Hyperlipidemia is the medical term for high cholesterol. Cholesterol causes plaque formation in the arteries reducing blood flow and oxygen throughout the body. Plaque buildup and hardening of the arteries (atherosclerosis) can cause chest pain, heart attack, stroke, blood clots, and poor circulation.
Low-density lipoprotein (LDL) cholesterol is known as the “bad” cholesterol and the main cause of cardiovascular disease. LDL greater than 190 mg/dL is considered high cholesterol, and this number reduces as additional risk factors are added (age, family history, smoking, other diseases).
Lifestyle changes through diet, exercise, weight management, and not smoking are the cornerstone of controlling hyperlipidemia. A drug class known as statins can lower LDL levels and reduce the risk of cardiovascular events.
The Nursing Process
Nurses are important in the education process in managing hyperlipidemia. Nurses educate patients on their risk factors for hyperlipidemia and appropriate treatment. Nurses can help patients in creating and progressing toward their lifestyle goals to achieve positive outcomes.
Nursing Care Plans Related to Hyperlipidemia
Sedentary Lifestyle Care Plan
A sedentary lifestyle lowers HDL cholesterol, the “good” cholesterol, which means there is more LDL (bad) cholesterol in the blood.
Nursing Diagnosis: Sedentary Lifestyle
- Lack of motivation/interest
- Lack of resources (time, access to gym, safe place to exercise)
- Impaired mobility preventing movement
- Chronic disease causing pain
- Lack of training on proper/safe exercise
As evidenced by:
- Verbalizes disinterest in exercising
- Overweight/obese appearance
- Chooses sedentary activities
- Poor strength and general deconditioning
- Patient will participate in 30 minutes of exercise 3-4 days per week
- Patient will choose activities that do not cause pain but improve strength
Sedentary Lifestyle Assessment
1. Determine exercise and dietary habits.
Assess the patient’s current activity level and usual dietary intake as well as their schedule, living environment, and access to resources to develop interventions.
2. Assess for pain or conditions that limit movement.
Chronic pain conditions, surgeries, multiple sclerosis, and impaired mobility can make it unsafe to participate in certain activities. The nurse can help the patient identify exercises they can safely participate in.
3. Assess interests.
To engage the patient and overcome a lack of motivation, assess activities that interest the patient or exercise/sports they played in the past.
Sedentary Lifestyle Interventions
1. Educate why exercise is important.
The nurse should first instruct the patient on how exercise affects their cholesterol. Patients often know that a poor diet is a cause of high cholesterol but may not know that a sedentary lifestyle is also a contributor.
2. Start slow.
Educate the patient that the recommended amount of exercise is 150 minutes per week. That can seem impossible to someone who doesn’t exercise. Don’t overwhelm them with unattainable goals. Start slow with a 5-minute walk and increase weekly.
3. Review HDL periodically.
An improvement in HDL and total cholesterol levels can aid the patient in visualizing progress and continuing to exercise.
4. Plan ahead.
A few missed workouts, bad weather, an illness, and holidays are just a few roadblocks that can detail a patient’s entire exercise regimen. Plan ahead for these barriers by offering alternatives such as following an exercise video at home if the gym is closed, exercising with family to increase adherence, or even just stretching when feeling unwell. Any movement is better than no movement.
Ineffective Adherence (Formerly Noncompliance) Care Plan
An inability to adhere to the treatment plan and instructions can result in ineffective outcomes.
Nursing Diagnosis: Ineffective Adherence
- Lack of motivation to change
- Poor understanding of treatment plan
- Cultural influences on lifestyle
- Addiction (food, smoking)
- Underlying mental health issues (anxiety, depression)
As evidenced by:
- Inability to decrease intake of saturated fats
- Absence of weight loss
- No improvement in physical activity
- No progress to quit smoking
- Nonadherence with statin medication
- Development of conditions attempting to prevent (heart disease, stroke)
- Patient will not miss any doses of statin medication for 2 weeks
- Patient will verbalize one reason to decrease cholesterol
- Patient will decrease smoking to less than a pack per day
Ineffective Adherence Assessment
1. Assess readiness for change.
Have an open conversation with the patient regarding the need for change. Do not scold or reprimand if behavior change has not occurred. Inquire about what motivates them and if they see benefits to improving their lifestyle.
2. Identify factors that limit adherence.
Depression, anxiety, and addictions can limit the patient’s ability to adhere to diet and lifestyle changes and are bigger than their self-control. These issues may require counseling or other treatment before behavior change can occur. A lack of support, lack of belief, and low health literacy are also barriers.
3. Review medication management.
Forgetfulness is the most common reason for not adhering to the treatment plan. Assess the patient’s understanding of their medications, when they should be taken, and why they may be missing doses (unable to afford, pick up from pharmacy, complex regimen).
Ineffective Adherence Interventions
1. Implement motivational interviewing.
The nurse provides education and can assist the patient in making positive changes through motivational interviewing. The Stages of Change Model can help the nurse determine where the patient is in the cycle of changing their health.
2. Instruct on medication strategies.
The nurse can recommend strategies to increase medication adherence. This can be delivery of their medications from the pharmacy to their home, setting timers as a reminder, keeping medications in a pillbox to be filled by a competent family member, and keeping medications visible such as on the nightstand to take before bed. (Statin medications are usually prescribed to take at night.)
3. Establish manageable goals.
Changing lifestyle behaviors can be difficult. Quitting smoking, losing weight, and changing eating habits doesn’t happen overnight but over time. Help the patient establish graduated goals such as smoking 1 less cigarette per day.
4. Help the patient understand consequences.
Stressing the importance of adherence can include consequences for not doing so. Providing education on how high cholesterol leads to serious conditions such as heart attacks and strokes may aid in making better choices.
Ineffective Tissue Perfusion Care Plan
The ultimate goal of controlling hyperlipidemia is to prevent heart disease, strokes, and MIs.
Nursing Diagnosis: Ineffective Tissue Perfusion
- Plaque formation causing decreased perfusion
- Other contributing chronic conditions (hypertension)
As evidenced by:
- Chest pain
- Stroke symptoms: weakness, slurred speech, vision changes
- High LDL levels
- Observed plaque formation through testing
- Leg pain when walking (intermittent claudication)
- Patient will not experience a heart attack or stroke
- Patient will verbalize understanding of reducing cholesterol through lifestyle changes, chronic disease management, and medication
Ineffective Tissue Perfusion Assessment
1. Assess lab work and vital signs.
Assess LDL, HDL, and total cholesterol levels. Assess blood pressure and heart rate and compare results to baseline data.
2. Assess health history.
Assess for a history of diabetes, hypertension, heart disease, MIs, TIAs, or stroke as well as a family history of these conditions. A family history increases the risk of heart attack or stroke.
3. Assess complaints of chest pain/dyspnea.
Assess precipitating factors and if chest pain occurs at rest or with exertion. Assess the degree of dyspnea. Chest pain that is severe or doesn’t ease with rest is an emergency.
Ineffective Tissue Perfusion Interventions
1. Know your numbers.
The patient should be educated on their cholesterol numbers. The goal is <130 mg/dL for low density lipoprotein (LDL), 100-199 mg/dL total cholesterol for adults, >45 mg/dL for high density lipoprotein (HDL), and <150 mg/dL for triglycerides.
2. Educate on dietary changes.
A heart-healthy diet requires lowering the intake of saturated and trans fats. Reduce red meats, dairy products, and fried foods. Increase fruits, vegetables, whole grains, and fish.
3. Educate on statin medication.
Patients who cannot reduce their cholesterol levels through lifestyle changes require statin medication. Changes in diet, exercise, and smoking should still be encouraged.
4. Obtain echo, ultrasound, or angiography.
An echocardiogram shows the heart’s valves and how well it is pumping. Ultrasounds visualize the arteries and can show hardening or narrowing. Angiography can locate and measure blockages in the arteries. These tests can diagnose atherosclerosis and help plan treatment to prevent heart attacks and stroke.
References and Sources
American Heart Association. (2020, November 11). Prevention and Treatment of High Cholesterol (Hyperlipidemia). American Heart Association. Retrieved April 28, 2022, from https://www.heart.org/en/health-topics/cholesterol/prevention-and-treatment-of-high-cholesterol-hyperlipidemia
Cleveland Clinic. (2019, May 24). LDL Cholesterol & Heart Health. Cleveland Clinic. Retrieved April 28, 2022, from https://my.clevelandclinic.org/health/articles/16866-cholesterol-guidelines–heart-health
Cleveland Clinic. (2022, February 25). Atherosclerosis: Causes, Symptoms, Risks & Tests. Cleveland Clinic. Retrieved April 28, 2022, from https://my.clevelandclinic.org/health/diseases/16753-atherosclerosis-arterial-disease#management-and-treatment
Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2008). Nurse’s Pocket Guide Diagnoses, Prioritized Interventions, and Rationales (11th ed.). F. A. Davis Company.
Ibrahim MA, Asuka E, Jialal I, et al. Hypercholesterolemia (Nursing) [Updated 2021 Nov 7]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK568722/
LaMorte, W. W. (2019, September 9). The Transtheoretical Model (Stages of Change). SPH. Retrieved April 28, 2022, from https://sphweb.bumc.bu.edu/otlt/mph-modules/sb/behavioralchangetheories/behavioralchangetheories6.html