Category: HEARTe

Case 3: Stuart

Stuart portrait

Meet Stuart

Stuart is a 67-year old gentleman. His past medical history includes having hypertension and he had a myocardial infarction (MI) in 2012. Following his MI, he attended the cardiac rehabilitation programme in his local hospital where he learned to take his own pulse and measure his blood pressure, using an automated machine.

He has recently found that the automated BP machine that he uses has been giving him rather erratic readings. Despite this, he has been feeling normal. He decides to phone the nurse at his GP practice for advice on the BP readings.

Stuart wielding a trowel in his garden, with his shed behind him

 

Social care assessment

Sally has not been managing well at home and so she, her family and the nurse agree that there needs to be a holistic review of her living arrangements.

Sally portrait with labels: Physiological, Spiritual, Psychological and Social

A person-centred holistic assessment includes reviewing all areas of living.

It’s about getting to know the person behind the patient.

It is important that we understand the knock-on effects that one has on the other. As Sally is having difficulty coping at home, it is important that she is referred for a multi-agency review.

Part of this would look at Sally’s environment and how safe she is and how well she copes. If there are areas needing improved, Sally could be provided with aid or assistance in order to ensure that she is able to stay at home or in a homely environment where she is safe and happy.

Things that you would need to consider are:

  • The layout of the house
  • Accessibility to all rooms
  • Her ability to do housework and make meals.

These may change when there is a change in their health, particularly with older people. It is therefore important that a person-centred review is carried out at every consultation.

Sally and her daughter meet the pharmacist

Pharmacist documentation and leaflets

The pharmacist gives Sally the NPSA “Yellow Booklet” after filling in her details and completing the Warning Card that she should show to Health Care Professionals.

Using the booklet as a guide the following aspects of her treatment are covered:

  • Why she is on warfarin and what it does
  • Current dose and duration of treatment (lifelong in AF unless there is a reason to stop)
  • The colours of the different strengths of warfarin tablets and how to make up her dose
  • How she should take the tablets, focussing on why it is important to take her tablets, ways to remember if she has taken a dose and making sure she has enough tablets at home
  • What to do if she misses a dose
  • The need for blood test (INR) and where these will be done
  • Side effects of treatment and what to do if they happen
  • The need to tell other health care professionals, especially dentists and hospitals, that she is treated with warfarin
  • The effect of other medicines, diet and alcohol on warfarin therapy
  • For women, the effect on pregnancy and periods

Sally is given the opportunity to ask questions about her treatment and reminded that she has any questions or concerns at any time she should ask her doctor, pharmacist or nurse.

The nurse calls Sally in

The nurse calls Sally in to discuss her results. The nurse refers to the 1,2,3 of management of AF to help structure her conversation. Consider the additional information box in relation to other challenges relating to other medications.