUR CPAP SYSTEM.
CPAP MAY BE GIVEN AT A CONTINUOUS (FIXED) PRESSURE OR VARIED
(AUTOTITRATING) PRESSURE. IN FIXED CPAP, THE PRESSURE STAYS
CONSTANT. IN AUTOTITRATING CPAP, THE LEVELS OF PRESSURE ARE
ADJUSTED IF THE DEVICE SENSES INCREASED AIRWAY RESISTANCE.
BILEVEL POSITIVE AIRWAY PRESSURE (BPAP), ANOTHER TYPE OF
POSITIVE AIRWAY PRESSURE, DELIVERS A PRESET AMOUNT OF
 PRESSURE WHEN YOU BREATHE IN AND A DIFFERENT AMOUNT OF
PRESSURE WHEN YOU BREATHE OUT.
CPAP IS MORE COMMONLY USED BECAUSE IT'S BEEN WELL STUDIED FOR
OBSTRUCTIVE SLEEP APNEA AND HAS BEEN SHOWN TO EFFECTIVELY
TREAT OBSTRUCTIVE SLEEP APNEA. HOWEVER, FOR PEOPLE WHO HAVE
DIFFICULTY TOLERATING FIXED CPAP, BPAP OR
AUTOTITRATING CPAP MAY BE WORTH A TRY.
DON'T STOP USING YOUR POSITIVE AIRWAY PRESSURE MACHINE IF YOU
HAVE PROBLEMS. CHECK WITH YOUR DOCTOR TO SEE WHAT
ADJUSTMENTS YOU CAN MAKE TO IMPROVE ITS COMFORT.
IN ADDITION, CONTACT YOUR DOCTOR IF YOU STILL SNORE DESPITE
TREATMENT, IF YOU BEGIN SNORING AGAIN OR IF YOUR WEIGHT GOES
UP OR DOWN BY 10% OR MORE.
 MOUTHPIECE (ORAL DEVICE). THOUGH POSITIVE AIRWAY PRESSURE IS
OFTEN AN EFFECTIVE TREATMENT, ORAL APPLIANCES ARE AN
ALTERNATIVE FOR SOME PEOPLE WITH MILD OR MODERATE
OBSTRUCTIVE SLEEP APNEA. THESE DEVICES MAY REDUCE YOUR
SLEEPINESS AND IMPROVE YOUR QUALITY OF LIFE.
THESE DEVICES ARE DESIGNED TO KEEP YOUR THROAT OPEN. SOME
DEVICES KEEP YOUR AIRWAY OPEN BY BRINGING YOUR LOWER JAW
FORWARD, WHICH CAN SOMETIMES RELIEVE SNORING AND
OBSTRUCTIVE SLEEP APNEA. OTHER DEVICES HOLD YOUR TONGUE IN A
DIFFERENT POSITION.
IF YOU AND YOUR DOCTOR DECIDE TO EXPLORE THIS OPTION, YOU'LL
NEED TO SEE A DENTIST EXPERIENCED IN DENTAL SLEEP MEDICINE
APPLIANCES FOR THE FITTING AND FOLLOW-UP THERAPY. A NUMBER OF
DEVICES ARE AVAILABLE. CLOSE FOLLOW-UP IS NEEDED TO ENSURE
SUCCESSFUL TREATMENT.

BENIGN PROSTATIC HYPERPLASIA

INSTRUCTED PT. ON DISEASE PROCESS OF BPH. BENIGN PROSTATIC HYPERPLASIA
(BPH) — ALSO CALLED PROSTATE GLAND ENLARGEMENT — IS A COMMON
CONDITION AS MEN GET OLDER. AN ENLARGED PROSTATE GLAND CAN CAUSE
UNCOMFORTABLE URINARY SYMPTOMS, SUCH AS BLOCKING THE FLOW OF URINE
OUT OF THE BLADDER. IT CAN ALSO CAUSE BLADDER, URINARY TRACT OR KIDNEY
PROBLEMS.
THERE ARE SEVERAL EFFECTIVE TREATMENTS FOR PROSTATE GLAND
ENLARGEMENT, INCLUDING MEDICATIONS, MINIMALLY INVASIVE THERAPIES AND
SURGERY. TO CHOOSE THE BEST OPTION, YOU AND YOUR DOCTOR WILL CONSIDER
YOUR SYMPTOMS, THE SIZE OF YOUR PROSTATE, OTHER HEALTH CONDITIONS YOU
MIGHT HAVE AND YOUR PREFERENCES.
S&SX:

EDUCATED PT ON SIGNS AND SYMPTOMS OF BPH. THE SEVERITY OF SYMPTOMS IN

PEOPLE WHO HAVE PROSTATE GLAND ENLARGEMENT VARIES, BUT SYMPTOMS TEND
TO GRADUALLY WORSEN OVER TIME. COMMON SIGNS AND SYMPTOMS OF BPH
INCLUDE:

 FREQUENT OR URGENT NEED TO URINATE

 INCREASED FREQUENCY OF URINATION AT NIGHT (NOCTURIA)
 DIFFICULTY STARTING URINATION
 WEAK URINE STREAM OR A STREAM THAT STOPS AND STARTS
 DRIBBLING AT THE END OF URINATION
 INABILITY TO COMPLETELY EMPTY THE BLADDER
LESS COMMON SIGNS AND SYMPTOMS INCLUDE:

 URINARY TRACT INFECTION

 INABILITY TO URINATE
 BLOOD IN THE URINE
THE SIZE OF YOUR PROSTATE DOESN'T NECESSARILY DETERMINE THE SEVERITY OF
YOUR SYMPTOMS. SOME MEN WITH ONLY SLIGHTLY ENLARGED PROSTATES CAN
HAVE SIGNIFICANT SYMPTOMS, WHILE OTHER MEN WITH VERY ENLARGED
PROSTATES CAN HAVE ONLY MINOR URINARY SYMPTOMS.
IN SOME MEN, SYMPTOMS EVENTUALLY STABILIZE AND MIGHT EVEN IMPROVE OVER
TIME.
CAUSES:

INSTRUCTED PT. ON CAUSES OF BPH. THE PROSTATE GLAND IS LOCATED BENEATH

YOUR BLADDER. THE TUBE THAT TRANSPORTS URINE FROM THE BLADDER OUT OF
YOUR PENIS (URETHRA) PASSES THROUGH THE CENTER OF THE PROSTATE. WHEN
THE PROSTATE ENLARGES, IT BEGINS TO BLOCK URINE FLOW. MOST MEN HAVE
CONTINUED PROSTATE GROWTH THROUGHOUT LIFE. IN MANY MEN, THIS
CONTINUED GROWTH ENLARGES THE PROSTATE ENOUGH TO CAUSE URINARY
SYMPTOMS OR TO SIGNIFICANTLY BLOCK URINE FLOW. IT ISN'T ENTIRELY CLEAR
WHAT CAUSES THE PROSTATE TO ENLARGE. HOWEVER, IT MIGHT BE DUE TO
CHANGES IN THE BALANCE OF SEX HORMONES AS MEN GROW OLDER.
MANAGEMENT:

EDUCATED PT. ON MANAGEMENT OF BPH. A WIDE VARIETY OF TREATMENTS ARE

AVAILABLE FOR ENLARGED PROSTATE, INCLUDING MEDICATION, MINIMALLY
INVASIVE THERAPIES AND SURGERY. THE BEST TREATMENT CHOICE FOR YOU
DEPENDS ON SEVERAL FACTORS, INCLUDING:

 THE SIZE OF YOUR PROSTATE

 YOUR AGE
 YOUR OVERALL HEALTH
 THE AMOUNT OF DISCOMFORT OR BOTHER YOU ARE EXPERIENCING
IF YOUR SYMPTOMS ARE TOLERABLE, YOU MIGHT DECIDE TO POSTPONE
TREATMENT AND SIMPLY MONITOR YOUR SYMPTOMS. FOR SOME MEN, SYMPTOMS
CAN EASE WITHOUT TREATMENT.
MEDICATION IS THE MOST COMMON TREATMENT FOR MILD TO MODERATE
SYMPTOMS OF PROSTATE ENLARGEMENT. THE OPTIONS INCLUDE:
  ALPHA BLOCKERS. THESE MEDICATIONS RELAX BLADDER NECK
MUSCLES AND MUSCLE FIBERS IN THE PROSTATE, MAKING URINATION
EASIER. ALPHA BLOCKERS — WHICH INCLUDE ALFUZOSIN (UROXATRAL),
DOXAZOSIN (CARDURA), TAMSULOSIN (FLOMAX) AND SILODOSIN
(RAPAFLO) — USUALLY WORK QUICKLY IN MEN WITH RELATIVELY SMALL
PROSTATES. SIDE EFFECTS MIGHT INCLUDE DIZZINESS AND A HARMLESS
CONDITION IN WHICH SEMEN GOES BACK INTO THE BLADDER INSTEAD OF
OUT THE TIP OF THE PENIS (RETROGRADE EJACULATION).
 5-ALPHA REDUCTASE INHIBITORS. THESE MEDICATIONS SHRINK YOUR
PROSTATE BY PREVENTING HORMONAL CHANGES THAT CAUSE
PROSTATE GROWTH. THESE MEDICATIONS — WHICH INCLUDE
FINASTERIDE (PROSCAR) AND DUTASTERIDE (AVODART) — MIGHT TAKE
UP TO SIX MONTHS TO BE EFFECTIVE. SIDE EFFECTS INCLUDE
RETROGRADE EJACULATION.
 COMBINATION DRUG THERAPY. YOUR DOCTOR MIGHT RECOMMEND
TAKING AN ALPHA BLOCKER AND A 5-ALPHA REDUCTASE INHIBITOR AT
THE SAME TIME IF EITHER MEDICATION ALONE ISN'T EFFECTIVE.
 TADALAFIL (CIALIS). STUDIES SUGGEST THIS MEDICATION, WHICH IS
OFTEN USED TO TREAT ERECTILE DYSFUNCTION, CAN ALSO TREAT
PROSTATE ENLARGEMENT.
MINIMALLY INVASIVE OR SURGICAL THERAPY MIGHT BE RECOMMENDED IF:

 YOUR SYMPTOMS ARE MODERATE TO SEVERE

 MEDICATION HASN'T RELIEVED YOUR SYMPTOMS
 YOU HAVE A URINARY TRACT OBSTRUCTION, BLADDER STONES, BLOOD
IN YOUR URINE OR KIDNEY PROBLEMS
 YOU PREFER DEFINITIVE TREATMENT
MINIMALLY INVASIVE OR SURGICAL THERAPY MIGHT NOT BE AN OPTION IF YOU
HAVE:

 AN UNTREATED URINARY TRACT INFECTION

 URETHRAL STRICTURE DISEASE
 A HISTORY OF PROSTATE RADIATION THERAPY OR URINARY TRACT
SURGERY
 A NEUROLOGICAL DISORDER, SUCH AS PARKINSON'S DISEASE OR
MULTIPLE SCLEROSIS
ANY TYPE OF PROSTATE PROCEDURE CAN CAUSE SIDE EFFECTS. DEPENDING ON
THE PROCEDURE YOU CHOOSE, COMPLICATIONS MIGHT INCLUDE:

 SEMEN FLOWING BACKWARD INTO THE BLADDER INSTEAD OF OUT

THROUGH THE PENIS DURING EJACULATION (RETROGRADE
EJACULATION)
 TEMPORARY DIFFICULTY WITH URINATION
 URINARY TRACT INFECTION
 BLEEDING
 ERECTILE DYSFUNCTION
 VERY RARELY, LOSS OF BLADDER CONTROL (INCONTINENCE)
PAROXYSMAL ATRIAL FIBRILLATION
INSTRUCTED PT. ON DISEASE PROCESS OF PAF. PAROXYSMAL ATRIAL
FIBRILLATION OCCURS WHEN A RAPID, ERRATIC HEART RATE BEGINS SUDDENLY
AND THEN STOPS ON ITS OWN WITHIN 7 DAYS. IT IS ALSO KNOWN AS INTERMITTENT
A-FIB AND OFTEN LASTS FOR LESS THAN 24 HOURS. THE AMERICAN HEART
ASSOCIATION (AHA) ESTIMATE THAT 2.7 MILLION AMERICAN PEOPLE LIVE WITH SOME
FORM OF A-FIB. THE LIKELIHOOD OF EXPERIENCING PAROXYSMAL A-FIB INCREASES
WITH AGE. WHILE PAROXYSMAL A-FIB IS NOT LIFE-THREATENING ON ITS OWN, IT CAN
HAVE SERIOUS CONSEQUENCES. AS A RESULT, DIAGNOSING AND TREATING THE
PROBLEM AS EARLY AS POSSIBLE IS VERY IMPORTANT.

CAUSES:

EDUCATED PT. ON CAUSES OF PAF. PAROXYSMAL A-FIB OCCURS WHEN THERE ARE
ABNORMAL ELECTRIC PATHWAYS IN THE HEART AND THE HEART IS NOT BEATING
REGULARLY OR PUMPING ENOUGH OXYGEN-RICH BLOOD AROUND THE BODY.
PINTERESTPAROXYSMAL A-FIB MAY BE CAUSED BY LIFESTYLE CHOICES SUCH AS
ILLEGAL DRUGS, SMOKING, ALCOHOL, OBESITY, AND EXCESSIVE EXERCISE.
IT CAN BE ASSOCIATED WITH PRE-EXISTING OR PREVIOUS HEALTH CONDITIONS,
SUCH AS:
 PREVIOUS HEART ATTACK OR HEART SURGERY
 HEART DISEASE
 DIABETES
 SLEEP APNEA
 HIGH BLOOD PRESSURE
 LUNG DISEASE
 OVERACTIVE THYROID
CERTAIN LIFESTYLE CHOICES CAN ALSO LEAD TO A-FIB, SUCH AS:
 EXCESSIVE ALCOHOL
 SMOKING
 OTHER STIMULANTS, SUCH AS CAFFEINE AND SOME OVER-THE-COUNTER
MEDICATION
 ILLEGAL DRUGS, SUCH AS AMPHETAMINES, METHAMPHETAMINES, AND
COCAINE
 BEING OVERWEIGHT OR OBESE
 STRESS
 POOR SLEEP
 PROLONGED EXERCISE
EXERCISE IS CONSIDERED A HEALTHFUL HABIT. HOWEVER, PEOPLE SHOULD
CONSULT WITH THEIR DOCTOR BEFORE STARTING A NEW WORKOUT OR
INCREASING THE INTENSITY OF THEIR EXERCISE. IN SOME CASES, INCREASED
PHYSICAL EXERCISE CAN ALSO LEAD TO A-FIB DUE TO THE STRAIN IT CAN PLACE ON
THE HEART.
S&SX:

INSTRUCTED PT. ON SIGNS AND SYMPTOMS OF PAF. COMMON SYMPTOMS OF

PAROXYSMAL A-FIB ARE:
STHEART PALPITATIONS AND SHORTNESS OF BREATH MAY BE COMMON SYMPTOMS
OF PAROXYSMAL A-FIB.
 RACING HEART OR PALPITATIONS
 SHORTNESS OF BREATH
 DIZZINESS OR LIGHT-HEADEDNESS
 FATIGUE OR WEAKNESS
 NAUSEA
IF ANYONE IS EXPERIENCING ANY OF THESE SYMPTOMS, THEY SHOULD CONTACT
THEIR DOCTOR AS SOON AS THEY NOTICE THEM. EVEN IF THE SYMPTOMS GO AWAY,
IT IS IMPORTANT FOR PEOPLE TO HAVE A PHYSICAL EXAMINATION AND MONITOR
THEIR HEART’S ACTIVITY.
SOMETIMES, THERE ARE NO SYMPTOMS AT ALL. HOWEVER, A DOCTOR WILL BE ABLE
TO DIAGNOSE THE PROBLEM WITH A PHYSICAL EXAM OR AN ELECTROCARDIOGRAM
(ECG OR EKG).
AN ECG IS A SIMPLE TEST THAT INVOLVES HAVING SENSORS ATTACHED TO THE SKIN
ON THE ARMS, LEGS, AND CHEST. THE SENSORS DETECT ELECTRICAL SIGNALS
EACH TIME THE HEART BEATS. A DOCTOR USES THE SIGNALS TO IDENTIFY ANY
PROBLEMS. AN ECG TEST NORMALLY ONLY TAKES A FEW MINUTES.

MANAGEMENT:

EDUCATED PT. ON MANAGEMENT OF PAF. THERE ARE A NUMBER OF TREATMENT

OPTIONS, WHICH INCLUDE:
 RATE CONTROL MEDICATION: THIS IS THE MOST COMMON A-FIB TREATMENT.
ITS AIM IS TO LOWER THE HEART RATE TO BETWEEN 60 AND 80 BEATS PER
MINUTE WHILE AT REST AND ALSO REGULATE ELECTRICAL CURRENTS.
 RHYTHM CONTROL: SOMETIMES KNOWN AS MEDICAL CARDIOVERSION,
RHYTHM CONTROL AIMS TO BRING THE HEART BACK TO A NATURAL RHYTHM.
 BLOOD THINNERS OR ANTICOAGULANTS: DOCTORS MAY PRESCRIBE THESE
DRUGS TO STOP THE BLOOD FROM CLOTTING, WHICH IN TURN DECREASE THE
LIKELIHOOD OF A STROKE.
 ELECTRICAL CARDIOVERSION: THIS TREATMENT USES AN ELECTRICAL
CURRENT TO RESTORE THE HEART TO A NATURAL RHYTHM. THIS TREATMENT
AIMS TO ACHIEVE THE SAME GOAL AS RHYTHM CONTROL MEDICATION. IT IS
MORE COMMONLY USED FOR PEOPLE WHO HAVE BEEN EXPERIENCING
PAROXYSMAL A-FIB FOR MORE THAN 48 HOURS.
DOCTORS WILL OFTEN GIVE BLOOD THINNERS ALONGSIDE ELECTRICAL
CARDIOVERSION TO LIMIT THE CHANCES OF A STROKE DURING THE PROCESS.
ANOTHER PROCEDURE TO TREAT A-FIB, CALLED CATHETER ABLATION, INVOLVES
SCARRING THE AREAS OF THE HEART THAT ARE CAUSING PROBLEMS. PAROXYSMAL
A-FIB OCCURS WHEN HEART’S ELECTRICAL CURRENT REACHES HEART MUSCLE
THAT IT WOULDN’T NORMALLY REACH, WHICH CAUSES IRREGULAR OR ERRATIC
HEARTBEATS. SCARRING THE AREA PREVENTS THIS FROM HAPPENING.
DURING THIS PROCEDURE, A DOCTOR INSERTS THIN WIRES CALLED CATHETERS
INTO A VEIN IN A PERSON’S NECK OR GROIN. THESE WIRES ARE THEN GUIDED TO
THE HEART, WHERE HEATED ELECTRODES ON THE END OF THE WIRES SCAR THE
PROBLEM AREA.
A PERSON UNDERGOING THIS PROCEDURE WILL USUALLY BE GIVEN A LOCAL
ANESTHETIC AT THE AREA WHERE THE WIRES ARE INSERTED. THE PERSON IS
USUALLY AWAKE DURING THE PROCEDURE BUT SOME PEOPLE MAY BE SEDATED.
MOST PEOPLE WILL BE ABLE TO GO HOME ON THE SAME DAY, ALTHOUGH OTHERS
MAY BE KEPT IN OVERNIGHT.
BECAUSE OF THE INCREASED RISK OF COMPLICATIONS OCCURRING DURING
SURGERY, DOCTORS ARE LIKELY TO RECOMMEND THAT PEOPLE WHO EXPERIENCE
PAROXYSMAL A-FIB SHOULD TAKE MEDICATION IN THE FIRST INSTANCE.

HYPERTENSIVE HEART DISEASE

INSTRUCTED PT. ON DISEASE PROCESS OF HYPERTENSIVE HEART DISEASE.
HYPERTENSIVE HEART DISEASE REFERS TO HEART CONDITIONS CAUSED BY HIGH
BLOOD PRESSURE. THE HEART WORKING UNDER INCREASED PRESSURE CAUSES
SOME DIFFERENT HEART DISORDERS. HYPERTENSIVE HEART DISEASE INCLUDES
HEART FAILURE, THICKENING OF THE HEART MUSCLE, CORONARY ARTERY DISEASE,
AND OTHER CONDITIONS. HYPERTENSIVE HEART DISEASE CAN CAUSE SERIOUS
HEALTH PROBLEMS. IT’S THE LEADING CAUSE OF DEATH FROM HIGH BLOOD
PRESSURE.

TYPES OF HYPERTENSIVE HEART DISEASE:

EDUCATED PT. ON THE TYPES OF HYPERTENSIVE HEART DISEASE

1.) NARROWING OF THE ARETERIES
CORONARY ARTERIES TRANSPORT BLOOD TO YOUR HEART MUSCLE. WHEN HIGH
BLOOD PRESSURE CAUSES THE BLOOD VESSELS TO BECOME NARROW, BLOOD
FLOW TO THE HEART CAN SLOW OR STOP. THIS CONDITION IS KNOWN AS
CORONARY HEART DISEASE (CHD), ALSO CALLED CORONARY ARTERY DISEASE.
CHD MAKES IT DIFFICULT FOR YOUR HEART TO FUNCTION AND SUPPLY THE REST OF
YOUR ORGANS WITH BLOOD. IT CAN PUT YOU AT RISK FOR HEART ATTACK FROM A
BLOOD CLOT THAT GETS STUCK IN ONE OF THE NARROWED ARTERIES AND CUTS
OFF BLOOD FLOW TO YOUR HEART.
2.) THICKENING AND ENLARGEMENT OF THE HEART
HIGH BLOOD PRESSURE MAKES IT DIFFICULT FOR YOUR HEART TO PUMP BLOOD.
LIKE OTHER MUSCLES IN YOUR BODY, REGULAR HARD WORK CAUSES YOUR HEART
MUSCLES TO THICKEN AND GROW. THIS ALTERS THE WAY THE HEART FUNCTIONS.
THESE CHANGES USUALLY HAPPEN IN THE MAIN PUMPING CHAMBER OF THE HEART,
THE LEFT VENTRICLE. THE CONDITION IS KNOWN AS LEFT VENTRICULAR
HYPERTROPHY (LVH).
CHD CAN CAUSE LVH AND VICE VERSA. WHEN YOU HAVE CHD, YOUR HEART MUST
WORK HARDER. IF LVH ENLARGES YOUR HEART, IT CAN COMPRESS THE CORONARY
ARTERIES.

COMPLICATIONS:
ADVISED PT. ON COMPLICATIONS ON BOTH CHD AND LVH. IT CAN LEAD TO:
 HEART FAILURE: YOUR HEART IS UNABLE TO PUMP ENOUGH BLOOD TO THE
REST OF YOUR BODY
 ARRHYTHMIA: YOUR HEART BEATS ABNORMALLY
 ISCHEMIC HEART DISEASE: YOUR HEART DOESN’T GET ENOUGH OXYGEN
 HEART ATTACK: BLOOD FLOW TO THE HEART IS INTERRUPTED AND THE
HEART MUSCLE DIES FROM LACK OF OXYGEN
 SUDDEN CARDIAC ARREST: YOUR HEART SUDDENLY STOPS WORKING, YOU
STOP BREATHING, AND YOU LOSE CONSCIOUSNESS
 STROKE AND SUDDEN DEATH

SYMPTOMS:

INSTRUCTED PT. ON SYMPTOMS OF HYPERTENSIVE HEART DISEASE. SYMPTOMS

VARY DEPENDING ON THE SEVERITY OF THE CONDITION AND PROGRESSION OF THE
DISEASE. YOU MAY EXPERIENCE NO SYMPTOMS, OR YOUR SYMPTOMS MAY
INCLUDE:
 CHEST PAIN (ANGINA)
 TIGHTNESS OR PRESSURE IN THE CHEST
 SHORTNESS OF BREATH
 FATIGUE
 PAIN IN THE NECK, BACK, ARMS, OR SHOULDERS
 PERSISTENT COUGH
 LOSS OF APPETITE
 LEG OR ANKLE SWELLING
YOU NEED EMERGENCY CARE IF YOUR HEART IS SUDDENLY BEATING RAPIDLY OR
IRREGULARLY. SEEK EMERGENCY CARE IMMEDIATELY OR CALL 911 IF YOU FAINT OR
HAVE SEVERE PAIN IN YOUR CHEST.
REGULAR PHYSICAL EXAMS WILL INDICATE WHETHER YOU SUFFER FROM HIGH
BLOOD PRESSURE. IF YOU DO HAVE HIGH BLOOD PRESSURE, TAKE EXTRA CARE TO
LOOK OUT FOR SYMPTOMS OF HEART DISEASE.

MANAGEMENT:

ADVISED PT. ON MANAGEMENT OF HYPERTENSIVE HEART DISEASE. TREATMENT FOR

HYPERTENSIVE HEART DISEASE DEPENDS ON THE SERIOUSNESS OF YOUR ILLNESS,
YOUR AGE, AND YOUR MEDICAL HISTORY.
1.) MEDICATION
MEDICATIONS HELP YOUR HEART IN A VARIETY OF WAYS. THE MAIN GOALS ARE TO
PREVENT YOUR BLOOD FROM CLOTTING, IMPROVE THE FLOW OF YOUR BLOOD, AND
LOWER YOUR CHOLESTEROL.
EXAMPLES OF COMMON HEART DISEASE MEDICATIONS INCLUDE:
 WATER PILLS TO HELP LOWER BLOOD PRESSURE
 NITRATES TO TREAT CHEST PAIN
 STATINS TO TREAT HIGH CHOLESTEROL
 CALCIUM CHANNEL BLOCKERS AND ACE INHIBITORS TO HELP LOWER BLOOD
PRESSURE
 ASPIRIN TO PREVENT BLOOD CLOTS
IT’S IMPORTANT TO ALWAYS TAKE ALL MEDICATIONS EXACTLY AS PRESCRIBED.
2.) SURGERIES AND DEVICES
IN MORE EXTREME CASES, YOU MAY NEED SURGERY TO INCREASE BLOOD FLOW TO
YOUR HEART. IF YOU NEED HELP REGULATING YOUR HEART’S RATE OR RHYTHM,
YOUR DOCTOR MAY SURGICALLY IMPLANT A BATTERY-OPERATED DEVICE CALLED A
PACEMAKER IN YOUR CHEST. A PACEMAKER PRODUCES ELECTRICAL STIMULATION
THAT CAUSES CARDIAC MUSCLE TO CONTRACT. IMPLANTATION OF A PACEMAKER IS
IMPORTANT AND BENEFICIAL WHEN CARDIAC MUSCLE ELECTRICAL ACTIVITY IS TOO
SLOW OR ABSENT.
CARDIOVERTER-DEFIBRILLATORS (ICDS) ARE IMPLANTABLE DEVICES THAT CAN BE
USED TO TREAT SERIOUS, LIFE-THREATENING CARDIAC ARRHYTHMIAS.
CORONARY ARTERY BYPASS GRAFT SURGERY (CABG) TREATS BLOCKED CORONARY
ARTERIES. THIS IS ONLY DONE IN SEVERE CHD. A HEART TRANSPLANT OR OTHER
HEART-ASSISTING DEVICES MAY BE NECESSARY IF YOUR CONDITION IS ESPECIALLY
SEVERE.

CARDIOMYOPATHY
INSTRUCTED PT. ON DISEASE PROCESS OF CARDIOMYOPATHY. CARDIOMYOPATHY
(KAHR-DEE-O-MY-OP-UH-THEE) IS A DISEASE OF THE HEART MUSCLE THAT MAKES IT
HARDER FOR YOUR HEART TO PUMP BLOOD TO THE REST OF YOUR BODY.
CARDIOMYOPATHY CAN LEAD TO HEART FAILURE.
THE MAIN TYPES OF CARDIOMYOPATHY INCLUDE DILATED, HYPERTROPHIC AND
RESTRICTIVE CARDIOMYOPATHY. TREATMENT — WHICH MIGHT INCLUDE
MEDICATIONS, SURGICALLY IMPLANTED DEVICES, HEART SURGERY OR, IN SEVERE
CASES, A HEART TRANSPLANT — DEPENDS ON WHICH TYPE OF CARDIOMYOPATHY
YOU HAVE AND HOW SERIOUS IT IS.

S&SYMPTOMS:
EDUCATED PT. ON SIGNS AND SYMPTOMS OF CARDIOMYOPATHY. THERE MIGHT BE
NO SIGNS OR SYMPTOMS IN THE EARLY STAGES OF CARDIOMYOPATHY. BUT AS THE
CONDITION ADVANCES, SIGNS AND SYMPTOMS USUALLY APPEAR, INCLUDING:
 BREATHLESSNESS WITH ACTIVITY OR EVEN AT REST
 SWELLING OF THE LEGS, ANKLES AND FEET
 BLOATING OF THE ABDOMEN DUE TO FLUID BUILDUP
 COUGH WHILE LYING DOWN
 DIFFICULTY LYING FLAT TO SLEEP
 FATIGUE
 HEARTBEATS THAT FEEL RAPID, POUNDING OR FLUTTERING
 CHEST DISCOMFORT OR PRESSURE
 DIZZINESS, LIGHTHEADEDNESS AND FAINTING
SIGNS AND SYMPTOMS TEND TO GET WORSE UNLESS TREATED. IN SOME PEOPLE,
THE CONDITION WORSENS QUICKLY; IN OTHERS, IT MIGHT NOT WORSEN FOR A
LONG TIME.

CAUSES:
ADVISED PT. ON CAUSES OF CARDIOMYOPATHY. OFTEN THE CAUSE OF THE
CARDIOMYOPATHY IS UNKNOWN. IN SOME PEOPLE, HOWEVER, IT'S THE RESULT OF
ANOTHER CONDITION (ACQUIRED) OR PASSED ON FROM A PARENT (INHERITED).
CERTAIN HEALTH CONDITIONS OR BEHAVIORS THAT CAN LEAD TO ACQUIRED
CARDIOMYOPATHY INCLUDE:
 LONG-TERM HIGH BLOOD PRESSURE
 HEART TISSUE DAMAGE FROM A HEART ATTACK
 LONG-TERM RAPID HEART RATE
 HEART VALVE PROBLEMS
 COVID-19 INFECTION
 CERTAIN INFECTIONS, ESPECIALLY THOSE THAT CAUSE INFLAMMATION
OF THE HEART
 METABOLIC DISORDERS, SUCH AS OBESITY, THYROID DISEASE OR
DIABETES
 LACK OF ESSENTIAL VITAMINS OR MINERALS IN YOUR DIET, SUCH AS
THIAMIN (VITAMIN B-1)
 PREGNANCY COMPLICATIONS
 IRON BUILDUP IN YOUR HEART MUSCLE (HEMOCHROMATOSIS)
 THE GROWTH OF TINY LUMPS OF INFLAMMATORY CELLS (GRANULOMAS)
IN ANY PART OF YOUR BODY, INCLUDING YOUR HEART AND LUNGS
(SARCOIDOSIS)
 THE BUILDUP OF ABNORMAL PROTEINS IN THE ORGANS (AMYLOIDOSIS)
 CONNECTIVE TISSUE DISORDERS
 DRINKING TOO MUCH ALCOHOL OVER MANY YEARS
 USE OF COCAINE, AMPHETAMINES OR ANABOLIC STEROIDS
 USE OF SOME CHEMOTHERAPY DRUGS AND RADIATION TO TREAT
CANCER
TYPES OF CARDIOMYOPATHY INCLUDE:
 DILATED CARDIOMYOPATHY. IN THIS TYPE OF CARDIOMYOPATHY, THE
PUMPING ABILITY OF YOUR HEART'S MAIN PUMPING CHAMBER — THE
LEFT VENTRICLE — BECOMES ENLARGED (DILATED) AND CAN'T
EFFECTIVELY PUMP BLOOD OUT OF THE HEART.
ALTHOUGH THIS TYPE CAN AFFECT PEOPLE OF ALL AGES, IT OCCURS
MOST OFTEN IN MIDDLE-AGED PEOPLE AND IS MORE LIKELY TO AFFECT
MEN. THE MOST COMMON CAUSE IS CORONARY ARTERY DISEASE OR
HEART ATTACK. HOWEVER, IT CAN ALSO BE CAUSED BY GENETIC
DEFECTS.
 HYPERTROPHIC CARDIOMYOPATHY. THIS TYPE INVOLVES ABNORMAL
THICKENING OF YOUR HEART MUSCLE, WHICH MAKES IT HARDER FOR
THE HEART TO WORK. IT MOSTLY AFFECTS THE MUSCLE OF YOUR
HEART'S MAIN PUMPING CHAMBER (LEFT VENTRICLE).
HYPERTROPHIC CARDIOMYOPATHY CAN DEVELOP AT ANY AGE, BUT THE
CONDITION TENDS TO BE MORE SEVERE IF IT OCCURS DURING
CHILDHOOD. MOST PEOPLE WITH THIS TYPE OF CARDIOMYOPATHY HAVE
A FAMILY HISTORY OF THE DISEASE. SOME GENETIC MUTATIONS HAVE
BEEN LINKED TO HYPERTROPHIC CARDIOMYOPATHY.
 RESTRICTIVE CARDIOMYOPATHY. IN THIS TYPE, THE HEART MUSCLE
BECOMES STIFF AND LESS FLEXIBLE, SO IT CAN'T EXPAND AND FILL WITH
BLOOD BETWEEN HEARTBEATS. THIS LEAST COMMON TYPE OF
CARDIOMYOPATHY CAN OCCUR AT ANY AGE, BUT IT MOST OFTEN
AFFECTS OLDER PEOPLE.
 RESTRICTIVE CARDIOMYOPATHY CAN OCCUR FOR NO KNOWN REASON
(IDIOPATHIC), OR IT CAN BY CAUSED BY A DISEASE ELSEWHERE IN THE
BODY THAT AFFECTS THE HEART, SUCH AS AMYLOIDOSIS.
 ARRHYTHMOGENIC RIGHT VENTRICULAR DYSPLASIA. IN THIS RARE TYPE
OF CARDIOMYOPATHY, THE MUSCLE IN THE LOWER RIGHT HEART
CHAMBER (RIGHT VENTRICLE) IS REPLACED BY SCAR TISSUE, WHICH CAN
LEAD TO HEART RHYTHM PROBLEMS. IT'S OFTEN CAUSED BY GENETIC
MUTATIONS.
 UNCLASSIFIED CARDIOMYOPATHY. OTHER TYPES OF CARDIOMYOPATHY
FALL INTO THIS CATEGORY.

PREVENTION:
EDUCATE PT. ON PREVENTION OF CARDIOMYOPATHY. IN MANY CASES, YOU CAN'T
PREVENT CARDIOMYOPATHY. LET YOUR DOCTOR KNOW IF YOU HAVE A FAMILY
HISTORY OF THE CONDITION.
YOU CAN HELP REDUCE YOUR RISK OF CARDIOMYOPATHY AND OTHER TYPES OF
HEART DISEASE BY LIVING A HEART-HEALTHY LIFESTYLE AND MAKING LIFESTYLE
CHOICES SUCH AS:
 AVOIDING THE USE OF ALCOHOL OR COCAINE
 CONTROLLING HIGH BLOOD PRESSURE, HIGH CHOLESTEROL AND
DIABETES
 EATING A HEALTHY DIET
 GETTING REGULAR EXERCISE
 GETTING ENOUGH SLEEP
 REDUCING YOUR STRESS

GOUT
INSTRUCTED PT. ON DISEASE PROCESS OF GOUT. GOUT IS A COMMON AND
COMPLEX FORM OF ARTHRITIS THAT CAN AFFECT ANYONE. IT'S CHARACTERIZED BY
SUDDEN, SEVERE ATTACKS OF PAIN, SWELLING, REDNESS AND TENDERNESS IN ONE
OR MORE JOINTS, MOST OFTEN IN THE BIG TOE.
AN ATTACK OF GOUT CAN OCCUR SUDDENLY, OFTEN WAKING YOU UP IN THE MIDDLE
OF THE NIGHT WITH THE SENSATION THAT YOUR BIG TOE IS ON FIRE. THE AFFECTED
JOINT IS HOT, SWOLLEN AND SO TENDER THAT EVEN THE WEIGHT OF THE BEDSHEET
ON IT MAY SEEM INTOLERABLE.
GOUT SYMPTOMS MAY COME AND GO, BUT THERE ARE WAYS TO MANAGE
SYMPTOMS AND PREVENT FLARES.

S&SX:
INSTRUCTED PT ON SIGNS AND SYMPTOMS OF GOUT. THE SIGNS AND SYMPTOMS OF
GOUT ALMOST ALWAYS OCCUR SUDDENLY, AND OFTEN AT NIGHT. THEY INCLUDE:
 INTENSE JOINT PAIN. GOUT USUALLY AFFECTS THE BIG TOE, BUT IT CAN
OCCUR IN ANY JOINT. OTHER COMMONLY AFFECTED JOINTS INCLUDE
THE ANKLES, KNEES, ELBOWS, WRISTS AND FINGERS. THE PAIN IS LIKELY
 TO BE MOST SEVERE WITHIN THE FIRST FOUR TO 12 HOURS AFTER IT
BEGINS.
 LINGERING DISCOMFORT. AFTER THE MOST SEVERE PAIN SUBSIDES,
SOME JOINT DISCOMFORT MAY LAST FROM A FEW DAYS TO A FEW
WEEKS. LATER ATTACKS ARE LIKELY TO LAST LONGER AND AFFECT
MORE JOINTS.
 INFLAMMATION AND REDNESS. THE AFFECTED JOINT OR JOINTS BECOME
SWOLLEN, TENDER, WARM AND RED.
 LIMITED RANGE OF MOTION. AS GOUT PROGRESSES, YOU MAY NOT BE
ABLE TO MOVE YOUR JOINTS NORMALLY.

CAUSES:
EDUCATED PT. ON THE CAUSES OF GOUT. GOUT OCCURS WHEN URATE CRYSTALS
ACCUMULATE IN YOUR JOINT, CAUSING THE INFLAMMATION AND INTENSE PAIN OF A
GOUT ATTACK. URATE CRYSTALS CAN FORM WHEN YOU HAVE HIGH LEVELS OF URIC
ACID IN YOUR BLOOD. YOUR BODY PRODUCES URIC ACID WHEN IT BREAKS DOWN
PURINES — SUBSTANCES THAT ARE FOUND NATURALLY IN YOUR BODY.
PURINES ARE ALSO FOUND IN CERTAIN FOODS, INCLUDING RED MEAT AND ORGAN
MEATS, SUCH AS LIVER. PURINE-RICH SEAFOOD INCLUDES ANCHOVIES, SARDINES,
MUSSELS, SCALLOPS, TROUT AND TUNA. ALCOHOLIC BEVERAGES, ESPECIALLY
BEER, AND DRINKS SWEETENED WITH FRUIT SUGAR (FRUCTOSE) PROMOTE HIGHER
LEVELS OF URIC ACID.
NORMALLY, URIC ACID DISSOLVES IN YOUR BLOOD AND PASSES THROUGH YOUR
KIDNEYS INTO YOUR URINE. BUT SOMETIMES EITHER YOUR BODY PRODUCES TOO
MUCH URIC ACID OR YOUR KIDNEYS EXCRETE TOO LITTLE URIC ACID. WHEN THIS
HAPPENS, URIC ACID CAN BUILD UP, FORMING SHARP, NEEDLELIKE URATE
CRYSTALS IN A JOINT OR SURROUNDING TISSUE THAT CAUSE PAIN, INFLAMMATION
AND SWELLING.
RISK FACTORS:
ADVISED PT. ON THE RISK FACTORS OF GOUT. YOU'RE MORE LIKELY TO DEVELOP
GOUT IF YOU HAVE HIGH LEVELS OF URIC ACID IN YOUR BODY. FACTORS THAT
INCREASE THE URIC ACID LEVEL IN YOUR BODY INCLUDE:
 DIET. EATING A DIET RICH IN RED MEAT AND SHELLFISH AND DRINKING
BEVERAGES SWEETENED WITH FRUIT SUGAR (FRUCTOSE) INCREASE
LEVELS OF URIC ACID, WHICH INCREASE YOUR RISK OF GOUT. ALCOHOL
CONSUMPTION, ESPECIALLY OF BEER, ALSO INCREASES THE RISK OF
GOUT.
 WEIGHT. IF YOU'RE OVERWEIGHT, YOUR BODY PRODUCES MORE URIC
ACID AND YOUR KIDNEYS HAVE A MORE DIFFICULT TIME ELIMINATING
URIC ACID.
 MEDICAL CONDITIONS. CERTAIN DISEASES AND CONDITIONS INCREASE
YOUR RISK OF GOUT. THESE INCLUDE UNTREATED HIGH BLOOD
PRESSURE AND CHRONIC CONDITIONS SUCH AS DIABETES, OBESITY,
METABOLIC SYNDROME, AND HEART AND KIDNEY DISEASES.
 CERTAIN MEDICATIONS. LOW-DOSE ASPIRIN AND SOME MEDICATIONS
USED TO CONTROL HYPERTENSION — INCLUDING THIAZIDE DIURETICS,
ANGIOTENSIN-CONVERTING ENZYME (ACE) INHIBITORS AND BETA
BLOCKERS — ALSO CAN INCREASE URIC ACID LEVELS. SO CAN THE USE
OF ANTI-REJECTION DRUGS PRESCRIBED FOR PEOPLE WHO HAVE
UNDERGONE AN ORGAN TRANSPLANT.
  FAMILY HISTORY OF GOUT. IF OTHER MEMBERS OF YOUR FAMILY HAVE
HAD GOUT, YOU'RE MORE LIKELY TO DEVELOP THE DISEASE.
 AGE AND SEX. GOUT OCCURS MORE OFTEN IN MEN, PRIMARILY BECAUSE
WOMEN TEND TO HAVE LOWER URIC ACID LEVELS. AFTER MENOPAUSE,
HOWEVER, WOMEN'S URIC ACID LEVELS APPROACH THOSE OF MEN. MEN
ARE ALSO MORE LIKELY TO DEVELOP GOUT EARLIER — USUALLY
BETWEEN THE AGES OF 30 AND 50 — WHEREAS WOMEN GENERALLY
DEVELOP SIGNS AND SYMPTOMS AFTER MENOPAUSE.
 RECENT SURGERY OR TRAUMA. EXPERIENCING RECENT SURGERY OR
TRAUMA CAN SOMETIMES TRIGGER A GOUT ATTACK. IN SOME PEOPLE,
RECEIVING A VACCINATION CAN TRIGGER A GOUT FLARE.

MANAGEMENT:
ADVISED PT.ON THE MANAGEMENT OF GOUT ATTACKS. DRUGS USED TO TREAT
GOUT FLARES AND PREVENT FUTURE ATTACKS INCLUDE:
 NONSTEROIDAL ANTI-INFLAMMATORY DRUGS (NSAIDS). NSAIDS INCLUDE
OVER-THE-COUNTER OPTIONS SUCH AS IBUPROFEN (ADVIL, MOTRIN IB,
OTHERS) AND NAPROXEN SODIUM (ALEVE), AS WELL AS MORE-
POWERFUL PRESCRIPTION NSAIDS SUCH AS INDOMETHACIN (INDOCIN,
TIVORBEX) OR CELECOXIB (CELEBREX). NSAIDS CARRY RISKS OF
STOMACH PAIN, BLEEDING AND ULCERS.
 COLCHICINE. YOUR DOCTOR MAY RECOMMEND COLCHICINE (COLCRYS,
GLOPERBA, MITIGARE), AN ANTI-INFLAMMATORY DRUG THAT
EFFECTIVELY REDUCES GOUT PAIN. THE DRUG'S EFFECTIVENESS MAY
BE OFFSET, HOWEVER, BY SIDE EFFECTS SUCH AS NAUSEA, VOMITING
AND DIARRHEA.
 CORTICOSTEROIDS. CORTICOSTEROID MEDICATIONS, SUCH AS
PREDNISONE, MAY CONTROL GOUT INFLAMMATION AND PAIN.
CORTICOSTEROIDS MAY BE IN PILL FORM, OR THEY CAN BE INJECTED
INTO YOUR JOINT. SIDE EFFECTS OF CORTICOSTEROIDS MAY INCLUDE
MOOD CHANGES, INCREASED BLOOD SUGAR LEVELS AND ELEVATED
BLOOD PRESSURE.