Worksheet #2 Chronic Disease Management, Health Promotion, and Preventative Care

Worksheet #2 Chronic Disease Management, Health Promotion, and Preventative Care

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BT’s Story

Life and social history: Having worked as a train engineer for Amtrak for nearly 18 years and being a father of three active kids, BT is used to eating food on-the-go. He has been married to his wife Rhoda for 20 years and has three kids so they have not had much time to themselves. On a recent date-night trip to a local restaurant, BT began having abdominal pain and he thought it was because of something he ate that didn’t agree with him. BT’s appetite diminished so much that he was losing five pounds a week. BTs wife convinced him to see a PCP to find out what might be going on. He was recently diagnosed with pancreatic cancer.

Health behaviors and beliefs: BT has always had a big appetite, a real meat-and-potatoes kind of guy. He’s about 35 pounds overweight and has tried many fad diets in the past. He belongs to a local gym but finds it hard to go regularly. He also says that since his job is physically demanding, he “gets a great workout at work”.  He has a PCP, and his last physical was 3 years ago.

Family health history: BT was adopted, and his birth parents are unknown.

Additional demographics, personal, and medical data: 48yo, African American, 115kg, 6’2”, BMI is 33

Support person: Wife

Past medical history: Mild hypertension, diet controlled, recent diagnosis of pancreatic cancer

Allergies: Reports none

Medications: None

Surgical History: None

 

Living situation:

Four-bedroom home built in 2001.

Lives 5 miles from a major grocery store.

Socioeconomic status: Both BT and his wife are employed and earn $110,000 between them. The family has health insurance through BTs employer, Amtrak.

 

Worksheet #1: Pathophysiology Mapping

Complete a pathophysiology map for BTs PMH (Hypertension and pancreatic cancer), identifying overlapping factors that influence health status.

Pathophysiology of Pancreatic Cancer

When cells in the pancreas acquire alterations in their DNA, pancreatic cancer occurs. DNA provides instructions to a cell that tell it how to act. In response to these mutations, the cells continue to grow and live, even after normal cells would die. Upon accumulation, these cells can become tumors (Dariya et al., 2019)

 

Pathophysiology of Hypertension

Chronic hypertension, a condition characterized by elevated blood pressure, leads to chronic organ damage and raises mortality and morbidity. Systemic vascular resistance and cardiac output contribute to blood pressure. Here is the pathophysiology of hypertension. There are many causes of hypertension. Sodium retention in the kidney, caused by excess sodium consumption, increases fluid volume, thereby increasing preload and contractility.

Modifiable risk factors: Smoking cigarettes, secondhand smoke, being overweight, eating red and processed meat, not eating enough fruits and vegetables, fiber, and calcium, not exercising, and drinking too much alcohol are all modifiable risk factors.

Non-modifiable risk factors: Some of these factors include advancing age, familial cancer syndromes, Afro-Américan race, hereditary and other types of chronic pancreatitis, diabetes, and non-O blood groups.

Modifiable risk factors: These include using unhealthy diets (overconsumption of salt, eating a high-fat diet, consuming few fruits and vegetables), being inactive, smoking, and drinking excessively.

Non-modifiable risk factors: Family history of hypertension, genetics, and age play a role. As we age, we become more likely to experience high blood pressure, sex, and ethnicity.

Diagnosed: A CT scan, MRI scan, ultrasound scan, and positron emission tomography (PET) scan may all be used in diagnosing pancreatic cancer. Also, biopsy and lab results.

Diagnosed: As per most major guidelines, hypertension is considered to be present when the patient’s systolic blood pressure (SBP) in the office or clinic is *140 mm Hg or even when the patient’s diastolic blood pressure (DBP) is *90 mm Hg following repeated examinations.

Treatment: It may be treated with surgery, radiation, chemotherapy, or a combination of these.

Lifestyle modifications: By strengthening your body, you can handle some of the rigors of treatment, boosting your immune system can help your body fight cancer, improve your emotional outlook, quitting smoking, work hard to improve nutrition, reduce infections, exercise regularly, managing fatigue, and seeking support you can begin to make positive changes to your life.

Medical interventions: Pancreatic cancer can currently be treated with surgery, radiation therapy, chemotherapy, targeted therapy, and immunotherapy. In addition to cancer treatment, your care plan may also address symptoms and side effects.

Treatment: Changing your diet, taking medication, and exercising can help you manage high blood pressure.

Lifestyle modifications: Diet, exercise, and social practices all fall into this category. Non-pharmaceutical therapy plays an important role in preventing hypertension in normal individuals as well as in reducing blood pressure (Alsaigh et al., 2018).

Medical interventions: Some medications known as diuretics assist the kidneys in removing sodium and water from the body, and Angiotensin-converting enzyme (ACE) inhibitors. Angiotensin II receptor blockers (ARBs), and Calcium channel blockers.

Identify interrelated factors between Hypertension and Pancreatic Cancer. How does one affect the other?

Metabolic conditions like obesity, hypertension, dyslipidemia, and others contribute to the development of pancreatic cancer. Cancer and hypertension often co-occur since both diseases share the same risk factors, including sedentary lifestyles, obesity, smoking, poor diets, and alcohol abuse (Lai, 2019).

What are the social and environmental factors that may influence BTs health?

BT eats food on-the-go all the time. He’s a real meat-and-potatoes type of guy. It’s stated that he weighs about 35 pounds more than he should and has tried many fad diets in the past. Despite belonging to a local gym, he has trouble going there regularly and he lives 5 miles from a major grocery store where he is exposed to a variety of unhealthy food options.

What are the complications of each disease process if effective treatment is not achieved, treatment goals are not met, and/or left untreated?

Without treatment, high blood pressure can lead to heart attacks, strokes, and heart failure after a prolonged period. The morphology and function of the pancreas may irreversibly change if complications develop in pancreatitis. Exocrine pancreatic insufficiency and diabetes mellitus are the possible outcomes of its loss of function. Fibrosis and inflammation can also cause other complications such as chronic abdominal pain, metabolic bone disease, and pancreatic cancer.

What other factors or data concerns you and/or what additional information data do you need to assess BTs overall health?

In general, if you are a relatively healthy person under 50 and under the age of 50, you should see your primary care physician every three years. Once you reach 50, you should schedule a checkup with your doctor once a year. Yet, even though BT is younger than 50, he suffers from mild hypertension, as well as a recent diagnosis of pancreatic cancer. As a result, he should be seen by his primary care physician regularly.

References:

Alsaigh, S. A., Alanazi, M. D., & Alkahtani, M. A. (2018). Lifestyle modifications for hypertension management. The Egyptian Journal of Hospital Medicine, 70(12), 2152–2156. https://doi.org/10.12816/0045044

Dariya, B., Alam, A., & Nagaraju, G. P. (2019). Biology, pathophysiology, and epidemiology of pancreatic cancer. Theranostic Approach for Pancreatic Cancer, 1–50. https://doi.org/10.1016/b978-0-12-819457-7.00001-3

Lai, S. W. (2019). The relationship between obesity in adolescence and pancreatic cancer in adulthood. Cancer, 125(12), 2132–2132. https://doi.org/10.1002/cncr.32018

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