What template or approach should a Family Nurse Practitioner (FNP) use when interviewing patients in a rehabilitation setting, particularly when transitioning from interventional cardiology?

Template for Interviewing Cardiac Rehabilitation Patients for FNPs Transitioning from Interventional Cardiology

A structured, comprehensive assessment template is essential for FNPs transitioning from interventional cardiology to rehabilitation settings to ensure optimal patient outcomes and reduce morbidity and mortality.

Initial Assessment Framework

Medical History Review

• Cardiovascular History
  • Primary cardiac diagnosis (MI, CABG, PCI, valve surgery, heart failure, etc.)
  • Date of index event/procedure
  • Current symptoms (chest pain, dyspnea, fatigue, palpitations)
  • Prior cardiac events and procedures
  • Complications during hospitalization
  • Current cardiac status and functional limitations

Medication Review

• Complete list of current medications with dosages
• Adherence assessment
• Side effects experienced
• Recent medication changes
• Secondary prevention medications (statins, antiplatelets, beta-blockers, ACE-I/ARBs)

Risk Factor Assessment

• Modifiable risk factors:
  • Smoking status
  • Blood pressure control
  • Lipid management
  • Diabetes management
  • Weight/BMI
  • Physical activity level
  • Dietary habits
  • Stress/psychosocial factors

Functional Assessment

• Current activity level
• Exercise capacity
• Activities of daily living (ADLs) limitations
• Use of assistive devices
• Home environment safety

Rehabilitation-Specific Assessment

Depression Screening

• PHQ-9 or other validated depression screening tool 1
• Assessment of need for mental health referral
• Impact of mood on rehabilitation engagement

Rehabilitation Goals

• Patient's personal goals for rehabilitation
• Understanding of cardiac rehabilitation benefits
• Barriers to participation in rehabilitation
• Support system availability

Educational Needs

• Knowledge of cardiac disease process
• Understanding of risk factor modification
• Medication knowledge
• Recognition of warning signs requiring medical attention

Collaborative Care Planning

Interdisciplinary Team Communication

• Coordinate with rehabilitation team members (physical therapists, occupational therapists, dietitians, etc.)
• Review prior referrals and consultations
• Identify gaps in care coordination 1

Discharge Planning Assessment

• Anticipated length of rehabilitation
• Post-rehabilitation care needs
• Home support requirements
• Follow-up appointment scheduling 2

Documentation Template

Cardiac Rehabilitation Assessment Note

SUBJECTIVE:
- Chief concern/reason for visit:
- Cardiac history summary:
- Current symptoms:
- Medication adherence:
- Exercise/activity level:
- Dietary habits:
- Psychosocial factors:
- Patient goals for rehabilitation:

OBJECTIVE:
- Vital signs: BP, HR, RR, O2 sat, weight
- Cardiovascular exam:
- Pulmonary exam:
- Functional status:
- Depression screening results:
- Recent lab values:

ASSESSMENT:
- Primary cardiac diagnosis:
- Secondary diagnoses:
- Risk factor status:
- Rehabilitation potential:
- Barriers to rehabilitation:

PLAN:
- Medication adjustments:
- Exercise prescription:
- Education needs:
- Referrals needed:
- Follow-up schedule:

Implementation Tips

Communication Strategies

• Use a standardized referral process as outlined in cardiac rehabilitation guidelines 1
• Emphasize the importance of cardiac rehabilitation to patients using the suggested script:

  "Cardiac rehabilitation has been shown to help people with heart problems live longer and have better life enjoyment than people who do not go to cardiac rehabilitation." 1

Monitoring Progress

• Establish baseline functional measures
• Set specific, measurable goals with timeframes
• Document progress at each visit
• Adjust plan based on patient response

Common Pitfalls to Avoid

1. Failing to coordinate with the interdisciplinary team - Ensure regular communication with all team members 1
2. Overlooking depression screening - Depression significantly impacts cardiac outcomes 1
3. Delaying discharge planning - Begin planning early in the rehabilitation process 2
4. Neglecting patient-centered care - Incorporate patient preferences and goals into the rehabilitation plan 3, 4
5. Rushing the transition process - Allow adequate time for patient education and understanding 5

Special Considerations

For Patients with Complex Needs

• Assess need for additional support services
• Consider caregiver training needs
• Evaluate home environment safety
• Plan for longer transition periods if needed 6

For Young Adult Patients

• Address unique psychosocial needs
• Ensure appropriate community support
• Focus on long-term independence goals 7

By implementing this structured approach to cardiac rehabilitation assessment, FNPs can effectively transition from interventional cardiology to rehabilitation settings while maintaining high-quality patient care and improving outcomes related to morbidity, mortality, and quality of life.