Coronary Heart Disease: Holistic Discharge Plan - Paper Example

Introduction

Coronary heart disease or coronary artery disease is a chronic illness that is a result of cholesterol building up on the artery walls hence creating plaques (Lambrinou et al., 2012). As a result, these plaques cause the artery to narrow thus minimizing the flow of the blood to the heart. Times, a clot may sometimes obstruct the blood flow hence causing serious health problems such as abnormal heart rhythm (Lambrinou et al., 2012). Notably, coronary arteries form a number of blood vessels, particularly on the surface of the heart that supply oxygen (Lambrinou et al., 2012). Thus, this discharge plan aims at examining a chronic illness (coronary heart disease) in a fictitious patient. The plan also aims at complete assessment of the patient, carrying out diagnosis/plan, advice on the education needs, establishing the financial worksheet, interpreting the complete format, and developing a conclusion for the plan of care.

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Patient Assessment

Stewart Jamal is a 60-year-old male born on 27th June 1960. The patient was admitted to the National Hospital on 4th July 2020 and later assessed on 5th July 2020. Notably, according to the assessment report examined, it is evident that the patient was diagnosed with a severe chronic illness referred to as coronary heart disease. This was due to the hardening of the arteries/build-up of plagues in the arteries of the patient's heart. Moreover, from the patient medical file retrieved, the patient's past medical history indicated that Stewart Jamal at the beginning of the year was admitted to the hospital due to Abnormal Heart Rhythm.

Summary of the Patient Physical Assessment

The assessment done involved a complete head-to-toe, particularly from the hospitalization documentation. Typically, the assessment involved, a general assessment of the blood circulation, the examination of the abdomen, a blood pressure check, the examination of the fatty deposits under the skin, listening to the heart using a stethoscope, and lastly, listening to the lungs specifically to determine the abnormal breath sounds (Lambrinou et al., 2012).

Patient Family and Social History

After consulting on the family and social history, the patient was open with the information. It was noted that the firstborn in the family of Stewart Jamal died of a heart attack. Moreover, his two parents are managing high cholesterol and are active smokers. Lastly, one of the Stewart siblings is currently managing high blood pressure.

Effects of Diagnosis on Daily Living

Notably, coronary heart disease typically affects what the patient eats, how he exercises, and the activities he does as well as what holidays he takes (Lambrinou et al., 2012). Moreover, from close examination, it was noted that the patient is allergic to sulfur and sulfur-containing products.

Current Medications

In order to help lower blood pressure, kidney problems, and heart attacks as well as relieve pains, and improve the chances for survival for the patient, certain medications are currently prescribed to the patient. These include 100mg of aspirin (Cardio- Aspirin) scheduled daily to help in relieving pain (Horwitz et al., 2013). Secondly, 25mg of Beta-Blockers (Carvedilol) is scheduled for every 2-4 weeks, and 1000mg of Ronalazine is scheduled twice daily based on clinical symptoms (Horwitz et al., 2013). Lastly, 10mg of Calcium channel blockers (Amlodipine) is scheduled daily for 14 days (Horwitz et al., 2013).

Patient Daily Living Assessment

There are a number of activities as well as instrumental activities the patient (Stewart Jamal) can do by himself. However, there are others whom he may need help from close family members. Despite Stewart's age, he can comfortably take a bath, dress up, and the toilet. Moreover, he may need assistance with personal cares, transferring products, eating, ambulation, climbing stairs, and using the phone. However, the patient is dependable on the following activities, shopping, food preparation, managing medication, housework, laundry, transportation, and managing finances.

Patient Support System

Based on the above assessment, several family members are available to provide good care and support to the patient essentially. These include the wife Abigail Johnson, the son Alphonso Davies, and the patient's younger brother Joseph Barrack. These people are available daily for 10 hours, 6 hours, and 4 hours consecutively.

Medical Follow-Up

Notably, the patient will receive medication follow-up for one year, particularly after discharge from the hospital (Horwitz et al., 2013). Consequently, a total of three meetings with the doctor are arranged for the patient as follows; first after discharge, second after three months, and the last one after one year (Horwitz et al., 2013). Also, the patient will be called upon for an arrangement of detailed consultation, and lastly, detailed written information regarding the drugs used will be given to the patient (Horwitz et al., 2013).

Financial Summary

An estimated $15,540 will be used in the whole process. This will cater for patient medical care for routine and specialty, and treatment interventions, medication needs, supplies, diagnostic testing, medical equipment, transportation, potential complications, home furnishings, and adaptations.

Diagnosis/Plan

Priority

During the patient assessment on 5th July 2020, a total of three priorities were listed in order to help the patient overcome the chronic illness (Coronary heart disease). The three top priorities include checking high blood pressure, checking cholesterol levels, and managing the build-up of plaque in the arteries (Intarakamhang & Intarakamhang, 2013).

Nursing Diagnosis and Goals

The nursing diagnosis was developed based on the data obtained during the nursing assessment on 5th July 2020. There were three diagnoses developed and two goals for each. For instance, the first diagnosis involved liver function test which was aimed at determining how the patient's liver functions and secondly, the test aimed at helping to measure the level of liver enzymes, proteins, and bilirubin in the patient blood (Intarakamhang & Intarakamhang, 2013). Notably, the other diagnosis plan lipid profile test aimed at maintaining normalcy in cholesterol levels as well as measuring the amount of good and bad triglycerides and cholesterol (Intarakamhang & Intarakamhang, 2013). Lastly, MRI scan was examined with the aim of monitoring treatment for many conditions within the patient's chest and also helping in full visualization of the body in order to diagnose coronary heart disease and evaluate injuries (Intarakamhang & Intarakamhang, 2013).

Education Needs

Education regarding coronary heart disease is extremely important for the patient (Stewart Jamal). A number of two education needs alongside methods and evaluation of learning have been examined to help the patient recover fully. The first education that needs to be recommended for the patient is eating a healthy diet (Andersson et al., 2014). This typically involved keeping a food diary in order for the patient to monitor what he eats, how much, when and why (Andersson et al., 2014). Also, the patient should write down what he eats even for a week in order to know his true eating habits. Secondly, the other need recommended for the patient is exercising regularly (Andersson et al., 2014). This can be an aerobic exercise such as cycling, walking, jogging, dancing, and swimming. Notably, the patient should set a goal of exercising for 150 minutes a week or 30 minutes a day in order to help lower his blood pressure by about 5 to 9 mm Hg (Andersson et al., 2014).

Financial Worksheet

Financial Summary

TOTAL: $13, 260.5 Reflection and Conclusion

Typically, after assessing the patient on the second day of admission, it was evident that the patient was diagnosed with a severe chronic illness referred to as coronary heart disease. This was due to the hardening of the arteries/build-up of plagues in the arteries of the patient's heart (Horwitz et al., 2013). Moreover, the patient's past medical history indicated that earlier at the beginning of the year, Stewart Jamal was admitted to the hospital due to Abnormal Heart Rhythm (Horwitz et al., 2013).

Notably, according to the patient assessment, the recommended nursing diagnosis for the patient includes the liver function test which was aimed at determining how the patient's liver functions and also measuring the level of liver enzymes, proteins, and bilirubin in the patient blood. Secondly, a lipid profile test is aimed at maintaining normalcy in cholesterol levels; however, an MRI scan was recommended for monitoring treatment for many conditions within the patient's chest and also helping in full visualization of the body in order to diagnose coronary heart disease and evaluate injuries.

Conclusion

In a nutshell, from this activity, I have categorically learned many lessons. For instance, I have exhaustively learned about coronary heart disease as a chronic illness. Through this, I have learned about the causes of the illness, the symptoms, complications, treatment methods, various medications, prevention, diagnosis, and the associated risk factors. Moreover, I have fully learned how to examine patient assessment and examine the patient plan of care alongside the appropriate education needs for the illness. Furthermore, this discharge plan is very useful for a number of reasons. For instance, the plan can be used to work out the financial costs of the illness as well as be used as a reference point for future complications. Typically, the discharge plan was useful in determining the various areas I have been sidelining in the previous discharge plans, for instance, the family and social history of the patient, patient allergies, and the effect of diagnosis on the patient daily living.

References

Andersson, C., Shalane, D., Go, A. S., Chang, T. I., Kazi, D., Solomon, M. D., ... & Hlatky, M. A. (2014). Beta-blocker therapy and cardiac events among patients with newly diagnosed coronary heart disease. Journal of the American College of Cardiology, 64(3), 247-252. https://www.sciencedirect.com/science/article/pii/S0735109714025212

Horwitz, L. I., Moriarty, J. P., Chen, C., Fogerty, R. L., Brewster, U. C., Kanade, S., ... & Krumholz, H. M. (2013). Quality of discharge practices and patient understanding at an academic medical center. JAMA Internal Medicine, 173(18), 1715-1722. https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/1754366

Intarakamhang, P., & Intarakamhang, U. (2013). Effects of the comprehensive cardiac rehabilitation program on psychological factors and quality of life among coronary heart disease patients. Global journal of health science, 5(2), 145. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4776774/

Lambrinou, E., Kalogirou, F., Lamnisos, D., & Sourtzi, P. (2012). Effectiveness of heart failure management programmes with nurse-led discharge planning in reducing re-admissions: a systematic review and meta-analysis. International journal of nursing studies, 49(5), 610-624. https://www.ncbi.nlm.nih.gov/books/NBK114288/