Hyperlipidemia is the medical term for elevated lipids (cholesterol and triglycerides) in the blood. 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 peripheral vascular disease.
In this article:
- Lipid Panel
- Nursing Process
- Nursing Assessment
- Nursing Interventions
- Nursing Care Plans
- Ineffective Adherence
- Ineffective Tissue Perfusion
- Sedentary Lifestyle
Lipid Panel
A total lipid panel assesses total cholesterol, LDL cholesterol, HDL cholesterol, and triglyceride levels. Low-density lipoprotein (LDL) cholesterol is known as “bad” cholesterol. You can remember this by keeping LDL levels low (“L = Low”). High-density lipoprotein (HDL) cholesterol is considered “good” cholesterol because it absorbs cholesterol from the blood and transports it back to the liver for removal. Remember you want to keep HDL levels high (“H = High”).
| Optimal level | |
| Total cholesterol | < 200 mg/dL |
| LDL cholesterol | < 100 mg/dL |
| HDL cholesterol | > 60 mg/dL |
| Triglycerides | < 150 mg/dL |
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 Assessment
The first step of nursing care is the nursing assessment, during which the nurse will gather physical, psychosocial, emotional, and diagnostic data. In this section, we will cover subjective and objective data related to hyperlipidemia.
Review of Health History
1. Determine the patient’s general symptoms.
Patients with underlying hyperlipidemia may be asymptomatic. However, plaque formation, primarily composed of cholesterol and lipids, can eventually restrict or even stop blood flow to the heart or brain. It can lead to signs and symptoms including:
- Dyspnea
- Activity intolerance
- Chest pain (angina)
- Paresthesias
2. Obtain a thorough family history.
When taking their medical history, it is critical to thoroughly evaluate each patient’s family history of cardiovascular disease, hyperlipidemia, and familial hypercholesterolemia. Note any cardiovascular disease in the family before the age of 50 for male relatives or 60 for female relatives.
3. Assess the patient’s risk factors.
These factors can raise the likelihood of hyperlipidemia by increasing “bad” cholesterol in the body:
Non-modifiable factors:
- Gender and age: Hyperlipidemia risk increases with age for all genders, but women may have lower LDL levels until menopause.
Modifiable risk factors:
- Diet high in saturated and trans fat
- Obesity
- Lack of physical activity
- Smoking
- Alcohol
- Diabetes increases the risk of hyperlipidemia by lowering “good” cholesterol and raising triglycerides and “bad” cholesterol levels.
4. Assess the patient’s treatment adherence.
To reach optimal cholesterol levels, patients with hyperlipidemia will require lifestyle modifications and, in many cases, medications. Assess the patient’s ability and willingness to adhere to their treatment plan.
5. Regularly monitor the patient’s weight.
Being overweight or obese increases the likelihood of hyperlipidemia. The nurse can assess the patient’s weight and physical activity.
Physical Assessment
1. Obtain accurate blood pressure measurements.
Fatty deposits accumulate in the blood vessels when cholesterol is high. It is challenging for blood to circulate through the narrowed arteries, causing increased blood pressure. Hypertension further increases the risk of stroke and myocardial infarction.
2. Assess perfusion status.
Oxygenated blood cannot adequately perfuse the body when vessels and arteries are blocked with plaque buildup. The patient may exhibit dyspnea, chest pain, and poor peripheral circulation, causing discoloration and coolness to the lower extremities.
3. Auscultate the heart sounds.
Auscultate for an S4 heart sound that can occur with coronary artery disease. The nurse can also assess for bruits, which are wooshing sounds due to a partially occluded artery.
4. Palpate the peripheral pulses.
Palpate the peripheral pulses in all four extremities to compare and assess the rate and characteristics. Due to the stiffening of the blood vessels and plaque buildup from cholesterol, pulses in the lower extremities may be difficult to detect.
5. Assess the skin.
A skin condition known as xanthoma occurs when lipids accumulate beneath the skin’s surface. Xanthomas are elevated, waxy-appearing skin lesions that are typically yellow. Abnormalities in the transportation of lipids such as cholesterol, triglycerides, and phospholipids cause these lipids to be deposited underneath the skin.
Diagnostic Procedures
1. Collect blood to assess the lipid profile.
LDL, HDL, triglycerides, and total cholesterol should be collected fasting for the most accurate result.
2. Review liver function.
It is crucial to do liver function testing because the liver is the organ that produces and clears cholesterol. A damaged liver may result in abnormal cholesterol levels. Statins, medications used to treat hyperlipidemia, may cause elevations in liver function tests. The provider will assess liver function prior to and three months after beginning statin therapy. Rarely do statins cause damage to the liver.
3. Check the thyroid.
To rule out underlying thyroid problems, a TSH test should be completed. Hyperlipidemia and hypothyroidism are linked through lipid production, absorption, circulation, and metabolism changes. Thyroid hormones promote the production of cholesterol.
Nursing Interventions
Nursing interventions and care are essential for the patients recovery. In the following section, you will learn more about possible nursing interventions for a patient with hyperlipidemia.
1. Advise on lipid profile screening.
Advise the patient to undergo lipid screening beginning at:
Males:
- 35 years old: without cardiovascular risk factors
- 25 years old: with risk factors
Females:
- 45 years old: without cardiovascular risk factors
- Between 30 and 35: with risk factors
Note: Lipid screening every five years is reasonable for patients with lower cardiovascular risk, and more frequent screening is advised as the patient’s cardiovascular risk increases.
2. Guide the patient in lifestyle modifications.
The first line of treatment against high cholesterol is to modify the lifestyle through activities like exercise and healthy eating. However, medication is more effective than diet alone in improving cholesterol levels.
3. Set a goal for weight loss.
Obesity and being overweight are associated with an increase in LDL (bad cholesterol) and a decrease in HDL (good cholesterol). Assist the patient in strategies to achieve their ideal body weight to decrease the risk of hyperlipidemia. A 5% to 10% weight decrease can help lower cholesterol levels.
4. Recommend a heart-healthy diet.
A heart-healthy diet incorporates the following foods:
- Fruits
- Vegetables
- Whole grains
- Chicken
- Fish
- Nuts
- Beans
- Soy
- Vegetable oils
5. Avoid fats.
The most effective way to reduce cholesterol is to consume fewer trans and saturated fats. Advise keeping trans fat intake to a minimum and keeping saturated fat intake to less than 6% of daily calories. Remind patients to reduce red and processed meats, butter, sodium, processed foods, and sugary foods and drinks.
6. Assist the patient in meal planning.
Encourage the patient to follow Dietary Approaches to Stop Hypertension (DASH) diet. Guide the patient as they make their meal plan. Emphasize the need to reduce the consumption of fats, cholesterol, and sweets while increasing the intake of fruits, vegetables, and low-fat dairy products.
7. Read food labels.
Advise the patient to read food labels carefully to make smart dietary choices.
- Recognize and understand which foods raise LDL
- Choose low-cholesterol options
- Understand limits on sodium
- Reduce frozen meals and canned foods and opt for fresh when possible
8. Encourage the patient to become more active.
A sedentary lifestyle decreases HDL (good) cholesterol. Low HDL means there is less good cholesterol to clean out the blood vessels of harmful cholesterol. Both high blood pressure and high cholesterol can be reduced with 150 minutes of weekly moderate-intensity aerobic exercise such as brisk walking, swimming, and biking.
9. Stop smoking and reduce alcohol intake.
Smoking raises the risk of coronary heart disease in patients with high cholesterol levels. Excessive alcohol consumption also increases the risk of hyperlipidemia.
10. Administer medications as prescribed.
Some patients may be able to lower their cholesterol levels by changing their diet and lifestyle, though medications are commonly required. These are the medications that can help reduce cholesterol levels:
- Statins hinder the liver from producing cholesterol. They are the most common antihyperlipidemic medication.
- Cholesterol absorption inhibitors prevent the intestines from absorbing cholesterol that has been consumed.
- PCSK9 inhibitors are a new class of drugs that lower LDL cholesterol.
- Niacin can increase HDL cholesterol and lower LDL cholesterol.
- Bile acid resins bind to the digestive bile that contains cholesterol to aid in removal through stool.
11. Promote treatment adherence.
Inform the patient about medication risks and advantages, side effects, and interactions. Statins, for example, may cause muscle pain that can be uncomfortable for the patient. Remind the patient to discuss side effects with the provider before discontinuing any medication.
12. Refer to a cardiologist if complications occur.
Cardiologists assist in treating various heart problems, including hyperlipidemia complications like coronary heart disease and angina.
Nursing Care Plans
Once the nurse identifies nursing diagnoses for hyperlipidemia, nursing care plans help prioritize assessments and interventions for both short and long-term goals of care. In the following section, you will find nursing care plan examples for hyperlipidemia.
Decreased Cardiac Output
Elevated cholesterol levels increase the risk of cardiovascular disease, reducing cardiac function and increasing the risk of myocardial infarction, stroke, and vascular disease.
Nursing Diagnosis: Decreased Cardiac Output
Related to:
- Atherosclerotic plaque in the coronary vessels
- Impaired contractility
- Impaired blood flow
- Decreased myocardial oxygenation
As evidenced by:
- Angina
- Exertional dyspnea
- Syncope
- Palpitations
- Tachypnea
- Jugular vein distension
- Carotid bruit
- Abnormal heart sounds (S3 and S4)
- Fatigue
- Activity intolerance
Expected outcomes:
- Patient will not experience chest pain with rest or activity.
- Patient will not experience heart failure, myocardial infarction, or stroke.
- Patient will maintain a normal sinus rhythm on EKG.
Assessment:
1. Monitor blood pressure.
Hypotension may be due to impaired perfusion to the myocardium and ventricular dysfunction. On the other hand, hypertension may be caused by plaque buildup occluding vessels.
2. Assess for chest pain.
Chest pain (angina) is a sign of reduced oxygenated blood to the heart. Stable angina occurs with exercise and resolves with rest, while unstable angina occurs at rest and is not relieved by medication. Chest pain requires further investigation.
3. Obtain EKG.
Hyperlipidemia may lead to irregular heart rhythms if coronary arteries become blocked, and life-threatening dysrhythmias like STEMI or NSTEMI may occur.
Interventions:
1. Educate on cardiovascular screenings.
Patients with hyperlipidemia are at risk for cardiovascular disease. Adults should have their lipid profile assessed every 5 years. If cholesterol numbers are abnormal, this screening increases to every 1-2 years. Blood pressure monitoring and diabetes screenings are also necessary to monitor cardiovascular risk.
2. Administer medications as indicated.
- Diuretics promote diuresis and reduce blood pressure.
- Vasodilators dilate blood vessels to reduce filling pressure and cardiac workload.
- Nitroglycerin causes coronary arterial and venous dilation reducing afterload, preload, and myocardial oxygen demand and increasing oxygen delivery. This medication is used to relieve chest pain.
- Inotropic drugs improve heart contractility.
- Aspirin prevents platelet aggregation, clumping, and activation that leads to thrombus formation in coronary arteries leading to acute coronary syndrome
3. Assist the patient in diagnostic studies and revascularization.
Severe cases of ischemic coronary heart disease due to atherosclerosis may necessitate cardiac catheterization. Revascularization through the use of stents or balloons can restore blood flow to the coronary arteries during cardiac catheterization.
4. Instruct on supplements.
Along with prescribed medications, omega-3 fatty acids may lower triglyceride levels and reduce the risk of heart attack and stroke.
Ineffective Adherence
An inability to adhere to the treatment plan and instructions can result in ineffective outcomes.
Nursing Diagnosis: Ineffective Adherence
Related to:
- 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)
Expected outcomes:
- 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.
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).
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
The ultimate goal of controlling hyperlipidemia is to prevent heart disease, strokes, and MIs.
Nursing Diagnosis: Ineffective Tissue Perfusion
Related to:
- Plaque formation causing decreased perfusion
- Other contributing chronic conditions (hypertension)
As evidenced by:
- Chest pain
- Dyspnea
- Stroke symptoms: weakness, slurred speech, vision changes
- High LDL levels
- Observed plaque formation through testing
- Leg pain when walking (intermittent claudication)
Expected outcomes:
- Patient will not experience a heart attack or stroke.
- Patient will verbalize understanding of reducing cholesterol through lifestyle changes, chronic disease management, and medication.
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.
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.
Sedentary Lifestyle
A sedentary lifestyle lowers HDL cholesterol, the “good” cholesterol, which means there is more LDL (bad) cholesterol in the blood.
Nursing Diagnosis: Sedentary Lifestyle
Related to:
- 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
Expected outcomes:
- 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.
- Patient will experience an improvement in HDL cholesterol levels as evidenced by lab work.
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.
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.
References
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- American Heart Association. (2021, May 4). Cholesterol and diabetes. www.heart.org. Retrieved April 2023, from https://www.heart.org/en/health-topics/diabetes/diabetes-complications-and-risks/cholesterol-abnormalities–diabetes
- 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
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