NON

COMMUNICABLE
DISEASES

CARDIOVASCULAR
DISEASES

CARDIOVASCULAR
DISEASES

Diseases of the heart and the

vascular system remain to be the
first and the second leading causes
of mortality among Filipino as of
2002.
According to the DOH, these are
mainly due to hypertension,
coronary heart disease and stroke.

Hypertension
Category

Systolic BP
(mmHg)

Diastolic BP
(mmHg)

Normal

<120

>80

Prehypertension

120 - 139

80 89

HYPERTENSION
Hypertension,
Stage 1

140 - 159

Hypertension,
Stage 2

>160

90 99
>100

NOTE: When a patients systolic and diastolic

BP fall into different categories, the higher
category should apply.

Risk Factors of
Hypertension

Family history of hypertension

Obesity
Cigarette smoking
Heavy alcohol consumption
Elevated blood cholesterol levels
Continued exposure to stress

Lifestyle Modification To
Manage Hypertension
MODIFICATION

Weight reduction

RECOMMENDATION

Maintain normal body

weight
(Body Mass Index 18.5 to
24.9 kg/m2)

APPROXIMATE
SYSTOLIC BP RED5
-UCTION
5 20 mmHg/10 kg
weight loss

Adopt dietary approaches Consume a diet rich in

8 14 mmHg
to STOP hypertension
fruits, vegetables and low
(DASH)
fat dairy product with a
reduced content of
saturated and total fat
Dietary sodium reduction

Dietary sodium intake

2 8 mmHg
<100 mmol/day (2.4 g Na
or 6g NaCl)

Physical activity

Regular aerobic activity

(brisk walking at least 30
mins/day, most days of
the week

4 9 mmHg

Dietary Approaches to
Stop Hypertension
(DASH) Diet
FOOD GROUP

NUMBER OF Serving Per Day

Grains and grain products

7 or 8

vegetables

4 or 5

fruits

4 or 5

Low fat or fat free dairy products

2 or 3

Meat, fish and poultry

2 or fewer

Nuts, seeds and dry beans

4 or 5 weekly

Diet is based on 2,000 calories per day

CAD Coronary Artery

Disease

Non Modifiable Risk Factors

Heredity
Increasing age
Gender
Modifiable Risk Factors
Hypertension
High cholesterol
Cigarette smoking, tobacco use
DM
Lack of exercise
Personality
Obesity
Lack of estrogen in women
High coagulability of the blood

The first four modifiable risk factors have been cited as the
MAJOR RISK factors for CAD and its complications.

Recommended Guidelines in
Screening for Elevated Cholesterol in
the Blood
Cholesterol
Level
<200 mg/100
ml
200 239
mg/100 ml

interpretati Frequency
on
of Tests
normal
Repeat every
five days
Elevated
Repeat tests,
(may be at
take average
risk)
of both tests

240 mg/100 Elevated (at

ml and above risk)

Further tests
(lipid profile
and

Desired Blood Cholesterol Levels

Low Density Lipoprotein
Characteristic of
Patient
Patient with one or no
risk factors

Desired Blood Level

<160 mg/dl

Patient with two or more <130 mg/dl

risk factors
Patients with CAD or at
high risk for CAD

<100 mg/dl

Patients at very high risk <70 mg/dl

for an acute coronary
event
High Density Lipoprotein >60 mg/dl

Cerebrovascular Disorder

Is an umbrella term that refers to a

central nervous system (CNS)
functional abnormality due to the
disruption of the normal blood
supply in the brain.
CVA or Stoke is the primary
cerebrovascular disorder in the
world.

Two Major Categories of

CVA

Ischemic Stroke
Also known as brain attack,
There is disruption of cerebral blood
flow due to obstruction of a blood vessel
Occurs in 85% patients

Hemorrhagic Stroke
Occursf or 15% of CVA disorders
Caused by intracranial and subarachnoid
hemorrhage

CANCER

Cancer

Disturbance of cellular growth

characterized primarily by an
abnormally excessive proliferation of
cells without apparent relation to
the physiological demands of the
organ involved

Growth and Spread of

Cancer
Directly extending into adjacent tissues
Invading a nearby body cavity, such as the
abdomen or pleural space
Invading along lymphatic vessels
Traveling via lymphatic vessels to the lymph
nodes which drain the region in which the cancer
is situated
Traveling via the blood vessels to any part of the
body, but particularly to the lungs, liver and
bones
NOTES: The last three modes of spread result in a
metastasis far from the site of the primary tumor.

New Warning Signs of

Cancer

Change in bowel or bladder habits

A sore that does not heal
Unusual bleeding or discharge
Thickening or lump in the breast or elsewhere
Indigestion or difficulty in swallowing
Obvious change in wart or mole
Nagging cough or hoarseness
Unexplained anemia
Sudden unexplained weight loss

Cancer Risk Factors

Age incidence increases with age

Sex significant differences among sexes, e.g. breast cancer
Race skin color, diet, custom
Occupational petrochemical workers with higher rates of
bladder cancer
Health habits those who do not smoke, protect themselves
from the sun and have a sensible diet have lower incidence of
cancer
Family history those with family history of breast cancer and
colorectal cancer have increased risk of developing these
Socio economic status
Lifestyle smoking, excessive alcohol drinking, betel nut
chewing, diet, sexual activity and sun exposure are associated
with cancer

HEALTH PROMOTION (REDUCING CANCER RISK)

Increase consumption of fresh
vegetables (especially those of
the cabbage family) since
studies show that roughage and
vitamin rich foods help prevent
certain types of cancer
Increase fiber intake. This
reduces the risk for breast,
prostate and colon cancer
Increase intake of food rich in
Vitamin C (E.g. citrus fruits and
broccoli). This protects against
stomach and esophageal cancer
Practice weight control. Obesity
is linked to cancer of the uterus,
gallbladder, breast and colon

Reduce intake of dietary fat since

a high fat diet increase the risk
for breast, colon and prostate
cancer
Practice moderate consumption
of salt cured smoked and nitrate
cured food. These are linked to
esophageal and gastric cancers
Stop smoking cigarettes and
cigars
Reduce alcohol intake. Large
amount of alcohol intake
increases the risk of liver cancer
avoid over expoure to the sun,
wear protective clothing and use
sunscreen to prevent skin damage
from ultraviolet rays which
increases the risk of skin cancer

CANCER PREVENTION AND EARLY DETECTION

TYPE

PREVENTION

DETECTION

LUNG

Do not smoke

None

UTERINE CERVIX

Having one sexual

partner lower risk;
clean safe sex

Regular pap smear

every 1 4 years

LIVER

Vaccination versus
Hepatitis B virus;
minimal alcohol
intake; avoid moldy
foods

None

COLON/RECTUM

Prudent diet of a
variety of foods also
with high fiber and
low fat intake

Regular medical
check up after 40
years of age, yearly
occult blood test in
stools; digital rectal
exam; sigmoidoscopy

MOUTH

Avoid smoking
Thorough dental
tobacco and betel nut check ups each year
chewing; modify
consumption of

CANCER PREVENTION AND EARLY DETECTION

TYPE

PREVENTION

DETECTION

BREAST

No conclusive
evidence

Monthly self exam, 7

to 10 days after the
first day of menses;
mammography for
high risk groups or for
females >50 years old

SKIN

Avoid excessive sun

exposure

Skin self examination

PROSTATE

No conclusive
evidence

Digital transrectal
exam for early
diagnosis

PRINCIPLES OF
TREATMENT OF
MALIGNANT DISEASES

Three Major Forms of

Cancer Treatment

Surgery
Oldest mode of treatment;
Removes principal deposit of cancer
Involved the removal of healthy tissues
surrounding the tumor and possibly the
adjacent lymph nodes

Three Major Forms of

Cancer Treatment

Radiation Theraphy

Localizes treatment where a beam of

high energy electromagnetic
radiation destroys cancer cells

Three Major Forms of

Cancer Treatment

Chemotheraphy
Use of chemicals in an attempt to
destroy tumor cells by interfering with
cellular functions, including replication
Drugs may be taken orally, parenterally
or by topical application
Those taken orally or parenterally
produce side effects

Palliative Care or
Supportive Care

Active, holistic care of patients and

their families given by a
multidisciplinary team of physicians,
nurses, nutritionists, social workers,
psychologists, rehabilitation medicine,
religious persons, relatives and friends.
This covers physical, psychological,
social and spiritual needs
Management is towards the patients
symptom free existence, with spiritual
and psychological support

DIABETES MELLITUS

Diabetes Mellitus

A group of metabolic diseases

characterized by hyperglycemia
resulting from defects of insulin
secretion, insulin action or both of
these.

Two Major Classifications

of DM

Type 1 previously
referred to as IDDM

Develops during
childhood or
adolescence and
affects about 10% of
all diabetic patients.
Sufferer require a
lifetime of insulin
injection for survival
since their pancreas
cannot produce
insulin

Type II referred as
NIDDM

Comprises about 90%

of all diabetic patients
who are mostly
overweight or obese.
They usually have
insulin resistance
Frequently
undiagnosed for many
years because
hyperglycemia develop
gradually, thus making
the symptoms go
unnoticed

Risk Factors for DM

Family history of diabetes

Obesity
Age >45 years old
Previously identified impaired fasting
glucose or impaired glucose tolerance
Hypertension >140/90mmHg
HDL cholesterol level <35mg/dl and/or
triglyceride level >250mg/dl
History of gestational diabetes or delivery
of babies over 9 lbs.

MANAGEMENT OF DM

Nutrition Management

Avoid simple sugar like cakes and chocolates.

Instead have complex carbohydrates like
rice, pasta, cereals and fresh fruits
Do not skip or delay meals. It causes
fluctuations in blood sugar levels
Eat more fiber rich foods like vegetables
Cut down on salt
Avoid alcohol. Dietary guidelines recommend
no more than 2 drinks for men and no more
than one drink per day for women

Exercise

Lowers blood glucose by increasing the

uptake of glucose by body muscles and by
improving insulin utilization
Improves circulation and muscle tone
Resistance training increases lean muscle
mass, thereby increasing the resting
metabolic rate
Exercise should be done at least 3 times a
week for at least 30 minutes each session

Exercise (cont)

General Precautions for Exercise in

Diabetics
Always carry quick sugar sources like candy or
softdrink to avoid hypoglycemia during and
after exercise
Use proper footwear and other protective
devices
Avoid exercise in extreme heat or cold
Inspect feet daily after exercise
Avoid exercise during periods of poor metabolic
control

Monitoring

Self monitoring of blood glucose

enables the diabetic to adjust the
treatment regimen to obtain optimal
blood glucose control

Pharmacologic Therapy

Exogenous insulin must be administered on a

long term basis to Type 1 diabetes because in
Type 1, the body loses its ability to produce
insulin.
If diet and oral agents have failed in Type 2
diabetes, insulin may also be necessary on a
long term basis.
Type 2 diabetic patients may temporarily
require insulin during illness, infection,
pregnancy, surgery or some other stressful
event

Categories of Insulin

Time
Course

agent

onset

peak

duration

indications

Rapid
Acting

Humalog

10 15 min

1 hour

3 hours

Used for
rapid
reductionof
glucose
level,

Short
Acting

Regular

- 1 hour

2 3 hours

4 6 hours

Usually
administere
d 20 30
minutes
a.c; may be
taken alone
or in
combinatio
n with long
lasting
insulin

3 4 hours

4 12
hours

16 20
hours

Usually
taken after
food

Intermedi NPH
ate Acting (neutral

protamine
Hagedorn)
Lente (L)

Education

Education on nutrition, medication

effects and side effects, exercise,
disease progression, prevention
strategies, monitoring techniques
and medication adjustment as part
of their self management behavior.

CHRONIC OBSTRUCTIVE
PULMONARY DISEASE
(COPD)

COPD

A disease characterized by progressive

and irreversible air flow obstruction.
It could be due to emphysema, chronic
bronchitis or even both

Chronic bronchitis defined as a

productive cough that lasts 3 months in
each 2 consecutive years where other
possible causes for cough have been
excluded

COPD (cont)

Emphysema an end stage of a slowly

progressing process characterized by
an abnormal distention of the air spaces
beyond the terminal bronchioles, with
destruction of the walls of the alveoli.

Suspect COPD in person

with the following:

> 50 years old

Smoking for many years
With symptoms of progressive and
increasing shortness of breath on
exertion
Chronic productive cough

Risk Factors for COPD

Exposure
Passive smoking
Occupational exposure
Ambient air pollution
Genetic abnormalities, including a
deficiency of alpha - antitrypsin

Diagnostic Procedure

Pulmonary Function Studies

Are used to determine disease severity.
Airflow obstruction is determined by
the ratio of forced expiratory volume
(FEV) to force vital capacity (FVC)
With obstruction the patient cannot
forcibly exhale air from the lung, thus
reducing the FEV.

Medical Management

Oxygen Therapy

Long term oxygen therapy improves the

quality of life and survival

Pulmonary Rehabilitation
Consists of educational, psychosocial,
behavioral and physical components
Breathing exercises, retraining and
exercise programs are used to improve
functional status

Nursing Management

Teaching patient about COPD

Breathing Exercises
Activity Pacing
Inspiratory muscle training to
strengthen muscles used in breathing
Self care activities
Physical conditioning
Promoting smoking cessation
Supportive nursing care