Counselling For Coronary Heart Disease
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COUNSELLING FOR CORONARY HEART DISEASE DONE BY: A.SHYAMALA CRRI GUIDED BY: Dr.RAJKUMAR
COUNSELLING Greet Ask Tell Help Explain Review
IN THE HOSPITAL Cardiac Status Drugs and their Dosages Risk Factors for CHD
RISK FACTORS FOR CHD -
NON - MODIFIABLE Increasing age (>65 yrs) Male sex Family History (< 50 yrs) Genetic Factors
MODIFIABLE -Tobacco smoke - High cholesterol - High BP - Physical inactivity - Obesity - Diabetes Mellitus - Stress
CARDIAC REHABILITATION Physical reconditioning & risk factor modification for patients recovering from MI
COUNSELLING FOR CHD Heart healthy diet Physical activity Stop tobacco use Psychological factors Health check ups Interventions
EAT A HEART HEALTHY DIET Salt Restriction - 5 gms per day - Reduce salt while cooking - Limit processed foods and fast foods Fruits and Vegetables - 5 servings per day ( 1 serving = 1 orange/ apple/mango/banana = 3 tablespoons of cooked vegetables)
Fat intake - Limit fatty meat, dairy fat and cooking oil(< 2 tbsp/day) - Replace palm/ coconut oil with safflower oil - Total fat intake – 30% - Saturated fat intake – 10% - Cholesterol - 300 mg / day Avoid heavy alcohol intake
PHYSICAL RECONDITIONING Regular exercise Brisk walking / cycling / jogging 10 mins warm up 40 mins conditioning period 10 mins cool down
STOP TOBACCO USE ASK Do you use tobacco
No - reinforce message
Yes ADVISE to quit in a clear, strong personalized manner ASSESS Make a quit attempt? No - info on health hazards Yes ASSIST in quitting plan 1. Set quit date
2. Inform family friends 3. Ask for their support
4. Remove cigarettes or tobacco 5. Follow-up
PSYCHOLOGICAL FACTORS Acute stage - Delirium - Anxiety - Depression Self efficacy Type - A behavior
HEALTH CHECK UPS History of previous angina / MI Regular BP monitoring Goal BP < 130/80 Continue anti-anginal, lipid lowering, anti-platelet drugs
INTERVENTIONS PTCA Coronary stenting Coronary artery bypass graft
REFERENCES WHO CVD RISK MANAGEMENT PARK TEXTBOOK OF COMMUNITY MEDICINE HARRISON’S PRINCIPLES OF INTERNAL MEDICINE BRAUNWARLD - HEART DISEASES www.mgh.harvard.edu www.americanheart.org www.umm.edu
COUNSELLING Greet Ask Tell Help Explain Review
IN THE HOSPITAL Cardiac Status Drugs and their Dosages Risk Factors for CHD
RISK FACTORS FOR CHD -
NON - MODIFIABLE Increasing age (>65 yrs) Male sex Family History (< 50 yrs) Genetic Factors
MODIFIABLE -Tobacco smoke - High cholesterol - High BP - Physical inactivity - Obesity - Diabetes Mellitus - Stress
CARDIAC REHABILITATION Physical reconditioning & risk factor modification for patients recovering from MI
COUNSELLING FOR CHD Heart healthy diet Physical activity Stop tobacco use Psychological factors Health check ups Interventions
EAT A HEART HEALTHY DIET Salt Restriction - 5 gms per day - Reduce salt while cooking - Limit processed foods and fast foods Fruits and Vegetables - 5 servings per day ( 1 serving = 1 orange/ apple/mango/banana = 3 tablespoons of cooked vegetables)
Fat intake - Limit fatty meat, dairy fat and cooking oil(< 2 tbsp/day) - Replace palm/ coconut oil with safflower oil - Total fat intake – 30% - Saturated fat intake – 10% - Cholesterol - 300 mg / day Avoid heavy alcohol intake
PHYSICAL RECONDITIONING Regular exercise Brisk walking / cycling / jogging 10 mins warm up 40 mins conditioning period 10 mins cool down
STOP TOBACCO USE ASK Do you use tobacco
No - reinforce message
Yes ADVISE to quit in a clear, strong personalized manner ASSESS Make a quit attempt? No - info on health hazards Yes ASSIST in quitting plan 1. Set quit date
2. Inform family friends 3. Ask for their support
4. Remove cigarettes or tobacco 5. Follow-up
PSYCHOLOGICAL FACTORS Acute stage - Delirium - Anxiety - Depression Self efficacy Type - A behavior
HEALTH CHECK UPS History of previous angina / MI Regular BP monitoring Goal BP < 130/80 Continue anti-anginal, lipid lowering, anti-platelet drugs
INTERVENTIONS PTCA Coronary stenting Coronary artery bypass graft
REFERENCES WHO CVD RISK MANAGEMENT PARK TEXTBOOK OF COMMUNITY MEDICINE HARRISON’S PRINCIPLES OF INTERNAL MEDICINE BRAUNWARLD - HEART DISEASES www.mgh.harvard.edu www.americanheart.org www.umm.edu
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