D117 Hospital Readmission Prevent Plan

Student Name

Western Governors University

D117 Advanced Health Assessment for the Advanced Practice Nurse

Prof. Name:

Date

Acute Myocardial Infarction (MI) Discharge Summary and Patient Education

Donald is a 55-year-old Hispanic male who was recently hospitalized for five days following an acute myocardial infarction (MI). He experienced chest tightness, nausea, and shortness of breath while gardening at home. After notifying his wife, an ambulance was called, and he was transported to the hospital emergency department. The initial assessment, including history, physical exam, and diagnostic tests, strongly indicated an acute MI. Within 50 minutes of symptom onset, Donald underwent cardiac catheterization, where angioplasty and the placement of two cardiac stents were successfully performed.

During his hospital stay, Donald began three new medications, received lifestyle modification education, and initiated light walking on the unit. He is scheduled for discharge today with plans to follow up with his cardiologist in two weeks, start cardiac rehabilitation in one week, and have laboratory blood draws within 5–7 days. Donald was under the care of a hospitalist during admission and does not currently have a scheduled appointment with his primary care provider, whom he last saw seven months ago.

Patient History and Current Status

Parameter	Details
Age, Gender, Ethnicity	55 years, Male, Hispanic
Height and Weight	5’10”, 245 lbs
Vital Signs	BP: 116/78 mmHg, Temp: 98.2°F, O2 Sat: 98% on room air
Pain Level	1/10 at groin access site
Insurance	Blue Cross Blue Shield
Past Medical History	Hypertension (15 years), Obesity (BMI 35), Hyperlipidemia (untreated), Tonsillectomy (age 15), Right knee ACL repair (age 36)
Family History	Father deceased (MI at 62), Mother alive (DM II, HTN, osteoporosis), two healthy children
Social History	Married, two children, college professor, moderate alcohol use, no smoking or illicit drugs, social church activities
Medications on Discharge	Atorvastatin 80 mg daily, Atenolol 25 mg twice daily, Lisinopril 10 mg daily, Clopidogrel 75 mg daily, Aspirin 81 mg daily
Allergies	No known drug, food, or environmental allergies

What New Medications Is Donald Prescribed, and What Should He Know About Them?

Donald was started on several new medications post-MI, including atorvastatin, atenolol, clopidogrel, and aspirin. These medications serve specific roles in managing his cardiovascular health:

Atorvastatin is prescribed to manage hyperlipidemia and reduce cholesterol levels, thus lowering the risk of further cardiovascular events.
Atenolol is a beta-blocker that helps control blood pressure and reduce cardiac workload.
Clopidogrel and Aspirin act as antiplatelet agents to prevent blood clots forming in the newly placed stents.

Patients should be informed that these medications are likely to be lifelong unless otherwise directed by their healthcare provider. It is essential to adhere strictly to the dosing schedule and not discontinue these drugs without consulting a healthcare professional.

How Should Donald Care for His Cardiac Stents and Access Site?

Donald received two cardiac stents via cardiac catheterization, which involved the use of contrast dye. He should increase fluid intake to help flush the dye from his system. Proper care of the groin access site is critical to prevent infection or bleeding complications:

Monitor for swelling, bruising, or bleeding.
Avoid strenuous activities such as lifting more than 10 pounds or straining during bowel movements for at least seven days.
Limit stair climbing and perform it slowly with assistance if necessary.
Shower daily but avoid baths, swimming, or hot tubs for seven days.
Do not apply ointments, lotions, or powders to the access site.
In case of bleeding, apply pressure for 15 minutes; if bleeding persists, contact the cardiologist or emergency services.

Donald will receive a temporary medical card indicating his stent placement, which should be kept in his wallet until a permanent card arrives.

What Lifestyle Changes Should Donald Make?

Donald’s previous lifestyle includes frequent eating out (restaurants, fast food 6-8 times weekly) and minimal exercise (15-20 minutes of walking once a week). Post-MI, lifestyle modifications are essential to reduce the risk of recurrence:

Adopt a heart-healthy diet focusing on low sodium, low-fat foods, lean proteins (poultry, fish), whole grains, and an abundance of fruits and vegetables with proper portion control.
Limit eating out and prepare meals at home; consider consulting a nutritionist for guidance on selecting heart-healthy foods.
Increase physical activity gradually to 30-60 minutes of light to moderate exercise, at least three times a week, utilizing nearby sidewalks and parks.
Utilize family and social support networks, including church groups, to maintain motivation and accountability.

What Follow-up and Monitoring Is Necessary?

Donald must keep all follow-up appointments to ensure proper recovery and monitor his cardiac status:

Appointment	Timing	Purpose
Cardiologist visit	Two weeks post-discharge	Evaluate cardiac recovery and medication effectiveness
Primary care provider visit	One week post-discharge (if not scheduled, arrange immediately)	General health monitoring and ongoing management
Cardiac Rehabilitation	Starting one week after discharge	Supervised exercise and lifestyle support
Laboratory Blood Tests	Within 5–7 days post-discharge	Assess cholesterol, kidney function, and medication side effects

Donald will be provided with lab orders and information on where to get blood work done. Additionally, contact numbers should be given for questions or concerns.

When Should Donald Seek Medical Attention?

Donald should be educated about symptoms requiring immediate medical attention, including chest pain, sweating, dizziness, nausea, and shortness of breath. If these symptoms occur:

He should rest initially.
If symptoms persist or worsen, he should contact his healthcare provider immediately or call emergency services.

References

After your cardiac catheterization. (2023). Cleveland Clinic. https://my.clevelandclinic.org/departments/heart/patient-education/recovery-care/interventional-procedures/after-your-cardiac-catheterization