NES Asthma Hospital Medication Care Plan 7

Transcription

1 NES Asthma Hospital Medication Care Plan 7 PATIENT DETAILS Name Liz Duncan Address Consultant Gender Female Weight 60kg Height 1.6m General Practitioner Dr Jones Community Pharmacist Date of Birth (Age) Age 73 years Social History Known Sensitivities NKDA PATIENT HOSPITAL STAY Admission date Discharge Date Discharged to Presenting complaint in primary care / reason for admission Chest pain and collapse RELEVANT MEDICAL HISTORY RELEVANT DRUG HISTORY Date Problem Description Date Medication Comments Asthma Seretide MDI 2 puffs twice a day Rheumatoid arthritis Hypertension Bendroflumethiazide 2.5mg in the morning Salbutamol MDI 2 puffs as required Ibuprofen 200mg three times a day RELEVANT NON DRUG TREATMENT Prescribed Medication Start Stop Clinical/Laboratory Tests Date 1 Aspirin 300mg stat Temp Today Clopidogrel 300mg stat Pulse Today Enoxaparin 60mg twice a day Blood pressure Today 140/100 4 Seretide MDI 2 puffs twice a day White cell count Today Bendroflumethiazide 2.5mg each morning Creatinine Today 90 6 Salbutamol MDI 2 puffs as required Urea Today 7 7 Ibuprofen 200 mg three times a day PEFR Today Troponin Today Result

2 CLINCIAL MANAGEMENT Diagnosis Suspected MI / ACS Pharmaceutical Need Ensure clinical pathway followed Ensure asthma management appropriate PHARMACEUTICAL CARE PLAN Date Care Issue/Desired Output Action Output Today Check medicine history Discuss with GP Medicine history as on admission Discuss with patient Takes her inhalers every day as prescribed. Sometimes doesn t take her bendroflumetiazide if she is going out. Doesn t normally have any asthma symptoms. Today Find out best PEFR Check old notes Best PEFR 340l/min Specialist 1 management of MI / ACS check current guidelines and local protocols for management stop bendroflumethiazide as not appropriate for MI /ACS discuss the suitability of a beta blocker for a patient with asthma check renal function if to start on an ACEI check the dose of enoxaprin ensure regular doses of aspirin and clopidogrel written up asthma management check strength of Seretide with the patient and GP ensure patient has an asthma action plan

3 Specialist 1 (cont) Rheumatoid arthritis review pain control assess suitability of NSAID in patient with asthma alternative may be paracetamol Specialist 2 Diagnosis suspected MI/ ACS Ensure appropriate treatments are prescribed? Too late for thrombolysis or urgent PCI if TNT already known so : Low molecular weight heparin or fondaparinux (local policy / PCI timescale??) If LMWH check patient s weight, renal function & dose prescribed all match Monitor need for LMWH once chest pain resolves or if PCI has been performed Renal function and platelets -check initially and provide ongoing monitoring Ongoing treatments once diagnosis confirmed Antiplatelets only one off doses prescribed, prompt prescribing of standard daily doses of both Betablockers may not be suitable, depends on severity of asthma risk versus benefit in this case, may choose calcium blocker instead, esp if step 4 asthma! ACEI not prescribed yet, watch U&Es / BP after started Statin not prescribed yet, check LFTs GTN spray not prescribed yet, ask Dr to prescribe since chest pain symptoms were the reason for admission Patient education about all of above What they are / how they work / the potential benefits of taking them / what side effects to look for.

4 Specialist 2 (cont) Diuretic prescribed for HBP RA Will it still be required if all cardiac meds are started review the need, if to be continued then watch U&Es Only on low dose NSAID, check no other medicines to help control inflammation? Is this true RA if managing on so little? Not ideal to continue presumably no asthma problems but now cardiac risks! Could try changing to paracetamol Asthma Check what step this asthma patient s treatment is at cannot confirm until the strength of seretide is known! Clarify strength on cardex once known Check if the patient has an asthma diary and check symptoms / as required reliever use / PEFR to confirm what she is telling you about being stable. How long have they been stable and when was their last step down? Consider, if appropriate as above, requesting GP to review the steroid inhaler dose or consider removing LABA depending on steroid dose once known but consider the patient s interest in this at this time! Check inhaler technique and compliance Is she happy with the device Asthma diary If they did not already have an asthma diary and / or an action plan to follow provide one or contact the relevant respiratory nurse at the GP practice to arrange this.

5 Specialist 2 (cont) Smoking status not documented For discharge Always check and if yes a smoker give advice about the benefits of stopping for both cardiac and respiratory reasons Education required regarding new medicines for cardiac problem plus diary / action plan / possible inhaler review for asthma.