Nursing

INSULIN, STATINS, AND ACE INHIBITORS—we've all cared for patients who seem to take these medications by the handful. When I imagine these patients, I picture a diabetic with sugar in his blood, making it as thick as syrup, flowing through arteries that are already constricted from hypertension, now narrowed with a coating of lipids pulsing through his torso, where abdominal girth due to obesity puts pressure on his weak cardiovascular network, increasing the work of an already overworked heart. One day, the plaque in the artery builds up a little too thickly, or his blood pressure spikes too high, and the heart becomes the victim of myocardial infarction and stops pumping.

Diabetes, lipid disorders, and hyper-tension don't comprise the trifecta of health, but that of demise. Surprisingly, these patients aren't even admitted because of diabetic ketoacidosis, hyperlipidemia, or hypertension. They're admitted due to an ordinary foot ulcer or congestive heart failure. Often, you'll see these patients time and time again. They'll become known as "train wrecks" or "frequent fliers." These disparaging monikers are always out of place, but especially when a patient suffers conditions that combine into a complicated disorder that wreaks havoc on the body—cardiometabolic disorder. One thing you'll find in common in many of these patients is obesity. Cardiometabolic disorders and weight are complex, and numerous guidelines have been written to teach practitioners risk-factor management of the disease.

Let's revisit the patient for a moment, and ask "How could we, as nurses, have helped this patient, who seems to be hopeless?" The first step is to understand the etiology of conditions comprising cardiometabolic disorders and weight.

RN will feature four articles covering nursing care plans based on current medical guidelines for each of the cardiometabolic component conditions: diabetes and lipid disorders in this issue; hypertension in October; and obesity in November.

Each article includes a patient case, describing the signs and symptoms of the disorder identified during an assessment. The disease state and medical diagnosis guide the nursing diagnosis and the goals for patient outcomes. We show how to focus interventions based on current medical guidelines to help eliminate knowledge deficiencies the patient might have about cardiometabolic disorders and weight. Practitioners will learn more about how to plan and incorporate healthcare interventions, including medication, therapeutic lifestyle modifications, and other treatments.

Practitioners are encouraged to help patients incorporate new health regimens into their lifestyles so they can control and manage the disease, and feel more in charge of their lives. We detail evaluation criteria, established by the success in meeting national guideline goals measured through follow-up appointments, and give you the resources you need to inform and support patients.

We investigate cardiometabolic disorders and how they interrelate to significantly increase cardiovascular risk. We provide the tools and information that primary care physicians, specialists, midlevels, nurses, pharmacists, managed care professionals, and the pharmaceutical industry need in order to work together to address this growing problem and ultimately improve patient outcomes.

The CardioMetabolic Disorders and Weight Resource Center can be accessed through http://www.modernmedicine.com/cardiometabolic/. We offer an array of publications that provide current and practical clinical information, including Contemporary Pediatrics, Geriatrics, Contemporary Ob/Gyn, Dermatology Times, and Drug Topics.

This month, RN explains diabetes and lipid disorder management in an action-for-outcomes format, which is familiar to you as the care plan. Also, RN Radio will air a podcast focusing on motivating the diabetic client to adhere to therapeutic lifestyle changes. Next month, RN will publish a table explaining the various guidelines for risk factors—blood pressure, lipids, central obesity, and microalbuminuria—that you'll no doubt encounter in your practice.

What would you like to see in print or on our web site? Send an e-mail to rnmagazine@advanstar.com
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