Patient Education and Health Maintenance
Goals are to restore patient to optimal physiologic, psychological, social, and work level; aid in restoring confidence and self-esteem; develop patient's self-monitoring skills, and assist in managing cardiac problems; modify risk factors.
- Inform the patient and family about what has happened to heart.
- Explain basic cardiac anatomy and physiology.
- Identify the difference between angina and MI.
- Describe how the heart heals and that healing is not complete for 6 to 8 weeks after infarction.
- Discuss what the patient can do to assist in the recovery process and reduce the chance of future heart attacks.
-
- Instruct patient on how to judge the body's response to activity.
- Introduce the concept that different activities require varying expenditures of oxygen.
- Emphasize the importance of rest and relaxation alternating with activity.
- Instruct patient how to take pulse before and after activity as well as guidelines for the acceptable increases in heart rate that should occur.
- Review signs and symptoms indicative of a poor response to increased activity levels: chest pain, extreme fatigue, shortness of breath.
-
- Design an individualized activity progression program for patient as directed.
- Determine activity levels appropriate for patient as prescribed and by predischarge low-level exercise stress test.
- Encourage patient to list activities he enjoys and would like to resume.
- Establish the energy expenditure of each activity (ie, which are most demanding on the heart), and rank activities from lowest to highest.
- Instruct patient to move from one activity to another after the heart has been able to manage the previous workload as determined by signs and symptoms and pulse rate.
-
- Give patient specific activity guidelines, and explain that activity guidelines will be reevaluated after heart heals:
- Walk daily, gradually increasing distance and time as prescribed.
- Avoid activities that tense muscles, such as weight lifting, lifting heavy objects, isometric exercises, pushing and/or pulling heavy loads, all of which can cause vagal stimulation.
- Avoid working with arms overhead.
- Gradually return to work.
- Avoid extremes in temperature.
- Do not rush; avoid tension.
- Advise getting at least 7 hours of sleep each night and take 20- to 30-minute rest periods twice per day.
- Advise limiting visitors to three to four daily for 15 to 30 minutes and shorten phone conversations.
-
- Tell patient that sexual relations may be resumed on advice of health care provider, usually after exercise tolerance is assessed.
- If patient can walk briskly or climb two flights of stairs, he can usually resume sexual activity with familiar partner; resumption of sexual activity parallels resumption of usual activities.
- Sexual activity should be avoided after eating a heavy meal, after drinking alcohol, or when tired.
-
- Advise eating three to four small meals per day rather than large, heavy meals. Rest for 1 hour after meals.
- Advise limiting caffeine and alcohol intake.
- Driving a car must be cleared with health care provider at a follow-up visit.
- Teach patient about medication regimen and adverse effects.
- Instruct the patient to notify the health care provider when the following symptoms appear:
- Chest pressure or pain not relieved in 15 minutes by nitroglycerin or rest
- Shortness of breath
- Unusual fatigue
- Swelling of feet and ankles
- Fainting, dizziness
- Very slow or rapid heart beat
-
- Assist patient to reduce risk of another MI by risk factor modification.
- Explain to patient the major risk factors that can increase chances for having another MI.
- Instruct patient in strategies to modify risk factors.
-