Rhode Island College Health A

Hello, the assignment is to respond to these two discussion post. The topic is about Respiratory/cardiac health assessment. Please see attached rubric for discussion response requirement. Please type discussion 1 and put your response under it as if you were replying to the writer. Be sure to include references of peer reviewed article used in theresponse. Each discussion should include 3 references. 400 words to each response.

Emmanuela : Post 1

While assessing a patient for a cardiac complaint it is very important to create a full picture. Not only of what is happening right now but also if the patient has any family history related to cardiac. According to Bickley (2021) it states that “among adults, 12% report a family history of heart attack or angina before age 50 years. Along with a family history of premature revascularization, this risk factor is associated with about a 50% increased lifetime risk for CHD and for CVD mortality” (p.256). Being that family history is considered as one of the risk factors of cardiac issues, that is why it’s very important to be able to obtain that information. In another study to show how important it is to ask about their family history a journal did a study where, “participants were asked whether any of their close biological (blood) relatives, including father, mother, sisters, or brothers, were ever told by a health professional that they had a heart attack or angina before the age of 50.” (Moonesinghe et al., 2019) The study confirmed the public health importance of family history as a risk factor. Not only that it showed that, “these data suggest that millions of people who are at risk for CVD in the United States can be identified using family history.” (Moonesinghe et al., 2019) Along with family history it is also important to obtain the knowledge of the patient’s lifestyle. The reason why this is important is because some of the lifestyle decisions could also be risk factors and reason why the patient is having cardiac complaints. Allowing yourself as their caregiver to know about these could allow you to help them change the habits to improve their health and longevity. Recent article discusses risk factors that can be controlled, or modified, and others that cannot, risk factors that can be controlled are, “high BP, high blood cholesterol levels; smoking; diabetes; overweight or obesity; lack of physical activity; unhealthy diet and stress. Those that cannot be controlled (conventional) are: age (simply getting older increases risk); sex (men are generally at greater risk of coronary artery disease); family history; and race.” (Hajar, 2017) Because there are many risk factors that are related to lifestyle, therefore preventative treatment can be tailored to modifying specific factors. It is very important to know these risks to reduce premature deaths, cerebrovascular disease and peripheral vascular disease. Unfortunately, today “CVD is a major cause of disability and premature death throughout the world. The underlying pathology of atherosclerosis develops over many years and is usually advanced by the time symptoms occur, generally in middle age.” (Hajar, 2017) Being able to address the modifiable risk factors early will allow the patient a better healthy life that will also be longer lived. As a provider this is why it is necessary to ask the hard questions and be able to educate patient about changing their ways of life, as well as giving them the hard truth about what will happen if they choose not to be compliant.

Courtney: Post 2

When evaluating a patient for a cardiac complaint, this is not something to tread lightly on. Many complaints of angina or shortness of breath can often lead to a major occurrence. We know that heart disease is the number one cause of death in the United States and that “heart disease has a “long asymptomatic latent period,” and about half of all coronary deaths occur without previous warning signs or cardiac diagnoses.” (Bickley 2021) It is important to be prepared for this type of interaction by knowing the right questions to ask and making quick but efficient decisions for the best patient outcomes. Utilizing the health history may lead us to the cause of a cardiac complaint as it may be related to a specific family history. Therefore, inquiring about family history early in the interview process may help narrow down the origin. Heart conditions can be congenital, meaning that they are present at the time of birth, but heart disease can also lay dormant and lifestyle factors can exacerbate the disease process. “Begin routine screening at 20 years for individual risk factors and for any family history of premature heart disease (age <55 years in first-degree male relatives and age <65 years in first-degree female relatives).” (Bickley 2021) A patient presenting with a cardiac complaint at any age warrants immediate intervention, but routine screening should take place during each wellness check.

It is important to inquire about factors that may heighten the patient’s risk of developing worsening cardiac disease. Heart attack, coronary artery disease and stroke tend to follow a familial pattern. Non-modifiable risk factors are known as biographical data, or predetermined components that cannot be changed, while modifiable risk factors are lifestyle choices that can be altered. Genetics are the main non-modifiable risk factor, so refraining from modifiable choices will in turn decrease the risk of death associated with cardiac based diseases.

“Non modifiable are age, family history and gender. Modifiable risk factors are high blood pressure, obesity, tobacco use, lack of physical activity, low fruit and vegetables intake, and heavy alcohol intake. Conventional risk factors for the development of CAD include hypertension, diabetes, sedentary lifestyle, obesity, smoking, and a family history. These all have an adverse influence on prognosis in those with established disease, presumably through their effect on the progression of atherosclerotic disease processes” (Chaudhry 2017)

The larger the presence of atherosclerotic plaque, the greater increased risk of a blockage resulting in ischemia. Therefore, patients who smoke, maintain an unbalanced diet, and do not participate in regular physical activity will worsen the build-up of atherosclerosis. “Along with a family history of premature vascularization, the risk factor is associated with about a 50% increased lifetime risk for CHD and for CVD mortality.” (Bickley 2021) Knowing your personal risk based on family history is important for your care and the care of any children. When caring for a patient coming in with complaint of slurred speech, unilateral numbness of the face or arm, they must be immediately evaluated for a stroke. “While family history of stroke is not a modifiable risk factor, efforts can be made to implement primary prevention in high-risk populations to identify and educate individuals on modifiable risk factors.” (Claeys 2020) Starting the conversation at an early age will help to establish a healthy lifestyle, particularly in patients who may not have healthy role models at home.

In personal experience, patients who tend to lead this type of lifestyle are those who do not seek regular medical care or have an established primary care physician. Therefore, the times when they are seeking medical attention is when a disease process is already underway and more times than not, a medical emergency is occurring. A patient coming in with a complaint of crushing chest pain that is radiating, is diaphoretic and experiencing anxiety needs to be treated immediately for a heart attack. It is difficult to obtain a family history during emergent times so establishing care before unhealthy habits begin is the key to successful prevention.

Yet there are also many circumstances in which congenital heart defects are present in patients we care for. Some congenital heart defects include but are not limited to: tetralogy of Fallot, patent foramen ovale, coarctation of the aorta, aortic stenosis, and atrial septal defect. Although this type of care would have already been established at the time of birth, it is relevant throughout the life cycle. When discussing reproductive health, “it is important for adolescents to understand that there is a potential genetic basis and recurrence risk for their heart defects not only for family planning purposes, and to improve discussions with doctors and family members.” (Crawford 2020) Particularly in women’s health, the mother knowing her own risk factors for carrying out a full-term pregnancy is important. Therefore, a woman coming in with a cardiac complaint during pregnancy, fast action will be the difference between life and death. Not only is the risk great for complications or loss of the fetus, but the risk for the mother having extreme complications with pregnancy or delivery is also staggeringly high. “Women with CVD particularly women with congenital heart disease (CHD) who are contemplating pregnancy should undergo a complete work-up including appropriate cardiac imaging for risk stratification prior to conception” (Ordovas 2021) Establishing primary care, maintaining it throughout the lifespan and educating along the way is critical to healthy outcomes.

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