lipid lowering therapy — simivastatin almost H e a l t h M e d i c a l

Create a teaching plan for the patient below using the example below with reliable sources in APA format:

Scenario: Mrs. Rodriquez is a forty-five-year-old Caucasian female who has recently been diagnosed with type two diabetes mellitus. She weights 192 pounds and is 65 inches. BMI 32 kg/m2 is and her hip size is 32 inches. She is married and has three children whom all live with her. The patient states that her diet consist of white bread bagels and cream cheese, pasta, processed foods, and refined flour. Mrs. Rodriquez exercise and physical activity is low to moderate. She smokes two packs of cigarettes per month and consumes minimal. She sates “I only drink red wine and it’s rarely daily. I normally have an occasional glass before bed and also at social gatherings”. Mrs. Rodriquez has a history of gestational diabetes from her last pregnancy several years ago. She received a glycated hemoglobin (A1C) test this month and her level came back at 7.8%. A random blood sugar was taken on the patient during this visit and her blood sugar was 220 mg/dL. She is confused and overwhelmed by this new diagnosis and all the new things she will be learning about her condition.

EXAMPLE ONLY:

TEACHING PLAN FOR PATIENT AFTER CABG

Content Outline

I. Ask patient if he knows CAD process is and health maintenance of disease. Also discuss CABG facts.

TEACHING PLAN FOR PATIENT AFTER CABG

II. Explain benefits of CABG

a. “Coronary artery bypass graft surgery, also known as CABG or bypass surgery can help to restore blood flow to an area of the heart. However, surgery does not stop the progression of atherosclerosis (coronary heart disease), which deposits fatty material into artery walls, narrowing them and eventually limiting blood flow. (Lewis, Dirksen, Heitkemper, Buchner, & Camera, 2011).

b. Helps a person feel better and have more energy (Aroesty & Gersh, 2011).

c. Improved quality of life and longer survival (Lewis et al., 2011, p.784).

III. Explain risk factors for CAD and death

a. Foods high in fat and cholesterol

b. Obesity

c. Stress

d. Smoking

e. High blood pressure

f. Sedentary lifestyle

IV. Teach about foods to avoid

a. Beer, soft drinks that contain sugar, fatty food, organ meats (liver), cheese, butter, red meats, bacon, fried foods including fried chicken and gravy.

V. Acceptable foods

a. Low-fat and fat-free dairy products such as chicken, pork, omega 3 fish like salmon, turkey (white meat) light cheese and yogurt, cottage cheese, eggs (in moderation), peanut butter and nuts, rice, noodles, pasta, potatoes, fruits, vegetables, beans, lentils, foods high in fiber, wine and tea and coffee (in moderation) (Aroesty & Gersh, 2011).

VI. Teach about Medications

a. Antiplatelet therapy — Clopidogrel (Plavix®) and aspirin are antiplatelet medications that are given to help prevent the formation of blood clots that can block either the graft or your own arteries. Clopidogrel is continued for at least one year after surgery while aspirin is usually recommended indefinitely (Aroesty & Gersh, 2011).

i. 75mg PO every morning. Take with or without food.

ii. Side effects include dry mouth, somnolence, sedation, dizziness and constipation (Hodgson, & Kizior, 2010, p.260)

b. Beta blockers — Atenolol slows the heart rate, lower blood pressure, and decrease

the heart’s demand for oxygen.They are given to some patients with high blood pressure, heart failure, or a heart attack, and to some patients in whom CABG is not expected to relieve all symptoms of angina (Aroesty & Gersh, 2011).

i. 50mg PO every morning.

ii. Monitor B/P before taking medication and be aware of hypotension

iii. Side effects include constipation, cold extremities, diarrhea, fatigue, nausea and headache (Hodgson, & Kizior, 2010, p. 92).

c. Nitrates — A nitrate, is short acting. These drugs dilate coronary blood vessels, bringing more blood to the heart muscle. Nitrates also reduce the amount of blood returning to the heart, which decreases the heart’s demand for oxygen. Nitrates are often given to treat or prevent further episodes of chest pain. Nitrates may be given to patients after CABG if some of the coronary blood vessels could not be bypassed (Aroesty & Gersh, 2011).

d. ACE inhibitor — Lisinopril are often used to treat high blood pressure. In addition, ACE inhibitors can reduce the incidence of ischemic events after CABG. Ischemic events include death, repeat bypass surgery, angioplasty or stent placement, heart attack, ischemic stroke, transient ischemic attack or recurrence of angina (Aroesty & Gersh, 2011).

i. 10mg every morning with or without food.

ii. Monitor B/P and rise slowly from sitting position to decrease hypotension.

iii. Side effects include headache, dizziness, hypotension, rash, fatigue abd. pain and nausea (Hodgson & Kizior, 2010, p. 680)

e. Lipid lowering therapy — Simivastatin almost all patients are given a medication to lower lipids after CABG. Cholesterol lowering can be beneficial both before and after CABG because it can halt the progression of atherosclerosis in both native and graft vessels.

i. 20mg every day at bedtime.

ii. Side effects. Generally well tolerated. May have headache, abdominal pain, cramps (Hodgson & Kizior, 2010, p. 1038).

VII. Teach about exercise

a. People who have undergone CABG benefit from a regular, structured exercise routine. You will work with a trained clinician on an outpatient basis to provide you with the instruction for exercise rehab. Benefits of exercise after CABG include

i. Improvement of heart function and lowering of heart rate

ii. Wt. loss and subsequent lowering of blood pressure.

iii. Better sleeping habits.

iv. Reduced risk of dying and complications from heart disease.

VIII. Teach about when to return to work.

a. It is important not to return to work for approximately 6-8 weeks

b. Follow-up with physician before returning to work.

IV. Teach about resuming sex

a. Sexual problems after a bypass surgery are common, occurring in one-half to three-quarters of patients. Both men and women may have less sex or feel less satisfied with sexual activity. A variety of factors may contribute, including side effects of drugs (such as beta blockers), depression, and fears about triggering a new heart attack or dying (Aroesty & Gersh, 2011).

b. Talk to physician at 6 week follow-up about resuming sexual activity. If exercise is tolerated well at this point then sexual activity can usually be resumed.

c. If taking Nitrates should not take Viagra if having performance problems. Talk to physician about different Beta Blocker or alternative methods.

V Teach about avoiding constipation and valsalva maneuver.

a. Patient should stay hydrated and increase dietary intake of fiber to avoid constipation.

b. He should act on an urge to defecate and not retain stool for longer periods of time because it may cause constipation.

c. Stool softeners are used daily until normal bowel habits return.

d. Avoid valsalva maneuver because bearing down while defecating can cause bradycardia and or arrhythmias.

Teaching Methods:

I will have patient do a return demonstration of splinting, coughing and deep breathing exercises and also how to change his dressings. I will have him verbalize signs of when to call the doctor like excessive bleeding, foul odor, purulent drainage, redness, swelling and fever. I will give patient information about his procedure and reinforce important items in handouts. I will give him dietary appropriate materials and also arrange a meeting with a dietician. I will give patient a written list of medications, when to take them and what they are for. I will allow patient to stop me anytime for verification and also if he does not understand.

Evaluation of Teaching:

After teaching Mr. Johnson I would ask him questions about his disease and having undergone a CABG to ensure that he understood the material we just discussed. If Mr. Johnson was unclear of any portion of the teaching I would explain the information again and in a different way so he may better understand me. Teaching would be effective if he stated that he understood the reasons adhere to medication, reasons to notify the physician and also reasons to change his current work, eating, smoking and drinking habits and the need to incorporate exercise into his daily schedule.

Documentation of Teaching

1400-Prior to discharge I entered patients room to do discharge instructions. I informed patient and his wife that he would be going home soon. I discussed with pt. and his wife the pathophysiology of coronary artery disease and why he underwent CABG. Smoking cessation, dietary changes, exercise and stress reduction were also discussed and the importance of following all prescription medication. Patient demonstrated how to change his dressing and ways to alleviate pain like splinting. Patient was very cooperative and alert during teaching. He stated that he understood the importance of changing his lifestyle and also to follow medication regiment. Patients stated that he had no further questions and was given all discharge instructions which he signed.

References

Ackley, B.J. & Ladwig, G.B. (2008). Nursing Diagnosis Handbook (8th ed.) New York: Mosby Elsevier.

Aroesty, J. & Gersh, B. (2011). Patient information: Recovery after coronary artery bypass graft surgery (CABG). Up To Date. Retrieved from

http:// bypass-graft-surgery-cabg

Hodgson, B. & Kizior, R. (2010). Nursing Drug Handbook 2010. St. Louis, MO: Saunders Elsevier.

Lewis, S.L., Dirksen, S.R., Heitkemper, M.M., Buchner, L., & Camera, I.M. (2011). Medical- surgical nursing: Assessment and management of clinical problems (8th ed.). St. Louis, MO: Mosby Elsevier.