Patient Education_ Geriatric-Patient Care

Nabiha Saade Castillo | Jordana Oliva González | Floranne Andrea Martínez Zinelli
Elías de Jesús Solórzano López | Mauricio Cortés Fuentes 2022

How to use Guide ………………………………………………………………………….3
Rheumatoid Arthritis …………………………………………………………………..4
Dyslipidemia ………………………………………………………………………………….11
Diabetes Mellitus type 2 …………………………………………………………….16
Lifestyle Recommendations …………………………………………………….21
References …………………………………………………………………………………….22

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What is this resource?
If you have a chronic disease or you know a family member with one, this
booklet is for you! Chronic diseases can cause a variety health problems,
including gastrointestinal (GI) diseases which can affect anything from
the esophagus to the intestines. This booklet is a resource that will help
guide you through the possible GI complications of different chronic
diseases so that they can be identified and then treated or even prevented
with the help of your doctor. If any specific GI concerns arise while reading
this guide, bring them up to your doctor!
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This booklet includes key information that is quick and easy to understand
along with fun activities to complete. Every section includes a follow-up
chart to fill with your/your family member’s GI health concerns, future
doctor appointments, and doctor’s notes in order to have a better control
of your/your family member’s health and wellbeing.
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Objectives
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Inform about the GI complications of chronic diseases in order to identify
them and to promote mentioning them to a healthcare professional.
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Inform about lifestyle recommendations for a healthy life and to prevent
complications.
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Promote a follow-up schedule with periodic doctor’s appointments guided
towards the care of both chronic diseases and GI complications.
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Rheumatoid
Arthritis

1 1 1
1
1
1
5

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What is it?
Disease where the body mistakenly attacks itself, especially the joints, and
causes inflammation 3 .
➔ Common symptoms 3
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Joints that are swollen, warm,
and with limited movement.
Stiffness, fatigue, fever, and loss
of appetite.
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How is it treated?
A combination of
anti-inflammatory drugs,
commonly: 1
●
●
●
Methotrexate.
Glucocorticoids
NSAIDs.
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GI-tract relation?
Rheumatoid arthritis makes you 70% more likely to have gastrointestinal
problems 2 .
How?
◆ Vasculitis 1
● RA can cause inflammation of the blood vessels, which can rarely
affect the GI tract.
◆ Associated immune conditions 1
● RA can share genes with immune conditions affecting the GI tract like:
celiac disease, and inflammatory bowel disease, immune liver disease.
◆ Medications 1
● See “Rheumatoid Arthritis algorithm” for more information

Try this fun word search!
➔ How often do you go to the rheumatoid arthritis
specialist?
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A doctor's visit is recommended every three months. 3 Ask your doctor for
more details.
If you present any of the symptoms in the word search, consult your
doctor as soon as possible and mention the symptoms. You can also write
them down in the follow-up page.
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Follow-up
Suggested frequency: 3 months
Specialist: Rheumatologist
Write down your symptoms or concerns on “Patient symptoms”
Date Patient symptoms Doctor’s notes

DYSLIPIDEMIA
9

Atherosclerotic
Cardiovascular Disease
5
Acute
Pancreatitis 6 10
HDL, as known as, good cholesterol. It
reduces the level of bad cholesterol.
LDL, as known as, bad cholesterol. It sends
cholesterol to our cells and increase the
risk of comorbidities.
HDL, as known as, good cholesterol. It
reduces the level of bad cholesterol.
Triglycerides are other type of fat that can
cause damage if it is not controled.

➔ What is it? 4
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Disease in which our body has high amounts of fat. Doctors diagnose this
disease when they find high cholesterol, high LDL, low HDL, or high
triglycerides in your blood.
➔ Common symptoms 5
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Most people with dyslipidemia do not
have symptoms of the disease.
When symptoms appear it is because
of possible complications of
untreated dyslipidemia: dizziness,
chest pain, stomach ache.
➔ How is it treated? 5
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Lifestyle modifications: reduce the
intake of fats, avoid alcohol, do
exercise.
Drugs called statins that help you
to reduce the fat in your blood.
➔ GI-tract relation? 6
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➔ How? 6
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High levels of triglycerides may damage your pancreas.
If you have high amounts of triglycerides in your blood, this can damage
your pancreas. Triglycerides are a type of fats that when they accumulate
in the pancreas becomes toxic.
You may feel pain in the pit of the stomach, back pain, nausea, and
vomiting.
Most of the times the symptoms appear suddenly. One day before you
may not feel nothing strange in your body.
It is always important to monitor your level of fats (triglycerides,
cholesterol, LDL, HDL) in your blood frequently.
Consult to your doctor for more information.
11

➔
DID YOU KNOW?
Complete the Sudoku!
According to the Turkish
Statistical Institute, 1 in 3
Turks has high fats in the
blood. 7
Dyslipidemia does not affect
only your pancreas. Your
heart, brain, and blood
vessels may be at risk too. 5
Having a healthy lifestyle is
the best way to prevent
dyslipidemias. 5
Normal values in your blood 8
Total cholesterol: Lower than 200 mg/dL (desirable)
LDL: Lower than 100 mg/dL (optimal)
HDL: Higher than 40 mg/dL (men) or 50 mg/dL (women)
Triglycerides: Lower than 150 mg/dL (normal)

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Follow-up
Suggested frequency: Every 3 months or every year (depends on instructions from your
doctor).
Specialist: Endocrinologist, cardiologist, internal medicine.
Write down your symptoms or concerns on “Patient symptoms”
Date Patient symptoms Doctor’s notes
13

Diabetes
Mellitus
Type 2

15

➔ What is it? 15
◆
Chronic disease that occurs either when the pancreas does not produce enough insulin
or when the body cannot effectively use the insulin it produces. With type 2 diabetes, your
body doesn’t use insulin well and can’t keep blood sugar at normal levels.
➔ Common symptoms 14
◆ Urinate (pee) a lot, often at night
◆ Are very thirsty
◆ Lose weight without trying
◆ Are very hungry
◆ Have blurry vision
◆ Have numb or tingling hands or feet
◆ Feel very tired
◆ Have very dry skin
◆ Have sores that heal slowly
◆ Have more infections than usual
➔ How is it managed? 13
◆ Diet and exercise to achieve a
healthy weight.
◆ Blood sugar monitoring.
◆ Diabetes medications: commonly
Metformin.
◆ Insulin therapy.
◆ SGLT2 inhibitors and GLP 1
➔ GI-tract relation? 12
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Approximately 75% of patients with diabetes have some form of
gastrointestinal (GI) symptoms.
How?
◆ Gastroparesis 11
● Diabetes can damage the vagus nerve which is a major nerve in the GI tract.
This causes the eaten food to slow down or stop on its way from the stomach
to the small intestine.
◆ Diabetic enteropathy 11
● Much like gastroparesis, diabetic enteropathy is caused by nerve damage in
the intestines which can lead to a combination of constipation and diarrhea.
◆ Non-alcoholic fatty liver disease 11
●
Insulin resistance, liver accumulation of triacylglycerol and an unbalanced
diet can cause a buildup of fat cells in the liver which in turn makes it harder
to control the diabetes.

Down:
Use these clues to solve the Crossword Puzzle!
1. A sugar that comes from the food we eat.
2. A hormone that helps the body use glucose
for energy.
3. Condition that affects normal movement of
the muscles in the stomach, impeding
normal digestion.
7. Loose or watery poop, common side effect of
metformin.
Across:
4. Doctors recommend taking metformin with
____ to reduce possible side effects.
5. Type of diabetes in which the body doesn't use
insulin properly.
6. Medication commonly used for the treatment
of Diabetes.
8. All of the physical and chemical processes in
the body that occur when food is broken down,
energy is created and wastes are produced.
9. This condition is caused by damage to the
nerves of the intestines and dehydration. It
presents with diarrhea, difficulty to poop, and
not being able to hold in your poop.
10. Chronic disease that occurs either when the
pancreas does not produce enough insulin or
when the body cannot effectively use the
insulin it produces.
7.DIARRHEA, 8.METABOLISM, 9.DIABETIC ENTEROPATHY, 10.DIABETES
1.GLUCOSE, 2.INSULIN, 3.GASTROPARESIS, 4.FOOD, 5.TWO, 6.METFORMIN,
ANSWER KEY
Normal values in your blood 16
A1C: Lower than 5.7%
Fasting blood sugar: Lower than 100 mg/dL
Glucose tolerance test at 2 hrs: Lower than 140 mg/dL
Random blood sugar test: Lower than 200 mg/dL
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➔
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Follow-up
Suggested frequency: Every 3-6 months if there are no complications.
Specialist: Endocrinologist
Write down your symptoms or concerns on “Patient symptoms”
Date Patient symptoms Doctor’s notes

➔ Lifestyle modifications can prevent certain
gastrointestinal disease when living with a chronic illness.
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Keep a healthy diet
Include fruits and vegetables.
Avoid high sodium and sugar
Avoid alcohol and tobacco
Identify and reduce
irritating foods. Common
irritants include:
Coffee and tea
Carbonated drinks
Chocolate
Spicy food
Tomatoes
Citric fruits: oranges, lemons,
grapefruits
Bread/cereals in celiac disease
(gluten)
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Exercise
If you don’t like exercise, try
these alternatives:
● Yoga, gardening, dancing,
walking, swimming
Check your medications
Some may cause symptoms
like heartburn, problems
swallowing, abdominal pain,
diarrhea, constipation, bloody
vomit or feces, bloating, and
abnormal feces.
Talk to your doctors about GI
symptoms and your
medications.
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Treat the chronic illness or gastrointestinal problem
Many diseases interrelate with each other.
Make sure to follow the treatment for your existing conditions to prevent
the appearance or exacerbation of other conditions.
If any new symptom appears or worsens, consult your doctor as soon as
possible to find a solution.
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2. Arthritis Foundation. (n.d.). RA and Gastrointestinal Problems.
https://www.arthritis.org/health-wellness/about-arthritis/related-conditions/other-diseases/gastrointestinal-problems-ra#:~:text=Studies%20show%20that%20people%20with,pro
blem%20than%20people%20without%20RA
3. Kontzias, A. (2022, 4 abril). Artritis reumatoide. Manual MSD versión para profesionales.
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4. Ferranti, S., & Newburguer, J. (2022). Dyslipidemia in children and adolescents: Definition, screening, and diagnosis. UpToDate.
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https://www.uptodate.com/contents/hypertriglyceridemia-in-adults-approach-to-evaluation
6. Swaroop, S. (2022). Clinical manifestations and diagnosis of acute pancreatitis. UpToDate.
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7. Turkish Statistical Institute. (2019). Turkey Health Survey. https://data.tuik.gov.tr/Kategori/GetKategori?p=saglik-ve-sosyal-koruma-101&dil=2
8. American Board of Internal Medicine. (2022). ABIM Laboratory Test Reference Ranges. ABIM.
https://www.abim.org/Media/bfijryql/laboratory-reference-ranges.pdf
9. Davies, M., Dricker, D., Lingvay, I., Mosenzon, O., Rubino, D., & Pedersen, S. (2021). Managing the gastrointestinal side effects of GLP-1 receptor agonists
in obesity: recommendations for clinical practice. Taylor & Francis. https://www.tandfonline.com/doi/full/10.1080/00325481.2021.2002616
10. Siavash, M., Tabbakhian, M., Sabzghabaee, A., & Razavi, N. (2017). Severity of Gastrointestinal Side Effects of Metformin Tablet Compared to Metformin
Capsule in Type 2 Diabetes Mellitus Patients. National Library of Medicine. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5463552/
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https://www.aafp.org/pubs/afp/issues/2008/0615/p1697.html
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education of diabetes and related disorders, 9(Suppl 1), 1–42. https://doi.org/10.1007/s13300-018-0454-9
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13. Mayo Clinic. (202). Type 2 diabetes - Diagnosis and treatment - Mayo Clinic.
https://www.mayoclinic.org/diseases-conditions/type-2-diabetes/diagnosis-treatment/drc-20351199
14. CDC. (2022). Diabetes Symptoms. Centers for Disease Control and Prevention. https://www.cdc.gov/diabetes/basics/symptoms.html
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