Page 67 - Encyclopedia of Nursing Research

34 n CAREGIvER

the American Heart Association’s (AHA) cornerstone of treatment. Therapeutic regi-
guidelines for primary prevention (Kavey mens including pharmacotherapy and TLC
C et al., 2003) and the American Academy of are based on the individual’s risk status;
Pediatrics (AAP) recent recommendation treatment outcomes are optimized with case
(Daniels & Greer, 2008) are consistent with management by nurses within the context of a
nCEP definitions: acceptable TC (<170 mg/dl; multidisciplinary team approach. Directions
4.4 mmol/L), borderline TC (170–199 mg/dl), for future research build on and extend cur-
and elevated TC (≥200 mg/dl). Similar to rent programs of nursing and multidisciplin-
adults, both lipid and nonlipid risk factors ary research focused on innovative models
are addressed, LDL-C levels are targeted as for primary and secondary prevention of
the basis for treatment decisions, and TLC is CvD across the life span and with emphasis
the cornerstone of treatment. LDL-C levels on both quality and cost as outcomes (Allen
110 mg/dl or less are considered acceptable & Dennison, 2010; Berra, Miller, & Fair, 2006;
for children and adolescents without comor- Fletcher et al., 2005; Ma et al., 2009). In addi-
bidities; LDL-C less than 100 mg/dl is recom- tion, current recommendations emphasize
mended for children and adolescents with family-based approaches to CvD risk reduc-
diabetes. An important pharmacological tion (Hayman et al., 2007); however, minimal
modification in treatment recommended by data exist regarding strategies for effective
AAP (Daniels & Greer, 2008) and the AHA implementation in clinical practice.
(McCrindle et al., 2007) focuses on timing of
initiation and class of lipid-lowering agents. Laura L. Hayman
Specifically, current recommendations
emphasize TLC as cornerstone of treatment;
however, if an adequate trial of TLC does not
result in target goals (LDL-C is persistently Caregiver
>190 mg/dl with no other risk factors; LDL-C
is persistently >160 mg/dl with family his-
tory of premature heart disease or ≥2 other Caregiver is defined as an individual who
risk factors; and LDL-C ≥130 mg/dl in the set- assists ill person(s), often helps with a patient’s
ting of diabetes), pharmacological treatment physical care, typically lives with the patient,
beginning at 8 years and older should be con- and does not receive monetary compensation
sidered. on the basis of accumulated safety for the help. Also, a caregiver is a person who
and efficacy data, the AHA recommends that not only performs common caregiver respon-
statins be considered as the first line of drug sibilities (i.e., providing physical, social, spir-
treatment. itual, financial management, and complex
Assessment and management of hyper- home care) but also advocates for the ill
cholesterolemia and other lipid abnormal- person within health care systems and soci-
ities is an important component of both ety as a whole (national Family Caregivers
individual/high risk and population-based Association, 2009). The caregiver’s role is
approaches to CvD risk reduction. Current often expected in relation to one’s elders, yet
evidence-based guidelines, including ATP rarely is there preparation for caregiving for
III, the AHA primary prevention guidelines one’s child or one’s spouse.
for children and youth, and the AAP recom- Direct patient care encompasses much
mendations for lipid screening and cardio- more than physical care; it also necessitates
vascular health in childhood, consider both learning an extensive amount of informa-
lipid and nonlipid risk factors, target LDL-C tion about illness, symptoms, medications,
in algorithms for assessment and treatment technological treatments, and how to relate
considerations, and emphasize TLC as the to health care professionals (Smith, 1995;