CONDITION CARE GUIDELINES
Copyright © 2023 [Rebecca Falanga]. All Rights Reserved.
Preface
The objective of this booklet is to provide brief, readable health and lifestyle guidelines from recognized credible references for the predominant chronic conditions currently experienced in the United States. The prevalence of chronic conditions guarantees that all health professionals will interact with clients who have one or more chronic condition. In depth or extensive patient educational sessions are not possible in the rapid pace of the health care environment. The opportunity to provide effective education is possible through understanding the six elements of chronic condition care, having an assessment conversation with the patient, and focusing education based on the patient’s current status and understanding of the self-care for the condition.
Table of Contents
Preface
02
03
Introduction
Six Elements of Chronic Condition Care (Centers for Disease Control and Prevention)
05
06
How To Begin
Heart Disease (American Heart Association)
07
10
Stroke (American Stroke Association)
Lung Disease (American Lung Association)
08
11
Diabetes (American Diabetes Association)
09
Cancer (American Cancer Society)
12 Alzheimer's Disease (Alzheimer's Association)
Introduction These guidelines are to be used in conjunction with the guidance and directions of the primary care provider who is overseeing the total care for a person with a chronic condition.
The six elements of chronic condition care, primary care, preventative measures and screenings, medication adherence, healthy diet, healthy lifestyle, and self-monitoring are applicable for every chronic condition. Six Elements of Chronic Condition Care
Primary Care
Healthy Diet
Emphasis on vegetables, fruits, whole grains, and fat-free or low-fat dairy products. Includes lean meats, poultry, fish, beans, eggs, and nuts. Limits saturated and trans fats, sodium, and added sugars. Control of portion sizes.
A primary care provider assesses current status and risk factors, develops a treatment plan, will order screenings, vaccines, medications, community and social services, coordinate care and provide ongoing clinical monitoring.
Preventative Measures
Healthy Lifestyle
Eat a healthy diet, be active with regular physical exercise, maintain a healthy weight, manage/avoid stress, no smoking, be social with family and friends, participate in activities that use brain power, limit alcohol, establish nightly sleep pattern of 7 to 8 hours.
Infectious and viral conditions, such as the flu, colds, pneumonia, Hepatitis B and shingles often impact people with chronic conditions severely. The results may be prolonged recovery, complications, and decline in their overall health. It is recommended that cancer screening tests be done regularly to detect cancer early when most treatable.
Self-monitoring
Medication Adherence
Taking medications as prescribed improves symptom management, and provides relative stabilization of the health condition. Medication non-adherence results in uncontrolled conditions leading to complications, worsening state of health and even death.
Self-monitoring of key health and wellbeing indicators such as weight, symptoms of illness, follow-up appointments, is required so that issues are identified, and corrective steps may be taken to manage a condition and keep on the path of a healthy lifestyle.
How To Begin?
Become familiar with Six Elements of Chronic Condition Care.
Practice the conversational three-item assessment which will identify the education & self-management gaps needing educational intervention. Always reinforce the three-priority care elements: regular visits to a primary care provider; management of risk factors; medication adherence. Take the time to review the condition’s strategies for healthcare and lifestyle, give guidance if there are omissions in diet, lifestyle, or self-monitoring.
Get Started!
For those who interact with chronic condition clients episodically, a brief conversational assessment with targeted education and guidance will be beneficial steps towards chronic condition care.
Conversational Chronic Condition Care Assessment of Patient Self-management
Do you regularly, at least yearly, see a primary care provider?
Your health history shows that you have (a chronic condition.) What do you know about your condition and how it affects you? What have you done and are doing to prevent your condition from getting worse?
Priority elements of Chronic Condition Education
Regular visits to a primary care provider Management of risk factors Medication Adherence 1. 2. 3.
CONDITION CARE GUIDELINES
Healthcare professionals have the unique opportunity to interact and educate patients in innumerable settings. The following pages are configured to provide a brief outline of basic chronic condition care and lifestyle guidelines that are key to prevention, the delay of progression and minimization of health complications. The content has been curated from reputable, credible organizations for the specific condition, and each guideline is hyperlinked to a resource for additional information.
Heart Disease Lung Disease Cancer
Stroke Diabetes Alzheimer's
Heart Disease - American Heart Association
Take medication as they are prescribed. Do not skip or stop unless directed by the primary care provider.
Frequent visits initially until symptoms are controlled by medication and lifestyle changes. Thereafter, annually, or as needed to address health issues. Establish a relationship with a primary care provider.
Regular Exercise Maintain a healthy weight No smoking Limited Alcohol
Vaccines - Flu, Pneumonia, Shingles, COVID-19,Tdap,Td Screenings - Colon, Breast, Cervical
Blood Pressure If Diabetic, monitor blood sugar
Heart healthy diet Low sodium
Lung Disease - American Lung Association
Frequent visits initially until symptoms are controlled by medication and lifestyle changes. Thereafter, annually, or as needed to address health issues. Establish a relationship with a primary care provider.
Take medication as they are prescribed. Do not skip or stop unless directed by the primary care provider.
Pulmonary Rehab Stretching Aerobic Resistance exercises Moderate Exercise with physician guidance
Vaccines - Flu, Pneumonia, Shingles, COVID-19 , Tdap vaccination (dTaP/dTPa) for those not vaccinated in adolescence Screenings - Colon, Breast, Cervical , Lung Diet rich in whole-grain bread, pasta, fresh fruits, and vegetables Limit sugar, candy, cake, cookies,
Practice infectious disease preventions strategies
Call provider for the following:
Increase in shortness of breath, cough Increase or thicker phlegm/mucus Using quick relief inhaler often Weight loss Frequent use of purse lip breathing Medication are not helping
and regular soft drinks Include high fiber foods
Eat protein at least twice a day Limit, butter, fat, shortening, fried foods, crackers, and pastries
Cancer - American Cancer Society
Every 3 to 4 months for first and second year Every 6 months thereafter After Cancer treatment monitoring as prescribed Establish a relationship with a primary care provider. Oncologist visits
Take medication as they are prescribed. Do not skip or stop unless directed by the primary care provider.
Vaccines - Flu, Pneumonia, Shingles, COVID-19, Tdap, Td, HPV, Hepatitis B Screenings - Colon, Breast, Cervical , Lung Diet rich in fruits and vegetables Eat whole grain bread, rice and cereals Eat more fish and chicken than red meat and fewer processed meats like hot dogs, bacon, lunch meats Avoid sugary drink s
Regular exercise Maintain a healthy weight No smoking Limited Alcohol Practice infectious disease preventions strategies
Attend to routine follow-up test Report unusual symptoms to primary care provider
Stroke - American Stroke Association
Establish a relationship with a primary care provider. Frequent visits until symptoms are stabilized. Thereafter annually or as needed to address health issues.
Take medication as they are prescribed. Do not skip or stop unless directed by the primary care provider.
Vaccines - Flu, Pneumonia, Shingles, COVID-19, Tdap, Td, Screenings - Colon, Breast, Cervical Eat a variety of fruits and vegetables , whole grain bread and cereals Do not salt your food Eat more nuts, fish and chicken than red meat Avoid processed meats like hot dogs, bacon, lunch meats Avoid sugary drinks and items with added sugar Choose low-fat or nonfat dairy Use low salt/sodium products
Follow Life's Essential 8 from American Stroke Association
Eat Better Be More Active Quit Tobacco Get Healthy Sleep
Manage your weight Control Cholesterol Manage Blood Sugar Manage Blood Pressure
Diabetes - American Diabetes Association
Establish a relationship with a primary care provider. Frequent visits until symptoms are stabilizeds. Thereafter, every 3 to 6 months to monitor blood sugar, blood pressure , cholesterol .
Take medication as they are prescribed. Do not skip or stop unless directed by the primary care provider.
Vaccines - Flu, Pneumonia, Shingles, COVID-19, Tdap, Td, Hepatitis B Annual screenings for kidney function and vision. Cancer screens for colon, breast, cervical Include non-starchy vegetables, such as broccoli, spinach, and green beans Include very few dishes with added sugar Limit white bread, rice, and pasta Include whole foods, such as multigrain bread and cereals Avoid fruit juice, substitute whole fruit
Learn about Diabetes Self-Management through a class or by reading Know your healthy weight and try to maintain it Be physically active 30 minutes a day, 5 days a week Test your blood sugar and record the results Know the signs of high or low blood sugar and what to do Observe your feet and skin for cuts, scrapes, and wounds. Seek treatment if not healing Manage stress and deal with daily diabetes care Take your medicines every day
Use the Diabetes Plate Method
Alzheimer's - Alzheimer's Association
Visit according to care needs, no less than annually Seek treatment for signs of pain, inflammation, infection, constipation Have regular, annual, dental, hearing and eye exams Establish a relationship with a primary care provider.
Take medication as they are prescribed. Do not skip or stop unless directed by the primary care provider.
Exercise regularly Be socially active with family and friends Participate in activities that use brain power Know your healthy weight and try to maintain it Learn about Alzheimer's disease and tips for living with dementia Find local services that support those with Alzheimer disease Plan for your financial, legal and future care. Begin using memory aids such as notepads, medication organizers, calendar for appointments and weekly tasks Find services or a family member to assist with meals, bill paying, transportation, shopping
Vaccines - Flu, Pneumonia, Shingles, COVID-19, Tdap, Td, Hepatitis B Cancer screens for colon, breast, cervical Follow the MIND (Mediterranean–DASH Intervention for Neurodegenerative Delay) Diet which encourages eating from 10 healthy food groups Leafy green vegetables, other vegetables, berries, whole grains, fish, poultry, beans, nuts, olive oil, wine, 1 glass/day Limited servings of red meat, sweets, cheese, butter/margarine and fast/fried food.
Devleoped by
Our goal is to provide brief, readable health and lifestyle guidelines from recognized credible references for the predominant chronic conditions currently experienced in the United States. Additionally, we hope the format will allow the pages to be useful educational tools for client teaching. Please send feedback regarding this booklet, suggestions for improvements as well as your thoughts about how to use this booklet in your practice to us through the contact information below.
Rebecca M. Falanga, MBA, RN rebecca.falanga@gmail.com Chronic Condition Care (CCC) for You www.linkedin.com/in/rebecca-falanga-ccc4you
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