DISCHARGE SUMMARY: PCI IN THE ELDERLY PATIENT 1 DISCHARGE SUMMARY: PCI IN THE ELDERLY PATIENT DISCHARGE SUMMARY: PCI IN THE ELDERLY PATIENT 6 DISCHARGE SUMMARY: PCI in the Elderly Patient Professor: XXXX Student Name Grand Canyon University-ANP 654 Date DISCHARGE SUMMARY Discharge Summary Date XXXX-ANP 654 Patient Name: H.W. MRN: 123456 Sex: Male Date of Birth: 12/12/1933 Provider: C.H. APRN/MILLENIUM PHYSICIAN GROUP Primary Care Provider: Dr. S.B. Admission Date: xx/xx/xxxx Discharge Date: xx/xx/xxxx Admitting Diagnoses: I25.1 Atherosclerotic heart disease of native coronary artery R00.1 Bradycardia, unspecified (permanent pacemaker placed by Dr. R 12/28/2019) I10 Renovascular hypertension N18.6 End stage renal disease (on peritoneal dialysis) Discharge Diagnosis: I25.1 Atherosclerotic heart disease of native coronary artery-elective cardiac catheterization on this admission R00.1 Bradycardia, unspecified I10 Renovascular hypertension controlled I70.1 Atherosclerosis of renal artery N18.6 End stage renal disease (peritoneal dialysis 1/14/20 prior to discharge) Admission Procedure: 01/13/20- Cardiac catheterization under moderate sedation with use of IVP contrast for coronary angiography Impression: Non-dominant RCA without significant obstructive disease <60%. OM with an 80% proximal lesion, Circumflex with mid 90% lesion, LAD is without disease, large diagonals without disease. LV function is normal, EF 50%, no wall motion abnormalities. PCI to the OM and Circumflex were performed with good results. Consultations: Dr. R Interventional Cardiologist- performed elective cardiac catheterization 1/13/20 Course of Treatment: This is an 86 year-old male patient with a complex cardiac history. The patient had a permanent pacemaker placed on 12/28/2019 for severe symptomatic bradycardia. After pacemaker placement, the patient underwent a Lexiscan showing ischemia. A planned cardiac catheterization was scheduled for 1/13/20. Dr. R. performed PCI and placed BM stents to the patient’s OM and Circumflex arteries. His RCA was assessed and was deemed not severe enough for intervention and was a non-dominant vessel. The patient was admitted for further observation overnight post procedure. He had no complaints of chest pain, no shortness of breath, no nausea or vomiting, no dizziness, and no numbness or tingling in his bilateral lower extremities. No hematoma, redness or swelling noted at his right groin catheterization site. Overall, the patient is stable for discharge this evening after his peritoneal dialysis treatment. Admission Home Medications: Auryxia 210mg, 2 tabs, po three times daily Entresto 24/26mg, 1 tab, po twice daily Thiamine 100mg po daily Docusate sodium 100mg po twice daily Discharge Medication: Auryxia 210mg, 2 tabs, po three times daily Entresto 24/26mg, 1 tab, po twice daily Thiamine 100mg po daily Docusate sodium 100mg po twice daily New: Nitroglycerine 0.4mg, one tablet SL ...

1. DISCHARGE SUMMARY: PCI IN THE ELDERLY PATIENT
1
DISCHARGE SUMMARY: PCI IN THE ELDERLY PATIENT
DISCHARGE SUMMARY: PCI IN THE ELDERLY PATIENT
6
DISCHARGE SUMMARY: PCI in the Elderly Patient
Professor: XXXX
Student Name
Grand Canyon University-ANP 654
Date

2. DISCHARGE SUMMARY
Discharge Summary
Date
XXXX-ANP 654
Patient Name: H.W.
MRN: 123456
Sex: Male
Date of Birth: 12/12/1933
Provider: C.H. APRN/MILLENIUM PHYSICIAN GROUP
Primary Care Provider: Dr. S.B.
Admission Date: xx/xx/xxxx
Discharge Date: xx/xx/xxxx
Admitting Diagnoses:

3. I25.1 Atherosclerotic heart disease of native coronary artery
R00.1 Bradycardia, unspecified (permanent pacemaker placed
by Dr. R 12/28/2019)
I10 Renovascular hypertension
N18.6 End stage renal disease (on peritoneal dialysis)
Discharge Diagnosis:
I25.1 Atherosclerotic heart disease of native coronary artery-
elective cardiac catheterization on this admission
R00.1 Bradycardia, unspecified
I10 Renovascular hypertension controlled
I70.1 Atherosclerosis of renal artery
N18.6 End stage renal disease (peritoneal dialysis 1/14/20 prior
to discharge)
Admission Procedure:
01/13/20- Cardiac catheterization under moderate sedation with
use of IVP contrast for coronary angiography
Impression: Non-dominant RCA without significant obstructive
disease <60%. OM with an 80% proximal lesion, Circumflex
with mid 90% lesion, LAD is without disease, large diagonals
without disease. LV function is normal, EF 50%, no wall motion
abnormalities. PCI to the OM and Circumflex were performed
with good results.
Consultations:
Dr. R Interventional Cardiologist- performed elective cardiac
catheterization 1/13/20
Course of Treatment:
This is an 86 year-old male patient with a complex cardiac
history. The patient had a permanent pacemaker placed on
12/28/2019 for severe symptomatic bradycardia. After
pacemaker placement, the patient underwent a Lexiscan
showing ischemia. A planned cardiac catheterization was

4. scheduled for 1/13/20. Dr. R. performed PCI and placed BM
stents to the patient’s OM and Circumflex arteries. His RCA
was assessed and was deemed not severe enough for
intervention and was a non-dominant vessel. The patient was
admitted for further observation overnight post procedure. He
had no complaints of chest pain, no shortness of breath, no
nausea or vomiting, no dizziness, and no numbness or tingling
in his bilateral lower extremities. No hematoma, redness or
swelling noted at his right groin catheterization site. Overall,
the patient is stable for discharge this evening after his
peritoneal dialysis treatment.
Admission Home Medications:
Auryxia 210mg, 2 tabs, po three times daily
Entresto 24/26mg, 1 tab, po twice daily
Thiamine 100mg po daily
Docusate sodium 100mg po twice daily
Discharge Medication:
Auryxia 210mg, 2 tabs, po three times daily
Entresto 24/26mg, 1 tab, po twice daily
Thiamine 100mg po daily
Docusate sodium 100mg po twice daily
New:
Nitroglycerine 0.4mg, one tablet SL every 5 minutes (may
repeat x 3) as needed for chest pain-call 911 if no relief-
dispense #30, 1 refill
New:
Clopidogrel 75mg, one tablet by mouth daily, dispense-#30, 1
refill
Physical Exam:
Vital signs: BP 125/55, HR paced, 70, Pulse Ox on room air
>92%, RR 18

5. General: no acute distress, well developed, well nourished,
appears younger than stated age, pleasant and cooperative
Chest: Clear to auscultation and percussion, breath sounds
normal, equal expansion, air movement good, no cyanosis, or
clubbing of fingers, no kyphosis, no scoliosis
Cardiovascular: S1, S2, no murmur s, bruits, or thrills noted.
Peripheral pulses +2, no JVD, trace pedal edema noted
Extremities: right groin catheterization site without swelling,
redness, or drainage, dressing in place, no cyanosis or edema
Abdomen- soft, non-tender, slightly distended, undergoing
peritoneal dialysis, bowel sounds positive, last BM this
morning, tolerating po diet
GU- no discharge, no abnormal bleeding, does not void
Neuro: Alert and oriented x 3, no motor or sensory deficits
noted, cranial nerves II-XII intact, sensation and strength
normal
Laboratory values:
Gluc-125, BUN 67, Cr 11.69, Na 139, K 3.4, Ca 7.9, Pt 12.2,
INR 1.04, Wbc 6.21, Hgb 8.3, Hct 26.0, Plt Ct 220, Mg 2.0
EKG (1/14/2020)-Ventricular paced rhythm, no acute changes
Assessment and Plan-
1. Coronary artery disease s/p PCI to OM and Circumflex due to
abnormal lexiscan/abnormal findings on cardiac catheterization-
continue current home medications, add SL Nitroglycerine, add
Plavix, ok to remove dressing at home or prior to discharge, ok
to shower, no heavy lifting, bending or strenuous activity for 1
week
From a cardiology standpoint, the patient is stable for discharge
once his dialysis treatment is complete. All questions and
concerns were answered at bedside with patient and wife.

6. Pending Results: All tests are completed, no results are pending
at time of discharge
Discharge Condition: Stable
Disposition: Home with wife
Time of Assessment: 09:20am
Time spent on Discharge and Care Planning: >30min
Discharge Instructions:
Diet- Cardiac/Heart Healthy, Renal Diet
Physical Activity- 1 week no heavy lifting, bending or
strenuous activity
Follow up provisions:
Primary Care Provider: Dr L.C, please call 123-1234 to
schedule an appt in 1 week
Cardiology: Dr R. 2/14/20 at 09:00am. Ph-123-2345 to change
if not convenient
*Discharge and PCP medication list has been reviewed and
verified with patient. Prescriptions have been given to patient
with in depth instruction for use.

7. Considerations:
This patient underwent stenting to his OM and distal
Circumflex arteries with bare metal stents. Current guidelines
are a minimum of one month of antiplatelet therapy following
elective percutaneous coronary intervention (Kereiakes, Yeh,
Massaro, 2015). In this patient’s case it was decided that he
should remain on clopidogrel indefinitely secondary to residual
coronary disease and PCI. Antithrombotic treatment in
cardiovascular disease consists of oral anticoagulation and
antiplatelet agents. Aging is the primary risk factor in the
development of arteriosclerosis. The elderly patient is at high
risk for developing thrombosis but also has a higher risk of
bleeding. Increased risks make it more difficult for providers to
choose appropriate anticoagulant strategies for their patients.
Elderly persons also have more comorbidities, such as diabetes,
and renal disease, which increase adverse reactions and risk
factors in patients. Three major problems are identified in
selecting the best therapy for the patient. They are
polypharmacy, comorbidity, and medication adherence
(Arahata, Asakura, 2018). Providers need to evaluate these
problems and make a decision for each patient based on benefit
versus risk. Another important thing is for providers is to
involve an interdisciplinary approach and view the overall
health of the patient. The intervention should not be based on
one disease process alone but should be based on the overall
health of the patient.
This is an active 83 year-old without physical mobility
compromise. He has no history of falls and uses no assistive
devices. He is compliant with his health care regimen. He is
aware of the increased risk of bleeding secondary to renal
disease (Ruscin, Linnebur, 2018). His health care goal is to
maintain a good quality of life. Benefit outweighs risk in this
patient’s case.

8. References
Arahata, M., & Asakura, H. (2018). Antithrombotic therapies
for elderly patients: handling problems originating from their
comorbidities. Clinical interventions in aging, 13, 1675–1690.
doi:10.2147/CIA.S174896
Kereiakes DJ, Yeh RW, Massaro JM, et al. Antiplatelet Therapy
Duration Following Bare Metal or Drug-Eluting Coronary
Stents: The Dual Antiplatelet Therapy Randomized Clinical
Trial. JAMA. 2015;313(11):1113–1121.
doi:10.1001/jama.2015.1671
Ruscin, M., Linnebur, S., (2018). Drug categories of concern in
older adults. Merck Manual, Professional Version. Retrieved
from
https://www.merckmanuals.com/professional/geriatrics/drug-
therapy-in-older-adults/drug-categories-of-concern-in-older-
adults
Benchmark Requires LopeswriteAssessment Description
Academic clinical discharge summary notes provide a unique
opportunity to practice and demonstrate advanced practice
documentation skills, develop and demonstrate critical thinking

9. and clinical reasoning skills, and practice identifying acute and
chronic problems and formulating an evidence-based plans of
care.
This assignment uses a template. Refer to the "AGACNP
Discharge Summary Template," located on the Student Success
Center page under the AGACNP tab.
Develop an academic clinical discharge summary note based on
a hospital patient seen during clinical/practicum. The discharge
summary note should include the following:
1. Reason for admission: Include the reason for admission, a list
of diagnoses in order of acuity, and an ICD-10 diagnosis.
2. List of all procedures: Include all dates, significant findings,
and any anesthetics and contrast used during procedures.
3. Complete list of consults during hospitalization: Include any
providers or services consulted during the stay.
4. Patient's condition at discharge: Include a physical exam
prior to discharge that documents that patient is stable at
discharge and has safe disposition and transportation. What
diagnostic criteria confirmed the discharge diagnosis?
5. Complete list of discharge medications: Full list with all
dosages, frequencies, and quantity of medications prescribed or
dispensed.
6. Pending test results for follow up: Complete list of any
pathology, cultures, radiology, or other diagnostic tests still
pending, and who is responsible for follow-up on the final
results.
7. Complete list of discharge instructions: Full list of directions
regarding infection prevention, new medications, and returning
to daily activities.
8. Complete list of discharge follow-ups: Full list of any
therapies, treatments, referrals, consults, and follow -up
appointments. What diagnostic criteria were needed after
discharge?
9. Summary: What questions were raised during the hospital
stay? Include all explanations and answers to these questions.
What questions were raised that required further exploration?

10. What kind of discharge planning did you need? Characterize
your patient interaction activities.
10. Overall assessment: Identify health promotions, health
education, ethical considerations, geriatric considerations, and
expected outcomes.
Incorporate three peer-reviewed articles in the assessment or
plan.
While APA style is not required for the body of this assignment,
solid academic writing is expected, and documentation of
sources should be presented using APA formatting guidelines,
which can be found in the APA Style Guide, located in the
Student Success Center.
This assignment uses a rubric. Please review the rubric prior to
beginning the assignment to become familiar with the
expectations for successful completion.
You are required to submit this assignment to LopesWrite. A
link to the LopesWrite Technical Support Articles is located in
Class Resources if you need assistance.