Patient Education Plan Jentry, Braydon, Amanda, Loran

The Patient Breakdown:

Mr. Totino, 68 yr old male retired pizza business owner, lives with wife, has 4 children and 8 grandchildren. He is physically active and independent with ADLs. Came into E.R. with recurrent chest pain, initiated at rest and lasted 30 mins with no relief. Current pain level = 5/10, pressure in mid-chest that radiates into neck; pain has started to relieve and is almost gone upon arrival to E.R; has lasted on and off past 2 days. Denies any SOB. Vitals: T=99.2 oral; P=54 reg.; R=20; BP=148/92; O2 sats=95% RA Assessment: RESP = breath sounds clear w/ equal aeration bilat., non-labored; CARDIAC = pale/pink, cool and moist skin, S1 S2, no edema, pulses 3+ in all extremities NEURO = alert and oriented X 4 GI/GU = active BS in all quads, abdomen soft/non-tender, voiding without difficulty, urine clear/yellow MISC = skin integrity intact History: hypertension, MI, AAA, GERD, hyperlipidemia, diabetes type II, 1ppd smoker 40 years. Diagnostic Tests: EKG 2mm ST elevation; Troponin T = 1.2 ng/mL; CK/CK-MB = 32 u/L

Assessment of the patients knowledge:

Being that Mr. Totino is a 1 pack a day smoker while having diabetes and hypertension we would assume that he is either lacking in knowledge of the disease process of coronary artery disease itself, or at least lacking the knowledge of how these factors greatly increase the risk of coronary artery disease and stress it places on your heart. We could assess this asking Mr. Totino questions as far as: What life-style factors do you think contributed to your heart attack? Do you understand how a heart attack occurs? What symptoms of a heart attack do you know? What do you know about coronary artery disease? Do you understand how diabetes/hypertension/smoking can affect the heart? *Here is a heart attack risk calculator that can show the risks involved in a heart attack (to help you understand the importance of this life-style change) and also help you to make a plan in reducing your risks: https://www.heart.org/gglRisk/main_en_US.html

Goals we want to achieve for Mr. Totino:

Decrease myocardial oxygen demand and increase oxygen supply Decrease Mr. Totinos chest pain.

Reduce and control his risk factors (hypertension, smoking, diet, exercise) Mr. Totino will understand importance of medication compliance. Mr. Totino will understand and adhere to self-care program. Absence of complications associated with heart disease and MI. Mr. Totino will be understand education of disease process and therefore understand how current lifestyle is contributing. Prevent any further angina episodes. Comply with orders on when to notify his provider of any side effects or symptoms he experiences; will also continue yearly check-ups with his primary care provider in hopes of staying in check on heart issues.

Disease process:
A number of risk factors precipitate coronary artery disease. In your case Mr. Totino smoking, hypertension, and high cholesterol put you at greater risk for a coronary attack. A coronary attack occurs when the blood flow to part of the heart is blocked often by a blood clot. This happens because coronary arteries that supply the heart with blood slowly become thicker and harder from a buildup of fat, cholesterol, and other substances, called plaque. It the plaque breaks open and a blood clot forms that blocks the blood flow, a heart attack occurs. Then the heart muscle supplied by that artery begins to die. Damage increases the longer an artery stays blocked. Once that muscle dies, the result is permanent heart damage. When those cells are permanently damaged they are replaced with scar tissue which makes the damaged heart muscle stiff and less elastic. This makes it harder for your heart to do its job and puts you at greater risk for heart failure. Doing what your doctor suggests and following medication regimens can prevent that from happening. *A great way for Mr. Totino to learn about the disease process would by watching an educational video. Sometimes getting a 3D visual helps bring the big picture together. His verbal statement of his understanding would be a great way to evaluate his understanding. *Here is a great educational video about heart disease: http://www.youtube.com/watch?v=_wre2WRPiFI

Medications:
*Lisinopril: 10mg twice per day, this is prescribed to help lower your blood pressure because of your hypertension, take as prescribed at the same time every day, do not stop medication without talking with your doctor, change positions slowly to prevent light-headedness, dont jump up quick, talk with doctor before taking any OTC cold medications, this may cause dizziness or a dry cough so contact your doctor if that persists and is bothersome to you. *Atenolol: 25mg twice per day, this is also prescribed to help lower your blood pressure because of your hypertension, take as prescribed at the same time every day, do not stop medication without talking with your doctor, check your pulse daily and your blood pressure biweekly, I will show how to do that and

you can pick up a blood pressure cuff at your local pharmacy, change positions slowly, this medication may increase your sensitivity to cold, notify your doctor if you experience: slow pulse, difficulty breathing, wheezing, cold hands and feet, dizziness, light-headedness, confusion, depression, rash, fever, unusual bleeding or bruising *Glyburide: 5mg once per day, this is to help control hyperglycemia, so to help your blood sugar not be too high, with this medication there is a possibility of your blood sugar getting too low, know signs of your sugar being too low and take orange juice or honey and then check your blood sugar, avoid alcohol use, with this medication you also have to watch your diet and exercise for this medication to be effective, may cause some dizziness or drowsiness, use sunscreen, if you experience unusual weight gain, swelling in ankles, shortness of breath, or muscle cramps notify your doctor. *Prilosec: 20mg once per day, take 30 minutes before your other medications, this is to help prevent reflux because of your GERD, may cause some dizziness or drowsiness, avoid: alcohol, aspirin, or NSAIDs, report: any black or tarry stools, diarrhea, abdominal pain, or persistent headache. *Simvastatin: 20mg once per day, this is to help lower you cholesterol levels due to your hyperlipidemia, take as prescribed, do not double up on doses if missed, with this medication you also need to watch cholesterol in your diet, exercise and quit smoking also need to be done with this medication, avoid alcohol, report: unexplained muscle pain, tenderness, or weakness especially with fever, wear sunscreen, need to follow-up with your doctor to see if medications have been effective. *The best way to teach about medications is to go over the most important things like dose, frequency, and things to watch for verbally with the patient; then provide reference materials for them to refer to at home because it is a lot of information to obtain in one sitting. Also notify patient that calling his doctors office and pharmacy for any questions is good idea. Evaluate and ask question on his understanding on the verbal teaching about his medications. When calling day or so after discharge to check in with patient, may want to ask if they have had time to look at brochures and if they have any questions on them, could also assess their understanding again at this time to ensure they are grasping importance of medication regimen.

Life-style Changes:
Medication compliance (assess current knowledge of medications and reason for taking them) Diet and Exercise Changes (assess current diet and physical fitness levels) Smoking Cessation (Supply with information on support for quiting) Stress reduction if applicable

Skills to teach Mr. Totino necessary for self-care:

How to monitor his blood pressure Understanding how to check pulse Glucose monitoring Medication schedule/organizer Education on disease Education on lifestyle changes needed Motivation and support system Education on signs and symptoms of cardiac event Signs and symptoms of complications to underlying and/or new health disorders. *Many of these well be able to teach by hands-on teaching, followed by having Mr. Totino demonstrate his comprehension and understanding.

Educate Mr. Totino on when to notify the provider:

New onset/reoccurring chest pain Unrelenting respiratory problems Excessive bleeding Uncontrolled hypertension/hypotension Swelling Vision changes Illness *This will be more of a verbal teaching followed by asking Mr. Totino questions to ensure he fully understands the importance and concept of when to call his provider. We may also want to write the important side effects to look out for and when to call the provider on these.