1 / 17

CARDIOVASCULAR CARE of the OUTPATIENT

CARDIOVASCULAR CARE of the OUTPATIENT. Diane M. Enzweiler, MSN, ANP-BC St. Elizabeth Physicians: Heart and Vascular. Case Study.

vea
Télécharger la présentation

CARDIOVASCULAR CARE of the OUTPATIENT

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. CARDIOVASCULAR CARE of the OUTPATIENT Diane M. Enzweiler, MSN, ANP-BC St. Elizabeth Physicians: Heart and Vascular

  2. Case Study • J.B. is a 52 year old Caucasian male who recently presented with complaints of chest pain and shortness of breath. Initial evaluation in the ER shows anterior ECG changes and elevated troponins. He was taken emergently to the cardiac cath lab and noted to have high grade LAD lesion that was stented. LV gram showed anterior hypokinesis with EF 40%.

  3. J.B. has history of HTN, tobacco use (60 pack years), obesity (BMI 30), and family history of CAD (Father died @age 50 from MI). • Home meds: HCTZ 25 mg daily and Diltiazem 240 mg daily.

  4. Being discharged today on ASA 325 mg daily, Effient 10 mg daily, Carvedilol 6.25 mg BID, Lisinopril 5 mg BID, Rosuvastatin 10 mg daily, NTG 0.4 mg SL PRN, and HCTZ 12.5 mg daily. • Follow-up in office in 1-2 weeks.

  5. Return Office Visit What is next? 1. Assessment (subjective and objective) 2. Review of meds a. Doses b. Indications c. Compliance/ Tolerance 3. Education

  6. Long Term Goals of Treatment • To aid the patient to be able to live with fewest restrictions and without pain. • Slow or reverse the degree of atherosclerosis. • Reduce cardiovascular risk factors • Reduce recurrent events

  7. Medications • Aspirin and Effient (Antiplatelet agents) * ASA 1st line unless allergy or GI bleed 81-325 mgs daily * Long term use makes acute ischemic episodes less likely * Clopidogrel or Effient increase the inhibition of clot formation

  8. Beta-blockers (Carvedilol) * Antihypertensive * Reduce heart rate, myocardial O2 demand and lower the incidence of episodes of angina. * Report changes in glucose levels.

  9. ACE-I Inhibitors (Lisinopril) * Antihypertensive * Monitor Creatinine and Potassium levels * Suppression of RAAS * Decreases afterload * Stabilizes plaque * Arterial vasodilator

  10. Statins (Rosuvastatin) * Reduces LDL, total cholesterol, TG, and increases HDL * Adjunct to diet to slow atherosclerosis progression * Used in conjunction with diet and exercise * Monitor liver profile

  11. Nitroglycerin * Relieve chest pain * Prevent chest pain * Educate on use (reinforce) * Avoid use with erectile dysfunction medicines

  12. Diuretics (Thiazide, Loop, Potassium Sparing) * Increases sodium and water excretion * Decreases preload * Monitor electrolytes

  13. Lifestyle Modifications • Smoking cessation • One of the most powerful predictors for development of ASHD • Contributes to the development of ASHD, DM, lung disease, dyslipidemias, cancers. • Provide support and counseling

  14. Lifestyle Modifications • Exercise - Improves body’s metabolism - Conditions heart muscle, increases stamina, improves lipid levels, lowers blood pressure, and increases feeling of well being. - Minimum 45 minutes most days of the week.

  15. Maintain healthy weight • Low fat diet • Keep BP low • Blood sugar control • ETOH consumption

  16. REINFORCE CHANGES WITH EACH VISIT

  17. QUESTIONS???

More Related