Introduction:
Mr. F male 79 years old medical number 11111. He is Divorced and he is retied.
Usually his friend visits him twice a week .
He lives in Adelaide which in Salisbury . drink alcohol 3 times a week , quite from smoking before 10 years but he used to smoke 35 years.
He lives alone in his own unit. He is independent with ADLs, mobility, drive house work, shopping and meals. No financial concern
Situation
Pt admitted at 12 of Aug 2016 @13:00 after having CABG, AVR which is Coronary Artery Bypass Graft, Aortic Valve replacement in Calvary Wakefield hospital in 3rd of Aug. The pt. here to have cardiac rehabilitation program and wefren mgnmment. Pt transferred from QEH to CWH post angiogram 2nd of Aug. pt presented at CEH with STEMI which is ST Segment Elevation Myocardial Infarction. Relating this pt had CABG and AVR.
Pt present to the ward with opened wounds which chest and thigh and the wounds clean and dry. Pt on daily INR checking because in the test shown that INR not stable as you know increase INR from 2.5 to 3.5 put the pt. in high risk of cardiac valves, complicated AF or Venous thromboembolism. Test show in 15 Aug. was 3.7 and after having 10mg is drop to 2.4 next day
Coronary bypass surgery is a surgical procedure that diverts the flow of blood around a section of a blocked or partially blocked artery in your heart. By creating a new pathway to the heart, coronary bypass surgery improves blood flow to your heart muscle.
During coronary bypass surgery, a healthy blood vessel is taken from leg, arm or chest and connected to the other arteries in your heart so that blood bypasses the diseased or blocked area.
After coronary bypass surgery, symptoms, such as chest pain and shortness of breath due to poor blood flow to the heart, generally improve. For some people, coronary bypass surgery may improve heart function and reduce the risk of dying of heart disease.
Background:
Mr. F is allergic to Penicillin.
Regarding his medical hx he got MI, Hypertension, appendectomy, osteoarthritis, high cholesterol and GORD. While he admitted QEH pt had several test and x-ray and Echo also Calvary hospital. As you know the pt have multiple of cardiac disease and that can led to current condition.
Myocardic infarction (MI) death of the cells of an area of the heart muscle (MYOCARDIUM) as a result of oxygen deprivation, which in turn is caused by obstruction of the blood supply; commonly referred to as a “heart attack.”
Cardiomyopathy is a condition in which heart muscle becomes inflamed and enlarged. And that because heart muscle is stretched and becomes weak.
This means it can’t pump blood as fast as it should. If heart muscle becomes too weak, may develop heart failure (a serious condition that needs special treatment).
However, people who have severe heart failure may need a heart transplant to treat
The most common causes of Cardiomyopathy Which Harte muscle disease
Is
• Alcohol – drinking more than the recommended amount of alcohol can damage the heart and liver. Sometimes damage can be reversed if you stop drinking alcohol completely.
• Family history – if pt has a family history of cardiomyopathy, your changes of developing it can increase.
• Heart attack – one or more heart attacks can damage your heart muscle, leading to scar tissue. Scar tissue in your heart doesn’t contract like normal heart muscle, so the rest of your heart has to work harder, making the healthy parts tired and weak.
Assessment:
Also the pt. had x-ray and the x-ray showing the heart in the normal size and ship
Currently Medication
Warfarin is an anticoagulant (blood thinner). Warfarin reduces the formation of blood clots.
Warfarin is used to treat or prevent blood clots in veins or arteries, which can reduce the risk of stroke, heart attack, or other serious conditions.
Warfarin may also be used for purposes not listed in this medication guide.
Nebivolol 2.5 mg po dialy and that is used alone or in combination with other medications to treat high blood pressure. Nebivolol is in a class of medications called beta blockers. It works by relaxing blood vessels and slowing heart rate to improve blood flow and decrease blood pressure.
Coversyl 2.5mg daily Perindopril belongs to a class of medicines called ACE inhibitors. These work by widening the blood vessels, which makes it easier for your heart to pump blood through them. Indapamide is a diuretic. Diuretics increase the amount of urine produced by the kidneys. However, indapamide is different from other diuretics, as it only causes a slight increase in the amount of urine produced. Each of the active ingredients reduces blood pressure and they work together to control your blood pressure.
Rosuvastatin 40 mg daily po
Rosuvastatin is used along with a proper diet to help lower “bad” cholesterol and fats (such as LDL, triglycerides) and raise “good” cholesterol (HDL) in the blood. It belongs to a group of drugs known as “statins.” It works by reducing the amount ofcholesterol made by the liver. Lowering “bad” cholesterol and triglycerides and raising “good” cholesterol decreases the risk of heart disease and helps to prevent strokes and heart attacks.
3-Oxycodone 5- 10 mg prn 4hury is an opioid pain medication. An opioid is sometimes called a narcotic.
Oxycodone is used to treat moderate to severe pain.
Oxycodone extended-release is used for around-the-clock treatment of pain. This form of oxycodone is not for use on an as-needed basis for pain.
Temazepam 10 mg prn nght time is a benzodiazepine (ben-zoe-dye-AZE-eh-peen). Temazepam affects chemicals in the brain that may be unbalanced in people with sleep problems (insomnia).
Temazepam is used to treat insomnia symptoms, such as trouble falling asleep or staying asleep.
Pholcodine 10mls qid prn is a cough suppressant that acts primarily on the central nervous system (CNS) causing depression of the cough reflex, partly by a direct effect on the cough centre in the medulla. It also has a mild sedative effect.
Pracetamol 2 tb qid
Pantoprazole 40mg daily; Pantoprazole is a proton pump inhibitor that decreases the amount of acid produced in the stomach.
Pantoprazole is used to treat erosive esophagitis (damage to the esophagus from stomach acid), and other conditions involving excess stomach acid such as Zollinger-Ellison syndrome.
Lasix 40mg daily: Lasix (furosemide) is a loop diuretic (water pill) that prevents your body from absorbing too much salt. This allows the salt to instead be passed in your urine.
Lasix is used to treat fluid retention (edema) in people withcongestive heart failure, liver disease, or a kidney disorder such as nephrotic syndrome.
Coversyl 2.5mg daily Perindopril belongs to a class of medicines called ACE inhibitors. These work by widening the blood vessels, which makes it easier for your heart to pump blood through them. Indapamide is a diuretic. Diuretics increase the amount of urine produced by the kidneys. However, indapamide is different from other diuretics, as it only causes a slight increase in the amount of urine produced. Each of the active ingredients reduces blood pressure and they work together to control your blood pressure.
Recommendation plan
Nurse make sure the vital sign checked and recorded 4/24 during hospitalization.
Check BP before giving furosemide
Don’t give the Ramipril if the BP below 90
Giving Meedcation as chart
Encourage him with mobility
Dietitian
Salt causes your body to retain fluid, which can build up and put more strain on your heart.
To reduce the amount of salt
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