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Nursing Care Plan | NCP Hyperlipoproteinemia

Hyperlipoproteinemia is a condition of increased lipids (fats) in the blood that has been caused by an increased rate of synthesis or a decreased rate of lipoprotein breakdown. Because lipoproteins transport triglycerides and cholesterol in the plasma, an increased level may cause pancreatitis and atherosclerosis.

Lipids are a mixed group of biochemical substances that are manufactured by the body or are derived from metabolism of ingested substances. The plasma lipids (cholesterols, triglycerides, phospholipids, and free fatty acids) are derived from dietary sources and lipid synthesis. Cholesterol and triglycerides are implicated in atherogenesis.

Hyperlipidemia, an elevation of serum cholesterol or triglycerides, can be primary or secondary to another underlying condition. Lipoprotein elevation, or hyperlipoproteinemia, is described by five specific types: types I, II, III, IV, and V

Primary hyperlipoproteinemia results from rare genetic disorders. Secondary hyperlipoproteinemia occurs as a manifestation of other diseases, which include hypothyroidism, nephrotic syndrome, diabetes mellitus, alcoholism, glycogen storage disease (type I), Cushing’s syndrome, acromegaly, anorexia, renal disease, liver diseases, immunologic disorders, stress, and the use of oral contraceptives or glucocorticoids.

Nursing care plan assessment and physical examination
Take a thorough history of existing illnesses because secondary hyperlipoproteinemia is related to a number of other conditions. Ask the patient if he or she has a history of renal or liver disease, diabetes mellitus, other endocrine diseases, or immune disorders. Ask if the patient is taking corticosteroids or oral contraceptives, and determine the extent of the patient’s alcohol use. Because hyperlipoproteinemia is sometimes treated with a range of bile acid sequestrant medications, which can affect the absorption of other medications, ask if the patient is taking any of the following: warfarin, thiazides, thyroxine, beta-adrenergic blockers, fat-soluble vitamins, folic acid, diuretics, or digitoxin. Symptoms of hyperlipoproteinemia vary, depending on which of the five types the patient has. Ask about recurrent bouts of severe abdominal pain, usually preceded by fat intake, or if the patient has experienced malaise, anorexia, or fever.

Observe general appearance for signs of obesity, which may be an exacerbating factor for hyperlipoproteinemia. Inspection may reveal papular or eruptive deposits of fat (xanthomas) over pressure points and extensor surfaces; likely locations include the Achilles’ tendons, hand and foot tendons, elbows, knees, and hands and fingertips (where you may observe orange or yellow discolorations of the palmar and digital creases). Ophthalmoscopic examination typically reveals reddish-white retinal vessels. In some forms of hyperlipoproteinemia, an opaque ring surrounding the corneal periphery (juvenile corneal arcus) is visible. Palpate the abdomen for spasm, rigidity, rebound tenderness, liver or spleen tenderness, and hepatosplenomegaly. Check for signs of hypertension and hyperuricemia.

Hyperlipoproteinemia is not an abrupt illness; it develops over years. The patient may have developed coping mechanisms during that time, but the patient may be anxious because of accelerated symptoms of atherosclerosis and CAD. The patient may have experienced the premature death of parents from this disorder and have long-lasting fears about her or his own early death. Body image disturbance may also occur because of obesity or the presence of unsightly xanthomas.

Nursing care plan primary nursing diagnosis: Altered nutrition: More than body requirements related to lipoprotein accumulation and accelerated blockage of the coronary arteries.

Nursing care plan intervention and treatment plan
The primary treatment is dietary management, weight reduction, increased physical activity, and the restriction of saturated animal fat and cholesterol intake. Adding polyunsaturated vegetable oils to the diet helps reduce LDL-C concentration. Secondary treatment is aimed at reducing or eliminating aggravating factors, such as alcoholism, diabetes mellitus, or hypothyroidism. To reduce risk factors that contribute to atherosclerosis, the regimen includes treating hypertension, implementing an exercise program, controlling blood sugar, and stopping smoking. For type V hyperlipoproteinemia, female patients are taken off oral contraceptives. Medications may also be prescribed to lower the plasma concentration of lipoproteins, either by decreasing their production or by increasing their removal from plasma.

In rare instances, for patients who cannot tolerate medication therapy, surgical creation of an ileal bypass may be necessary to accelerate the loss of bile acids in the stool and lower plasma cholesterol levels. For children with severe disease, surgery to create a portacaval shunt may be performed as a last resort to decrease plasma cholesterol levels. Plasma exchanges may also be used to reduce cholesterol levels.

Teach the patient about ways to manage diet to control the disorder. Urge the patient to adhere to a 1000- to 1500-calorie per day diet and avoid excess sugar intake. Explain the components of the lipid profile and their ramifications and discuss various means of lowering very low density lipoprotein (VLDL) and LDL levels and increasing high-density lipoprotein (HDL) levels.

Explain the prescribed medication regimen, by providing verbal and written information to the patient or significant others. Refer to effective programs or support groups for controlling cigarette and alcohol use. Teach alternate methods of contraception to the female patient who can no longer use oral contraceptives. A patient faces significant health threats unless he or she makes permanent lifestyle changes. Encourage him or her to verbalize fears, such as those concerning CAD. Offer support and provide clear explanations for the patient’s questions about the lifestyle changes and consequences.

Nursing care plan discharge and home health care guidelines
Teach the patient the importance of dietary and lifestyle changes. Refer the patient to a dietician if appropriate. Be sure the patient understands all medications, including the dosage, route,
action, adverse effects, and the need for routine laboratory monitoring for lipid profiles.

Teach the patient to report to her or his physician the occurrence of signs and symptoms of CAD, such as chest pain, shortness of breath, and changes in mental status. Teach the patient the need for follow-up serum cholesterol and serum triglyceride tests. Instruct the patient to maintain a stable body weight and to adhere to any dietary restrictions before undergoing cholesterol tests. Most tests require the patient to fast for 12 hours before the test.
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