Primary, secondary, and tertiary strategies to prevent hospitalization

·       Primary, secondary, and tertiary strategies to prevent hospitalization

 Research and discuss approaches to impact/reduce hospitalization utilizing primary, secondary, and tertiary prevention initiatives focusing on the individual, community, and system-level specific to HF condition. 

·       Based on research, create an extension of the HRRP that focuses on successfully preventing hospitalization through primary, secondary, and tertiary prevention methods.

Initiatives should incorporate individual, social, community, system-level, and condition/procedure specific considerations.  community is Dallas, Texas

Patient scenario is below and from order numbers 81086 & 81087 this is part 3 

HF 

Reggie is a 72-year-old black male who is being discharged from the hospital after an eight-day inpatient stay for treatment of Heart Failure exacerbation (HF). This is Reggie’s fourth hospitalization for HF in the last three years. Prior to being hospitalized, Reggie noted that his legs became severely swollen, his abdomen was distended, and he started feeling short of breath. When his daughter brought him a meal, she noticed how swollen his legs were, and how ill he looked. She called his primary care provider, who suggested that Reggie be taken to the local ER. Soon after arriving at the ER he was admitted to the telemetry unit for treatment of an exacerbation of HF.  

During his hospital stay, Reggie was treated with Lasix, potassium supplements, as well as his normally prescribed medications. The Lasix and potassium supplements were discontinued yesterday. He maintained a strict low sodium cardiac diet, with fluid restriction to 1500 cc per day. Additionally, Reggie and his daughter received education about lifestyle modification for HF and diabetes. Reggie will be discharged home today, with plans to see his cardiologist in one week, have laboratory blood draws in one week, and see his primary care provider as soon as possible. Reggie was treated by his usual cardiologist while in the hospital, and a hospitalist. Records of his hospitalization will be digitally sent to his primary care provider.  

Reggie’s other history is as follows: Ht: 6’0”  WT: 265 BP: 112/74 Temp: 98.8 F  O2 sats: 96% on RA Pain: 0/10 

Insurance: Medicare Advantage Plan (Coverage for A-D) 

PMH: Hypertension for 40 years. Obesity (BMI 35.9 kg/m2). Hyperlipidemia. DM II. Appendectomy at 42. Bilateral osteoarthritis of the knees.  

FH: Father deceased, lung cancer at 68. Mother deceased, MI at 80, DM II, HTN. Son, 47, DM II, hyperlipidemia. Daughter, 45, HTN. Son, 42, alive and well. 

SH: Bachelors degree  in civil engineering. Retired civil engineer. Widower of 3.5 years, with three grown children. Oldest son lives out of state. Daughter lives in the same city. Youngest son lives several hours away. Reggie lives in the same home he has occupied for 40 years in a well-maintained neighborhood with wide sidewalks, two nearby parks, and several local grocery stores with a wide variety of fruits and vegetables, both are about one mile from his home. Reggie eats frozen and canned foods often, especially since his wife passed away from breast cancer 3½ years ago. He does not exercise regularly. No smoking history. Does not drink alcohol. One cup of coffee per day with sugar and creamer. No soda but does drink orange juice with breakfast and vegetable juice with his dinner. Reggie and his wife attended a local church weekly, he has attended sporadically since her death. Reggie used to participate in a local hobby builder group, but has not attended meetings for over a year. Other than his daughter nearby, Reggie has no extended family nearby. 

Meds: Metoprolol XL 25 mg, 1 tab daily by mouth. Lisinopril 10 mg tab, 1 tab daily by mouth. Aspirin 81 mg tab, 1 tab daily by mouth. Aldactone 25 mg tab, 1 tab daily by mouth in the morning. Metformin HCl 500 mg tab, 2 tabs each am with breakfast, 1 tab each pm with dinner. Simvastatin 40 mg tab, 1 tab daily by mouth. Tylenol 500 mg tab, 1-2 tabs as needed by mouth for knee pain (do not exceed 3 grams daily). 

Allergies: NKDA, No food allergies, minor seasonal allergies.