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خرید پکیج
تعداد آیتم قابل مشاهده باقیمانده : 3 مورد
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Recommendations based on clinical practice guidelines for a hypothetical 79-year-old woman with hypertension, diabetes mellitus, osteoarthritis, osteoporosis, and COPD

Recommendations based on clinical practice guidelines for a hypothetical 79-year-old woman with hypertension, diabetes mellitus, osteoarthritis, osteoporosis, and COPD
Patient tasks
Joint protection
Energy conservation
Exercise
  • Non-weightbearing if severe foot disease present or weightbearing for osteoporosis
  • Aerobic exercise for 30 minutes on most days
  • Muscle strengthening
  • Range of motion
Avoid environmental exposures that might exacerbate chronic obstructive pulmonary disease (COPD)
Wear appropriate footwear
Limit intake of alcohol
Maintain normal body weight (body mass index of between 18.5 and 24.9)
Clinician tasks
Administer vaccine
  • Pneumonia
  • Influenza annually
Check blood pressure at all clinician visits and sometimes at home*
Evaluate self-monitoring of blood glucose
Foot examination at all clinician visits if neuropathy present; otherwise, check feet for protective sensation, structure, biomechanics, vascular status, and skin integrity annually
Laboratory tests
  • Microalbuminuria annually if not already present
  • Creatinine level and electrolytes at least 1 to 2 times per year
  • Cholesterol levels annually
  • Liver function biannually
  • Glycosylated hemoglobin level biannually to quarterly, depending on level of control
Referrals
  • Physical therapy
  • Ophthalmologic examination
  • Pulmonary rehabilitation
  • Dual-energy x-ray absorptiometry scan every other year
Patient education
  • High-risk foot conditions, foot care, and foot wear
  • Osteoarthritis
  • COPD medication and delivery system training
  • Diabetes mellitus
* Ambulatory blood pressure monitoring is helpful if "white coat hypertension" is suspected and no target organ damage, apparent drug resistance, hypotensive symptoms with antihypertensive medication, or episodic hypertension.
Reproduced with permission from: Boyd CM, Darer J, Boult C, et al. Clinical practice guidelines and quality of care for older patients with multiple comorbid diseases: Implications for pay for performance. JAMA 2005; 294:716. Copyright © 2005 American Medical Association. All rights reserved.
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