HPDP2 - Midterm 1 Study Guide

HPDP2 - Midterm 1 Study Guide

• Difficult Patient Types: The Feldman article outlines four types of challenging patients: Angry, Silent, Demanding, and Yes, But... patients. Strategies for dealing with each are also detailed.

The Angry Patient

• Nonverbal Communication: Rigid postures, piercing stares, refusal to shake hands, gritting teeth, and confrontational/abusive language are common. Subtle behaviors include refusing to answer questions, avoiding eye contact, and creating non-verbal barriers.
• Management: Evaluation should begin with calmly confronting the patient. Phrases like "You seem angry" can help the patient express their feelings, acknowledging the emotion as opposed to judging it. Encourage expression to find unresolved conflicts impacting care.

The Silent Patient

• Characteristics: Silent patients usually offer little verbal communication, appear withdrawn, avoid eye contact or acknowledgement, and may show signs of anxiety or sadness.
• Management Strategies: Acknowledge the patient's silence and offer quiet support, encourage expression of feelings, and address any underlying issues.

The Demanding Patient

• Characteristics: Patient requests are demanding (tests, specialist referrals, very specific treatments). These demands may stem from dissatisfaction with evaluation, wanting secondary gain, concerns about the diagnosis, or overlooking vital historical aspects.
• Management: Clinicians should consider why these demands are important to the patient, asking the patient about their desired outcome. Then, explain any realistic limits on treatment expectations.

The Yes, But... Patient

• Characteristics: These patients appear engaged initially but become withdrawn when recommendations are made. They often react with "I'd like to do that, but..."
• Management: Emphasize that taking responsibility for their own health is key to recovery.

Practitioner Well-being

• Important Considerations: Physical, emotional, and spiritual aspects of health in a practitioner. The relationship with patients is important.
• Personal Philosophy: The deeply held beliefs and values that impact how one perceives life, its purpose, suffering, and relationships.

Control vs. Relational Model

• Control Model: Focuses on control over diseases, patients, and teams. This is often stressful..
• Relational Model: Understanding the multidimensionality of patients and their context is key to successful interactions. This involves recognizing that patients are not just biological entities; acknowledging their lived experiences can also improve outcomes.

Diabetes Types

• Type 1 Diabetes: An autoimmune disease resulting in a lack of insulin production, and exogenous insulin administration is typically required. More common in children and younger adults.
• Type 2 Diabetes: A disease where the body either doesn't properly utilize insulin, or the body struggles producing enough insulin. More commonly found in adults, associated with increased risk for obesity.

Diabetes Diagnosis Testing

• Fasting Glucose: Plasma glucose levels of less than 100 mg/dL (Normal Fasting), 100-125 mg/dL (impaired fasting glucose tolerance), ≥126 mg/dL (Diabetes Mellitus).
• Oral Glucose Tolerance Test: A fasting blood sample is taken, followed by consumption of a glucose solution, and then samples are taken afterward at set intervals (0 and 120 minutes usually). Normal oral glucose tolerance ranges from values of less than 100 mg/dL (at 0 minutes) and less than 140 mg/dL (at 2-hour mark)."

Diabetes Ethnicity & Risk

• Groups at higher risk: Native Americans and Alaskan Natives (Pima) have higher risk than other groups.
• General Risk: Several groups have a higher incidence of Type 2 than others (Hispanic, Blacks) and a risk for development of diabetes.

Metabolic Syndrome

• Criteria: Includes waist circumference, elevated glucose, high blood pressure, elevated triglycerides, and low HDL cholesterol. Most individuals will have 3 out of these 5 criteria.
• Complications: Higher risk of developing diabetes and cardiovascular disease.

Diabetes Prevention Programs

• Diabetes Prevention Program: Demonstrates that lifestyle changes such as diet changes and exercise can prevent diabetes in high-risk individuals.
• UK Prospective Diabetes Study: Found that consistent monitoring of glucose (glycemic control) reduced cases of chronic complications in type 2 diabetes.
• Diabetes Control and Complications Trial (DCCT): Showed tight glucose control can lower risk of chronic complications in type 1 diabetes.

Testing for Diabetes

• HbA1c: Reflects the average blood glucose levels over the last three months. Reflects the overall compliance.
• Urine Glucose Test: Quick, accessible way to screen for glucosuria and high blood sugar levels ( >100mg/dL)
• Nitroprusside test: another indicator to detect glucose in urine.

CRC (Colorectal Cancer)

• Pathophysiology: Majority are adenocarcinomas, often appearing as bulky exophytic masses or constricting lesions. The tumor arises from malignant transformation of pre-cancerous polyps.
• Epidemiology: Usually develops in individuals older than 50 years old.
• Risk Factors: Family history (first-degree relative) is a risk factor; a risk increases with age. Increased risk with IBD; diets high in fat, red meat..
• Testing/Screening: Annual fecal occult blood testing, fecal immunochemical tests, or fecal DNA testing every 1-3 years (screening begins from age 45), colonoscopies recommended every 10 years for average risk individuals.

Prostate Cancer Screening

• Risk Factors: Family history, age, and ethnicity (African American men have a greater likelihood).
• Screening Tests: DRE (digital rectal exam), PSA (prostate-specific antigen), sometimes ultrasound-guided biopsy.
• Strengths and Limitations: The tests have some drawbacks, for instance a PSA level between 4.0-10.0 may be problematic, additional testing is suggested, to further investigate a suspicious case. A level > 10.0 is indicative of a more suspicious case of prostate cancer.

Other Conditions

• Osteoporosis: Characterized by a decrease in bone mineral density and matrix. Age, sex hormone deficiency, and alcohol abuse are risk factors. Bone dencity tests (DXA tests) are used to diagnose the disease (T-scores below -2.5).
• Musculoskeletal Conditions: RICE (rest, ice, compression, elevation) is a common treatment for many conditions.