Reference no: EM133563786

Directions: As a nurse working in a cardiac rehabilitation program, you are preparing to provide patient education for the patients listed below. Develop a pertinent detailed patient education plan.

Patient profile #1

Tom Gap is a 65 year-old white male who states he had been under a great deal of stress since his wife was diagnosed with lung cancer 6 months ago. He has a 25 year-old son with schizophrenia who lives at home. He currently works in a warehouse as a manager but states he does need to do physical work moving large items once in awhile. Over the past month he was more fatigued, short of breath, and had fleeting episodes of chest pain. The day of hospitalization he developed crushing midsternal chest pain radiating to his left arm associated with diaphoresis and nausea. His friend at work immediately drove him to the emergency department.

PMH: hyperlipidemia, Type II diabetes mellitus, obesity, hypertension, smoked for 45 years

Upon arrival he had a 12 lead EKG which showed ST elevation and T wave inversion in the leads facing the inferior wall of the myocardium. Initial vital signs were as follows: BP 164/90, HR 92, RR 24bpm, O2 sat 95%. His cardiac monitor showed normal sinus rhythm with occasional premature ventricular contractions. Tom received four baby aspirin to chew and sublingual nitroglycerine. After two doses of nitroglycerine there was no relief of chest pain. IV push morphine was then administered with relief.

Tom immediately had a cardiac catheterization performed with Percutaneous Coronary Intervention (PCI). A drug eluting stent was placed in the right coronary artery after a 90% occlusion was noted. He has a 60% occlusion of his circumflex artery that was not stented and will be managed medically. Post procedure he developed a hematoma in his right groin. After the procedure he had an echocardiogram performed, which showed some regional wall motion abnormalities of the inferior wall. Ejection fraction was 55%.

He was discharged 5 days post MI on the following medications:

Metoprolol 25mg once a day in am
Lisinopril 10mg once a day in am
Metformin 500mg twice a day in am
Simvastatin 40mg once a day (states he is supposed to take in pm but just takes it in am with the rest of his pills)
Prasugrel 10 mg once a day in am
Aspirin 81 mg once a day in am
Nitroglycerine 0.4mg sl as needed for chest pain.
For the past week he has been walking 10 minutes each day. He is anxious to make changes to improve his health. He does confide that he is worried about engaging in any sexual activity.