Disease progression the 3 Trajectories

Most disease progress in a somewhat predictable manner. Knowledge of the expected disease trajectory is essential for prognostication. Today, let’s talk about the three types of trajectories.

  • Trajectory 1: The patient experiences relative wellness followed by a short but predictable period of decline leading to death. Typically associated with cancer diagnoses, and the expected time from terminal diagnosis to death is approximately 6 months without interventions. During the period of decline, the patient may experience symptoms of weight loss, gradual decreased ability to engage in activities of daily living, and a progressive decline in overall condition. Such patients are most likely to access palliative care and hospice services because of the predictability of the disease process.
  • Trajectory 2: is characterized by periods of relative well-being punctuated by acute exacerbations that may require hospitalization. After each exacerbations, the patient’s level of overall health declines somewhat, with a clear declinatory pattern discernable over time. This trajectory is associated with chronic illnesses such as heart failure and chronic obstructive pulmonary disease (COPD). The time from terminal diagnosis to death is longer than the process in the first trajectory and may span a period of 2 to 5 years.
  • Trajectory 3: is associated with chronic conditions such as dementia, frailty, and debility. Such diseases involved a gradual functional decline over a period of 6 to 8 years without acute exacerbation. However, patients may fall subject to acute illnesses, such as pneumonia or cardiac events, that unexpectedly lead to their death.

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Hypertension 高血压 (reading & sharing) #2

The hypertension guidelines recommend that high risk patients should begin medications if their average BP is ≥130/80 mmHg. For lower risk patients (no history of cardiovascular disease or an ASCVD risk <10%) medications are recommended for primary prevention when their average BP is ≥140/90 mmHg.

高血压指南建议,如果高危患者的平均血压为 ≥130/80 mmHg,则应开始药物治疗。对于低风险患者(无心血管疾病病史风险 <10%),当平均血压为 ≥140/90 mmHg 时,建议使用药物进行一级预防。

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Hypertension 高血压 (reading & sharing) #1

The most recent American College of Cardiology/ American Heart Association clinical practice guidelines define hypertension as systolic BP greater or equal to 130 mmHg or diastolic BP greater or equal to 80 mmHg. Patients are then classified as having either stage 1 or stage 2 hypertension. Stage 2 usually requires medication in addition to lifestyle modifications to control blood pressure. If the diastolic and systolic blood pressure readings fall into different classifications, the higher classification is used. To make a clinical diagnosis of hypertension, two or more blood pressure readings obtained over two or more visit must fall into a particular classification (but not during acute illness or pain).

最新的美国心脏病学会/美国心脏协会临床实践指南将高血压定义为收缩压大于或等于 130 mmHg 或舒张压大于或等于 80 mmHg。然后将患者归类为患有 1 期或 2 期高血压。2 期高血压除了改变生活方式外,通常需要药物治疗来控制血压。如果舒张压和收缩压读数属于不同的分类,则使用较高的分类。为了对高血压进行临床诊断,在两次或多次就诊中获得的两个或多个血压读数必须属于特定类别(但不是在急性疾病或疼痛期间)。

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