Synonym/Acronym
Trigs, TG.
Rationale
To evaluate triglyceride (TG) levels to assess cardiovascular disease risk and evaluate the effectiveness of therapeutic interventions.
Patient Preparation
There are no activity or medication restrictions unless by medical direction. Instruct the patient to fast for 12 hr before specimen collection; fasting is required prior to measurement of TG levels. Ideally, the patient should be on a stable diet for 3 wk and avoid alcohol consumption for 3 days before specimen collection; alcohol increases TG levels. Protocols may vary among facilities.
Normal Findings
Method: Spectrophotometry.
| Acceptable Guidelines by Age | Conventional Units | SI Units (Conventional Units × 0.0113) |
|---|
| 2 yr–9 yr | Less than 75 mg/dL | Less than 0.85 mmol/L | | 10 yr–17 yr | Less than 90 mg/dL | Less than 1 mmol/L | | 18 yr and older | Less than 150 mg/dL | Less than 1.7 mmol/L |
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Study type: Blood collected in a gold-, red-, red/gray-, or green-top [heparin] tube; related body system: Circulatory system.
Fat or adipose is an important source of energy. TGs are a combination of three fatty acids and one glycerol molecule. Much of the fatty acids used in various metabolic processes come from dietary sources. However, the body also generates fatty acids, from available glucose and amino acids, that are converted into glycogen or stored as energy by the liver. Beyond TG, total cholesterol, high-density lipoprotein (HDL), low-density lipoprotein (LDL) cholesterol values, and other important risk factors must be considered. For additional information regarding screening guidelines for atherosclerotic cardiovascular disease (ASCVD), refer to the study titled “Cholesterol, Total and Fractions.” Evidence-based risk factors include age, sex, ethnicity, total cholesterol, HDLC, LDLC, blood pressure, blood-pressure treatment status, diabetes, and current use of tobacco products. TG levels vary by age, sex, weight, and ethnicity:
- Levels increase with age.
- Levels are higher in men than in women (among women, those who take oral contraceptives have levels that are 20 to 40 mg/dL higher than those who do not).
- Levels are higher in overweight and obese people than in those with normal weight.
- Levels in people of African descent are approximately 10 to 20 mg/dL lower than in people of European descent.
Factors That May Alter the Results of the Study
- Drugs and other substances that may increase TG levels include acetylsalicylic acid, beta blockers (atenolol, bisoprolol, labetalol, metoprolol, nadolol, pindolol, propranolol, timolol), cholestyramine, cyclosporine, diuretics (furosemide, thiazides), estrogens, glucocorticoids, icosapent ethyl, oral contraceptives, and tamoxifen.
- Drugs and other substances that may decrease TG levels include ACE inhibitors (captopril, enalapril), anabolic steroids (danazol), ascorbic acid, beta blockers (carvedilol, pindolol), colestipol, fibrates (bezafibrate, clofibrate, ciprofibrate, fenofibrate, gemfibrozil), insulin, levothyroxine, metformin, niacin, and statins (fluvastatin, lovastatin, pravastatin, simvastatin).
Potential Nursing Problems: Assessment & Nursing Diagnosis
| Problems | Signs and Symptoms |
|---|
| Nutrition(excess—related to excess caloric intake with large amounts of dietary sodium and fat; cultural lifestyle; overeating associated with anxiety, depression, compulsive disorder; genetics; inadequate or unhealthy food resources) | Observable obesity, high-fat or high-sodium food selections, high body mass index (BMI); high consumption of ethnic foods, sedentary lifestyle, dietary religious beliefs and food selections, binge eating, diet high in refined sugar, repetitive dieting and failure | | Tissue perfusion (inadequate—related to hypovolemia, decreased hemoglobin, interrupted arterial flow, interrupted venous flow) | Hypotension, dizziness, cool extremities, pallor, capillary refill greater than 3 sec in fingers and toes, weak pedal pulses, altered level of consciousness, altered sensation |
|
Before the Study: Planning and Implementation
Teaching the Patient What to Expect
- Discuss how this test can assist in monitoring and evaluating lipid levels.
- Explain that a blood sample is needed for the test.
Potential Nursing Actions
- Evaluate for the presence of other risk factors, such as family history of heart disease, smoking, obesity, diet, lack of physical activity, hypertension, diabetes, previous myocardial infarction (MI), and previous vascular disease, which should be investigated.
- Monitor and trend other ordered lipid studies (e.g., cholesterol, HDL cholesterol, LDL cholesterol).
- Explain that understanding genetics assists in identifying those who may benefit from additional education, risk assessment, and counseling.
- Genetics is the study and identification of genes, genetic mutations, and inheritance. For example, genetics provides some insight into the likelihood of inheriting a medical condition such as ASCVD.
- Genomic studies evaluate the interaction of groups of genes. The combined activity or combined expression of groups of genes allows assumptions or predictions to be made. As an example, genomic studies measure the levels of activity in multiple genes to predict how they, along with environmental and lifestyle decisions, influence the development of type 2 diabetes, ASCVD, MI, or ischemic stroke.
After the Study: Implementation & Evaluation Potential Nursing Actions
Treatment Considerations
Tissue Perfusion
- Monitor blood pressure; assess for dizziness, capillary refill, pedal pulses, numbness, tingling, hyperesthesia, hypoesthesia, and extremities for deep venous thrombosis.
- Monitor skin temperature, color, and warmth.
- Discuss the careful use of heat and cold on affected areas and the use of a foot cradle to keep pressure off of affected body parts.
Nutritional Considerations
- Discuss ideal body weight and the purpose of and relationship between ideal weight and caloric intake to support cardiac health.
- Review ways to decrease intake of saturated fats and increase intake of polyunsaturated fats.
- Discuss limiting intake of refined processed sugar and sodium; discuss limiting cholesterol intake to less than 300 mg per day.
- Encourage the intake of fresh fruits and vegetables, unprocessed carbohydrates, poultry, and grains.
- Numerous studies point to the prevalence of excess body weight in American children and adolescents. Findings from the 2017–2020 National Health and Nutrition Examination Survey (NHANES), regarding the prevalence of obesity in younger members of the population, estimate that obesity is present in 12.7% of the population ages 2 to 5 yrs, 20.5% ages 6 to 11 yrs, and 22.2% ages 12 to 19 yrs. The medical, social, and emotional consequences of excess body weight are significant. Special attention should be given to instructing the pediatric patient and caregiver regarding health risks and weight control education. For adults age 20 yr and over, the prevalence of obesity is 41.9%.
- The Centers for Disease Control and Prevention (CDC) define obesity as BMI at or above the 95th percentile for CDC gender-specific BMI-by-age growth charts.
- Nutritional therapy is recommended for those with identified CAD risk, especially for those with elevated cholesterol levels, other lipid disorders, diabetes, insulin resistance, metabolic syndrome, or elevated blood pressure.
- Always consider cultural influences with dietary choices to ensure better adherence to a change in lifestyle.
- Variety of dietary patterns are beneficial for people with ASCVD. For additional information regarding nutritional guidelines, refer to the study titled “Cholesterol, Total and Fractions.”
- Changeable risk factors warranting education include strategies to encourage regular participation in moderate aerobic physical activity three to four times per week, eliminating tobacco use, and adhering to a heart-healthy diet.
- Those with elevated triglycerides should be advised to eliminate or reduce alcohol.
Clinical Judgement
- Consider which methods of instruction would be most beneficial in addressing the therapeutic interventions necessary to maintain and improve cardiac health.
Follow-Up and Desired Outcomes
- Acknowledges contact information provided for the American Heart Association (www.heart.org/HEARTORG), National Heart, Lung, and Blood Institute (www.nhlbi.nih.gov), and U.S. Department of Agriculture’s resource for nutrition (www.choosemyplate.gov).
- Understands risk factors for CAD, necessary lifestyle changes (diet, smoking, alcohol use), the importance of weight control, and reportable signs and symptoms of heart attack.
- Recognizes that CAD risk is increased through a genetic link with diagnosed first-degree family members.