Case Presentation #3

Linda is a 51-year-old female who presents to her physician with complaints of a burning sensation in her chest. She has been experiencing intermittent burning for about one month, not consistent with the ingestion of a meal, but always after physical exertion. She tried a liquid antacid, thinking the burning was just heartburn, but received no relief. She has recently been promoted at work which resulted in an increased workload. She has been feeling stressed about managing her family, work and community responsibilities. She has smoked about ½ - 1 pack of cigarettes per day since the age of 18. She has attempted smoking cessation about four times, but always became nervous and gained a few pounds, which led her to resume smoking. At age 48, she experienced menopause; however, she elected to delay hormone replacement therapy until she was older. Her last lipid profile revealed a high total cholesterol of 270mg/dl, an HDL of 30 mg/dl, and an LDL of 190 mg/dl. Her only exercise, consists of walking which she finds difficult to fit into her new schedule. She is approximately 20 pounds overweight, and struggles to lose the extra pounds. She takes no routine medications. She was surprised to have her doctor tell her that she may have coronary artery disease.

What are Linda's risk factors for coronary heart disease?

Overweight, smoker, high cholesterol and LDL, low HDL, postmenopausal without hormone replacement therapy, stress, and sedentary lifestyle are Linda's risk factors.

As Linda's nurse in the clinic, What strategies can be implemented to assist her make healthy lifestyle changes? What smoking cessation techniques may be helpful to her?

Ask: Support systems, readiness to make changes, previous quit attempts, specific triggers.

Advise:Provide motivational information related to her current health status, self-help literature,

information related to diagnostic tests that she may be ordered, such as an exercise stress test.

Assist: Teach her strategies to incorporate dietary and exercise lifestyle changes in the plan, teach problem solving/skills training to enhance coping with stress. Provide specific information related to diagnostic tests may be ordered (e.g., exercise stress test). Pharmacological Options: Nicotine gum may help offset further weight gain and be useful for cravings at work during stress. Bupropion HCL may be helpful if there are any signs of underlying depression.

Arrange:Refer her for group support if she desires. Schedule follow-up telephone support or face-to-face visits. Reinforce short term successes.