EAPC Quiz: Care of the Cardio-oncologic Patient in Primary Care Practice

The case

A 69-year-old man diagnosed with:

• chronic atrial fibrillation
• hypertension
• hypercholesterolemia
• nicotinism
• implanted pacemaker
• left ventricle hypertrophy
• prior aortic aneurysm resection and aortic prosthesis implantation
• history of prostatic hypertrophy
• benign bladder tumor pTa LG(G1) after transurethral resection of bladder tumour (TURBT)

is under care of his general practitioner. He has had a recurrence of his bladder tumor and has been re-scheduled for a repeat TURBT.

The patient is overweight (BMI 28.70), leads a sedentary lifestyle and smokes one pack of cigarettes a day. His blood pressure control at home is fair, with values around 120/70 mmHg, and occasional drops in blood pressure, without fainting. The patient takes a vitamin K antagonist for chronic anticoagulation treatment.

Recommendations:

• lifestyle modification
• smoking cessation
• weight reduction
• regular use of medications
• taking warfarin under INR control
• control of blood pressure and recording results (morning, afternoon, and evening measurements)
• a diet limiting animal fats and salt
• regular urine culture monitoring
• remaining under constant care of a cardiologist and a urologist

Nursing Interventions:

• Psycho-education of the patient on symptom monitoring and self-management [2]
• Patient education on thromboembolic risk, use of anticoagulants (warfarin) and the importance of regular monitoring of INR level[1]
• Psycho-education and support in the process of lifestyle modification, i.e. weight reduction, encouraging and motivating the patient to engage in regular physical activity, changing nutritional habits (eating a diet rich in vegetables which contain minerals such as potassium), stopping smoking cigarettes[1,2],