Patient Care and Monitoring

For patients in acute distress and ACS is suspected:

• Follow recommendations in Figures 8-1 and 8-2 and Table 8-2. Also incorporate into your plan the recommendations detailed below under "For patients diagnosed with ACS."

For patients diagnosed with ACS:

1. Review patient's medical record to determine indications for each medication.

2. Review patient's medical record to determine contraindications for each medication. For ASA, P-blockers, ACE inhibitors, and ARBs, document contraindications in patient's medical record.

3. Review doses of medications for appropriateness. Titration toward target doses of ACE inhibitors and P-blockers should be in progress. Evaluate if the dose of ASA may be reduced to less than 100 mg if no recent stent.

4. Interview the patient to assess complementary or alternative medication use. Counsel appropriately based on indications and drug interactions.

5. Evaluate the patient's medical record and medication history, and conduct a patient interview to assess for the presence of drug allergies, adverse drug reactions, drug interactions, and medication adherence.

6. Educate the patient and evaluate their success with lifestyle modifications, including smoking cessation, diet, weight loss, and exercise. For patients with DM, tight glucose control should be emphasized.

7. Provide patient education with regard to CAD, MI, indications for medications, and potential adverse effects and drug interactions.

• How can the progression of CAD and MI be prevented?

• How does each medication benefit the patient?

• Why is adherence important?

• What potential adverse effects may occur?

• What potential drug interactions may occur?

• Warning signs to report to the physician or emergency medical services include chest squeezing, burning, or pain; jaw pain; pain radiation down the arm; bleeding; and loss of consciousness.

• Dial 911 if there is no chest discomfort relief after one SL NTG tablet.

• Important to train caregiver or relative to administer cardiopulmonary resuscitation (CPR).

8. Document smoking cessation counseling and patient receipt of discharge instructions in the patient's medical record.

Abbreviations Introduced in This Chapter

ACC American College of Cardiology

ACCP American College of Chest Physicians

ACE Angiotensin-Converting enzyme

ACS Acute corona ry syndrome

ADP Adenosine diphosphate

AHA American Heart Association

AMI Acute myocardial infarction a P I T Activated partial thromboplastin time

ARB Angiotensin receptor blocker

ASA Aspirin

BP Blood pressure

CABG Coronary artery bypass graft (surgery)

CAD Coronary artery disease

CHI) Coronary heart disease

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