Discharge Summary PCI In The Elderly Patient

Discharge Summary Pci In The Elderly Patient1discharge Summary Pc

Discharge Summary Pci In The Elderly Patient1discharge Summary Pc

DISCHARGE SUMMARY: PCI IN THE ELDERLY PATIENT 1 DISCHARGE SUMMARY: PCI IN THE ELDERLY PATIENT DISCHARGE SUMMARY: PCI IN THE ELDERLY PATIENT 6 DISCHARGE SUMMARY: PCI in the Elderly Patient Professor: XXXX Student Name Grand Canyon University-ANP 654 Date DISCHARGE SUMMARY Discharge Summary Date XXXX-ANP 654 Patient Name: H.W. MRN: 123456 Sex: Male Date of Birth: 12/12/1933 Provider: C.H. APRN/MILLENIUM PHYSICIAN GROUP Primary Care Provider: Dr. S.B. Admission Date : xx/xx/xxxx Discharge Date : xx/xx/xxxx Admitting Diagnoses : I25.1 Atherosclerotic heart disease of native coronary artery R00.1 Bradycardia, unspecified (permanent pacemaker placed by Dr.

R 12/28/2019) I10 Renovascular hypertension N18.6 End stage renal disease (on peritoneal dialysis) Discharge Diagnosis : I25.1 Atherosclerotic heart disease of native coronary artery-elective cardiac catheterization on this admission R00.1 Bradycardia, unspecified I10 Renovascular hypertension controlled I70.1 Atherosclerosis of renal artery N18.6 End stage renal disease (peritoneal dialysis 1/14/20 prior to discharge) Admission Procedure : 01/13/20- Cardiac catheterization under moderate sedation with use of IVP contrast for coronary angiography Impression: Non-dominant RCA without significant obstructive disease

LV function is normal, EF 50%, no wall motion abnormalities. PCI to the OM and Circumflex were performed with good results. Consultations : Dr. R Interventional Cardiologist- performed elective cardiac catheterization 1/13/20 Course of Treatment : This is an 86 year-old male patient with a complex cardiac history. The patient had a permanent pacemaker placed on 12/28/2019 for severe symptomatic bradycardia.

After pacemaker placement, the patient underwent a Lexiscan showing ischemia. A planned cardiac catheterization was scheduled for 1/13/20. Dr. R. performed PCI and placed BM stents to the patient’s OM and Circumflex arteries. His RCA was assessed and was deemed not severe enough for intervention and was a non-dominant vessel.

The patient was admitted for further observation overnight post procedure. He had no complaints of chest pain, no shortness of breath, no nausea or vomiting, no dizziness, and no numbness or tingling in his bilateral lower extremities. No hematoma, redness or swelling noted at his right groin catheterization site. Overall, the patient is stable for discharge this evening after his peritoneal dialysis treatment. Admission Home Medications : Auryxia 210mg, 2 tabs, po three times daily Entresto 24/26mg, 1 tab, po twice daily Thiamine 100mg po daily Docusate sodium 100mg po twice daily Discharge Medication : Auryxia 210mg, 2 tabs, po three times daily Entresto 24/26mg, 1 tab, po twice daily Thiamine 100mg po daily Docusate sodium 100mg po twice daily New : Nitroglycerine 0.4mg, one tablet SL every 5 minutes (may repeat x 3) as needed for chest pain-call 911 if no relief-dispense #30, 1 refill New : Clopidogrel 75mg, one tablet by mouth daily, dispense-#30, 1 refill Physical Exam : Vital signs: BP 125/55, HR paced, 70, Pulse Ox on room air >92%, RR 18 General: no acute distress, well developed, well nourished, appears younger than stated age, pleasant and cooperative Chest: Clear to auscultation and percussion, breath sounds normal, equal expansion, air movement good, no cyanosis, or clubbing of fingers, no kyphosis, no scoliosis Cardiovascular: S1, S2, no murmurs, bruits, or thrills noted.

Peripheral pulses +2, no JVD, trace pedal edema noted Extremities: right groin catheterization site without swelling, redness, or drainage, dressing in place, no cyanosis or edema Abdomen- soft, non-tender, slightly distended, undergoing peritoneal dialysis, bowel sounds positive, last BM this morning, tolerating po diet GU- no discharge, no abnormal bleeding, does not void Neuro: Alert and oriented x 3, no motor or sensory deficits noted, cranial nerves II-XII intact, sensation and strength normal Laboratory values : Gluc-125, BUN 67, Cr 11.69, Na 139, K 3.4, Ca 7.9, Pt 12.2, INR 1.04, Wbc 6.21, Hgb 8.3, Hct 26.0, Plt Ct 220, Mg 2.0 EKG (1/14/2020)-Ventricular paced rhythm, no acute changes Assessment and Plan- 1.

Coronary artery disease s/p PCI to OM and Circumflex due to abnormal lexiscan/abnormal findings on cardiac catheterization-continue current home medications, add SL Nitroglycerine, add Plavix, ok to remove dressing at home or prior to discharge, ok to shower, no heavy lifting, bending or strenuous activity for 1 week From a cardiology standpoint, the patient is stable for discharge once his dialysis treatment is complete. All questions and concerns were answered at bedside with patient and wife. Pending Results : All tests are completed, no results are pending at time of discharge Discharge Condition : Stable Disposition : Home with wife Time of Assessment : 09:20am Time spent on Discharge and Care Planning : >30min Discharge Instructions : Diet - Cardiac/Heart Healthy, Renal Diet Physical Activity - 1 week no heavy lifting, bending or strenuous activity Follow up provisions : Primary Care Provider: Dr L.C, please call to schedule an appt in 1 week Cardiology: Dr R.

2/14/20 at 09:00am. Ph- to change if not convenient *Discharge and PCP medication list has been reviewed and verified with patient. Prescriptions have been given to patient with in depth instruction for use. Considerations : This patient underwent stenting to his OM and distal Circumflex arteries with bare metal stents. Current guidelines are a minimum of one month of antiplatelet therapy following elective percutaneous coronary intervention (Kereiakes, Yeh, Massaro, 2015).

In this patient’s case it was decided that he should remain on clopidogrel indefinitely secondary to residual coronary disease and PCI. Antithrombotic treatment in cardiovascular disease consists of oral anticoagulation and antiplatelet agents. Aging is the primary risk factor in the development of arteriosclerosis. The elderly patient is at high risk for developing thrombosis but also has a higher risk of bleeding. Increased risks make it more difficult for providers to choose appropriate anticoagulant strategies for their patients.

Elderly persons also have more comorbidities, such as diabetes, and renal disease, which increase adverse reactions and risk factors in patients. Three major problems are identified in selecting the best therapy for the patient. They are polypharmacy, comorbidity, and medication adherence (Arahata, Asakura, 2018). Providers need to evaluate these problems and make a decision for each patient based on benefit versus risk. Another important thing is for providers is to involve an interdisciplinary approach and view the overall health of the patient.

The intervention should not be based on one disease process alone but should be based on the overall health of the patient. This is an active 83 year-old without physical mobility compromise. He has no history of falls and uses no assistive devices. He is compliant with his health care regimen. He is aware of the increased risk of bleeding secondary to renal disease (Ruscin, Linnebur, 2018).

His health care goal is to maintain a good quality of life. Benefit outweighs risk in this patient’s case. References Arahata, M., & Asakura, H. (2018). Antithrombotic therapies for elderly patients: handling problems originating from their comorbidities. Clinical interventions in aging , 13 , 1675–1690. doi:10.2147/CIA.S174896 Kereiakes DJ, Yeh RW, Massaro JM, et al.

Antiplatelet Therapy Duration Following Bare Metal or Drug-Eluting Coronary Stents: The Dual Antiplatelet Therapy Randomized Clinical Trial. JAMA. 2015;313(11):1113–1121. doi:10.1001/jama.2015.1671 Ruscin, M., Linnebur, S., (2018). Drug categories of concern in older adults. Merck Manual, Professional Version .

Retrieved from Discuss the difference between a nursing conceptual model and a nursing theory. Select a nursing theory and provide a concise summary of it. Provide an example in nursing practice where the nursing theory you selected would be effective in managing patient care. In words, APA format, 4 references Benchmark Requires LopeswriteAssessment Description Academic clinical discharge summary notes provide a unique opportunity to practice and demonstrate advanced practice documentation skills, develop and demonstrate critical thinking and clinical reasoning skills, and practice identifying acute and chronic problems and formulating an evidence-based plans of care. This assignment uses a template.

Refer to the "AGACNP Discharge Summary Template," located on the Student Success Center page under the AGACNP tab. Develop an academic clinical discharge summary note based on a hospital patient seen during clinical/practicum. The discharge summary note should include the following: 1. Reason for admission: Include the reason for admission, a list of diagnoses in order of acuity, and an ICD-10 diagnosis. 2. List of all procedures: Include all dates, significant findings, and any anesthetics and contrast used during procedures. 3. Complete list of consults during hospitalization: Include any providers or services consulted during the stay. 4. Patient's condition at discharge: Include a physical exam prior to discharge that documents that patient is stable at discharge and has safe disposition and transportation.

What diagnostic criteria confirmed the discharge diagnosis? 5. Complete list of discharge medications: Full list with all dosages, frequencies, and quantity of medications prescribed or dispensed. 6. Pending test results for follow up: Complete list of any pathology, cultures, radiology, or other diagnostic tests still pending, and who is responsible for follow-up on the final results.

7. Complete list of discharge instructions: Full list of directions regarding infection prevention, new medications, and returning to daily activities. 8. Complete list of discharge follow-ups: Full list of any therapies, treatments, referrals, consults, and follow-up appointments. What diagnostic criteria were needed after discharge?

9. Summary : What questions were raised during the hospital stay? Include all explanations and answers to these questions. What questions were raised that required further exploration? What kind of discharge planning did you need?

Characterize your patient interaction activities. 10. Overall assessment: Identify health promotions, health education, ethical considerations, geriatric considerations, and expected outcomes. Incorporate three peer-reviewed articles in the assessment or plan. While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting guidelines, which can be found in the APA Style Guide, located in the Student Success Center.

Paper For Above instruction

The distinction between a nursing conceptual model and a nursing theory lies in their scope and purpose within the nursing discipline. A nursing conceptual model provides a broad framework that guides nursing practice, education, and research by describing the major concepts and their relationships, serving as a blueprint for clinical implementation and academic instruction. Conversely, a nursing theory offers a more specific, testable explanation of nursing phenomena, aiming to predict outcomes and guide evidence-based practice. While conceptual models tend to offer philosophical perspectives or general structures, theories are rooted in empirical evidence and can be applied to specific clinical situations.

Among several nursing theories, the theory of Human Caring, developed by Jean Watson, stands out as a holistic and humanistic approach that emphasizes the caring relationship between the nurse and patient. Watson’s theory posits that caring is a fundamental component of nursing that promotes health, healing, and wholeness. The theory incorporates ten carative factors that serve as a guide for nursing interventions, emphasizing the importance of authentic presence, compassion, and the creation of a healing environment. Watson’s model underscores the interconnectedness of mind, body, and spirit, advocating for a patient-centered approach that fosters trust and holistic well-being.

An example of clinical practice where Watson’s Theory of Human Caring would be effective involves caring for elderly patients with chronic illnesses, such as heart failure or renal disease. In such cases, establishing a caring relationship can improve patient adherence to treatment regimens, enhance their understanding of their health conditions, and promote psychological comfort. For instance, a nurse using Watson’s principles might spend extra time engaging with the patient, listening empathetically, and providing emotional support during difficult life phases. This holistic attention can lead to improved patient satisfaction, better health outcomes, and a sense of empowerment, especially critical in geriatric care where psychological and social factors significantly impact health.

In summary, a nursing conceptual model offers a broad philosophical foundation for nursing practice, whereas a nursing theory provides specific, evidence-based explanations that guide clinical decisions. Jean Watson’s Theory of Human Caring exemplifies a practical, patient-centered approach that emphasizes the relational and holistic aspects of nursing care, making it particularly effective in managing complex, chronic health issues among elderly populations. Incorporating such theories into practice promotes not only physical health but also emotional and spiritual well-being, aligning with the core values of holistic nursing care.

References

• Watson, J. (2008). Nursing: The philosophy and science of caring. University Press of Colorado.
• Fawcett, J. (2017). Contemporary nursing knowledge: Analysis and evaluation of nursing models and theories. F.A. Davis Company.
• Alligood, M. R. (2014). Nursing theory: Utilization & application. Elsevier Health Sciences.
• Kearney-Nunnery, R. (2019). Theories of nursing: A systematic approach. F. A. Davis Company.
• Levine, S., & McCoy, M. (2017). The importance of holistic care in nursing. Journal of Nursing Practice, 13(4), 255-261.