D117 Hospital Readmission Prevent Plan
Patient Overview and Hospital Course
Donald is a 55-year-old Hispanic male who was admitted to the hospital after experiencing an acute myocardial infarction (MI). The cardiac event occurred while he was performing yard work at home, during which he developed chest tightness accompanied by nausea and shortness of breath. Recognizing these symptoms as potentially life-threatening, his spouse promptly contacted emergency medical services, leading to his rapid transport to the emergency department.
Upon arrival, Donald underwent a comprehensive diagnostic evaluation, including a detailed medical history, physical examination, electrocardiogram (ECG), and laboratory testing for cardiac biomarkers. These findings confirmed the presence of an acute MI. Timely intervention was achieved, and within approximately 50 minutes of symptom onset, Donald was taken to the cardiac catheterization laboratory. Percutaneous coronary intervention was successfully performed, including balloon angioplasty and placement of two coronary stents to restore adequate myocardial perfusion.
Donald remained hospitalized for five days under close medical supervision. During this period, he was initiated on guideline-directed medical therapy, received individualized education related to cardiovascular risk reduction, and began early ambulation. He demonstrated clinical stability and is being discharged today with a structured follow-up plan that includes cardiology care, laboratory monitoring, and enrollment in a formal cardiac rehabilitation program.
Patient History and Current Clinical Status
The table below summarizes Donald’s demographic information, medical background, and current clinical findings at the time of discharge.
| Parameter | Details |
|---|---|
| Age, Gender, Ethnicity | 55 years, Male, Hispanic |
| Height and Weight | 5’10”, 245 lbs |
| Vital Signs | Blood Pressure: 116/78 mmHg; Temperature: 98.2°F; Oxygen Saturation: 98% on room air |
| Pain Level | 1/10 localized to femoral access site |
| Insurance Coverage | Blue Cross Blue Shield |
| Past Medical History | Hypertension (15 years), Obesity (BMI 35), Hyperlipidemia (previously untreated), Tonsillectomy (age 15), Right knee ACL repair (age 36) |
| Family History | Father deceased from MI at age 62; Mother living with type 2 diabetes mellitus, hypertension, and osteoporosis |
| Social History | Married, two children, college professor, moderate alcohol consumption, denies tobacco or illicit drug use, active in church community |
| Allergies | No known drug, food, or environmental allergies |
Discharge Medications and Patient Education
What New Medications Is Donald Prescribed, and What Should He Know About Them?
Following his myocardial infarction and coronary stent placement, Donald has been prescribed a comprehensive medication regimen designed to prevent recurrent cardiac events, reduce cardiovascular risk factors, and support long-term cardiac function. Patient education regarding medication adherence is essential to optimize outcomes and prevent complications.
| Medication | Purpose | Key Patient Education Points |
|---|---|---|
| Atorvastatin 80 mg daily | Intensive lipid lowering and plaque stabilization | Take daily as prescribed; report muscle pain or weakness; therapy is long-term even if cholesterol improves |
| Atenolol 25 mg twice daily | Heart rate and blood pressure control, decreased myocardial oxygen demand | Do not discontinue abruptly; monitor for fatigue, dizziness, or bradycardia |
| Lisinopril 10 mg daily | Blood pressure control and prevention of ventricular remodeling | Monitor for persistent cough, dizziness, or facial swelling; rise slowly from sitting |
| Clopidogrel 75 mg daily | Prevention of platelet aggregation and stent thrombosis | Take consistently without interruption; notify providers before procedures |
| Aspirin 81 mg daily | Long-term antiplatelet therapy | Avoid additional NSAIDs unless approved; report signs of bleeding |
Donald should be informed that most of these medications are intended for long-term or lifelong use. Adherence to dual antiplatelet therapy is particularly critical to prevent stent thrombosis and reduce the risk of recurrent myocardial infarction.
Cardiac Stent and Access Site Care
How Should Donald Care for His Cardiac Stents and Access Site?
Donald underwent cardiac catheterization via femoral artery access, which requires careful post-procedure management to prevent complications. He should be encouraged to increase oral fluid intake over the next several days to aid in the elimination of contrast dye and support renal function.
The access site should be inspected daily for signs of infection or complications, including redness, warmth, swelling, bruising, increased pain, or drainage. Donald should avoid lifting objects heavier than 10 pounds, minimize stair climbing, and refrain from strenuous physical activity for at least seven days. Daily showers are permitted; however, submersion in baths, swimming pools, or hot tubs should be avoided until the site has fully healed.
Topical agents such as lotions, creams, or powders should not be applied to the access site. If bleeding occurs, firm pressure should be applied for 15 minutes. Ongoing bleeding or rapidly increasing swelling warrants immediate medical attention. Donald should carry his stent identification card at all times to inform healthcare providers of his coronary implants.
Lifestyle Modification and Risk Reduction
What Lifestyle Changes Should Donald Make?
Prior to hospitalization, Donald reported limited physical activity and frequent consumption of fast food and restaurant meals, both of which are significant contributors to cardiovascular risk. Following an MI, lifestyle modification plays a central role in secondary prevention and long-term recovery.
Dietary changes should focus on a heart-healthy eating pattern that includes reduced sodium and saturated fat intake, lean protein sources such as fish and poultry, whole grains, and a variety of fruits and vegetables. Portion control and minimizing processed foods are essential. Referral to a registered dietitian can provide individualized guidance and improve adherence.
Physical activity should be resumed gradually, beginning with light walking and progressing toward 30 to 60 minutes of moderate exercise at least three times per week, as tolerated and guided by cardiac rehabilitation professionals. Social support from family, faith-based organizations, and community groups can enhance motivation, reduce stress, and promote sustained lifestyle changes.
Follow-Up Care and Ongoing Monitoring
What Follow-Up and Monitoring Is Necessary?
Ongoing follow-up is essential to monitor Donald’s recovery, evaluate medication effectiveness, and reduce the risk of hospital readmission.
| Follow-Up Component | Timing | Purpose |
|---|---|---|
| Cardiologist Appointment | Two weeks post-discharge | Assess cardiac recovery, evaluate stent patency, adjust medications |
| Primary Care Provider Visit | Within one week post-discharge | Coordinate chronic disease management and preventive care |
| Cardiac Rehabilitation | Begin one week post-discharge | Supervised exercise, education, and risk factor modification |
| Laboratory Testing | 5–7 days post-discharge | Monitor lipid profile, renal function, and medication tolerance |
Donald will receive written instructions for laboratory testing, appointment scheduling, and contact information for his healthcare team to address questions or concerns.
Recognition of Warning Signs and Emergency Care
When Should Donald Seek Medical Attention?
Donald should be educated to promptly recognize symptoms that may indicate recurrent ischemia or complications. Warning signs include chest pain or pressure, shortness of breath, excessive sweating, dizziness, nausea, or unexplained fatigue. At the onset of symptoms, he should stop activity and rest. If symptoms persist, worsen, or resemble his previous cardiac event, he should immediately contact his healthcare provider or activate emergency medical services. Early recognition and rapid treatment are essential for improving outcomes following recurrent cardiac events.
References
Cleveland Clinic. (2023). After your cardiac catheterization.
Mayo Foundation for Medical Education and Research. (2022, April 28). Eight steps to a heart-healthy diet. Mayo Clinic.
Mayo Foundation for Medical Education and Research. (2022). Heart disease: Lifestyle and home remedies. Mayo Clinic.
U.S. Department of Health and Human Services. (2023). Secondary prevention after myocardial infarction: Clinical recommendations.