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LESSON PLAN FOR CARDIAC MODULE (CHF & POST-MI)

(Dan Judkins, 10-16-2015)

LEARNING OBJECTIVES
1. List and describe 10 structures and organs of the CARDIAC system.  [heart, aortic valve, pulmonic valve, septum,
pericardium, atria, ventricles, aorta vena cavae, pulmonary arteries, pulmonary veins, etc.]
2. Describe how blood flows (in terms of hydraulics and hemodynamics).
3. Describe the electrical control of the cardiac cycle.
4. Define cardiac cycle.
5. Describe the anatomy of the cardiac arteries.
6. Define myocardial infarction and STEMI.
7. List 4 different types of myocardial infarctions (locations).
8. Define angina and compare and contrast it with MI.
9. List 5 steps in the immediate treatment of MI.
10. List 5 common signs or symptoms of MI.
11. Discuss the epidemiology of cardiovascular disease.
12. List 5 risk factors for cardiac disease.
13. Define congestive heart failure.
14. List 3 common signs or symptoms of CHF.
15. List 5 common treatments for CHF.
16. Describe 5 common medications used for post-MI and CHF patients, including generic and brand names, actions,
dosages, and common side effects.
17. List 5 common elements of an action plan for post-MI self-management in the home.
18. List 5 common elements of an action plan for CHF self-management in the home.
19. Discuss key decision points in the UA / Banner UMC base hospital “Community Integrated Paramedic” algorithm
for “Recent MI”.
20. Discuss key decision points in the UA / Banner UMC base hospital “Community Integrated Paramedic” algorithm
for “CHF.”
21. Discuss key decision points in the UA / Banner UMC base hospital “Community Integrated Paramedic” algorithm
for “HTN.”
21. Demonstrate how to successfully use “motivational interviewing” techniques and assess a cardiac patient to
discover current status and relevant treatment challenges, and to motivate the patient to make positive changes.
22. Discuss the application of the principles of health behavior change to cardiac patients.
23. Describe how to develop a self-management, home-based” action plan for recent MI and CHF.
24. Discuss “patient refusal” provisions of the UA / Banner UMC base hospital “Community Integrated Paramedic”
algorithms for “Recent MI,” “CHF,” and “HTN.”
REQUIRED SKILLS
1. Recognize common cardiac arrhythmias.
2. Detect pulse rhythms that may be associated with cardiac arrhythmias.
3. Recognize changes to the T-wave, ST segment, and other EKG signs of ischemia and acute MI, as well as post-MI
changes.
4. Ability to conduct appropriate therapeutic “motivational interviewing” techniques and assessment in the home to
discover current patient status, changes from baseline, and current treatment challenges.
5. Demonstrate ability to apply the principles of health behavior change during interactions with a cardiac patient in
the home.
PRE-TEST
Complete written pre-test on cardiac A&P, pathophysiology, CHF, recent MI, relevant medications, and treatment
algorithms. (15 minutes)
Page 2 CARDIAC MODULE Lesson Plan

INTRODUCTION
(15 minutes)
1. Learning plan for this module.
2. Learning objectives.
3. Introductions (students and presenters).
4. What experiences and challenges have any of the students had with CHF and recent MI patients?
5. What do the students expect might be common aspects of helping cardiac patients manage their disease at home
with hospitalizations?
CARDIAC SYSTEM ANATOMY, PHYSIOLOGY, & PATHOPHYSIOLOGY
DATE NAME SECTION DETAILS RESOURCES
Dr. Frank Anatomy &  Structures, gross -- 40 minutes
Paul Physiology of  Structures  cardiac vessels classroom
the Cardiac  Function: presentation
System o Cardiac cycle -- Illustration-rich
o Pressure differentials that generate flow PowerPoint slides
 Pathophysiology: for anatomy &
o Acute MI physiological
o Arrhythmias associated with MI processes
o EKG changes associated with ischemia & -- Handouts to
MI complement
o Recovery from acute MI PowerPoint slides
o EKG changes post MI
o CHF
 Epidemiology of cardiovascular disease
o Prevalence
o Mortality
o Risk factors
o Prevention
Page 3 CARDIAC MODULE Lesson Plan

ACUTE MI & RECOVERY


Dr. Frank Acute MI  Introductory comments about MI -- 45 minutes
Paul and its  Risk factors classroom
(optionally aftermath in  Causes presentation
with a the home  Structural damage leading to dysfunction -- PowerPoint
pharmacist)  Physical assessment slides where
o Observation appropriate
o Skin signs -- Handouts:
o Oxygenation smoking cessation
o Rhythms -- Handouts:
o Dyspnea Recent MI
o Exercise tolerance medications
o Pain
 Diagnosis
 Recent MI home-based treatment:
o Smoking cessation  principles,
resources, applicable health behavior
change concepts
o Cardiac reconditioning treatment &
exercise plan
o Oxygen
o Medications
o Base station treatment algorithms
o Developing an action plan for home-based
self-management of recent MI
 Prognosis & disease progression
o Outpatient
o Home
o Hospitalizations
Primary  Case Scenario #1 -- 20 minutes
care o A detailed case scenario featuring multiple -- 1 primary care
clinician + common issues & decision points clinician
assistance - or – -- 1 victim actor
o A victim actor interviewed and assessed by a
of other -- 1 additional
nurse practitioner, physician, or other clinician
faculty faculty member
with multiple clinical issues & decision points
 Making and successfully executing a plan of care
-- Pre-prepared
 Typical issues and problems with recent MI patients scenario “scripts”
 Case Scenario #2
o A CIP student plays the victim role (5-minute
prep with “script”)
o Two CIP students play role of CIP care
providers – interview and assessment the
patient, and decide on appropriate actions
 Case Scenario #3
o A CIP student plays the victim role (5-minute
prep with “script”)
o Two CIP students play role of CIP care
providers – interview and assessment the
patient, and decide on appropriate actions
Page 4 CARDIAC MODULE Lesson Plan

CONGESTIVE HEART FAILURE


Dr. Frank CHF  Introductory comments about CHF -- 45 minute
Paul  Risk factors classroom
(optionally  Causes presentation
with a  Structural damage and other elements leading to -- PowerPoint
pharmacist) dysfunction slides where
 Physical assessment appropriate
o Observation -- Handouts: CHF
o Respiratory effort medications
o Skin signs
o Oxygenation
o Lung sounds
o Edema
 Diagnosis
 Treatment:
o Activity & exercise
o Medications
 Each specific medication in detail
o Base station treatment algorithms
o Developing an action plan for home-based
self-management of recent MI
 Prognosis & disease progression
o Outpatient
o Home
o Hospitalizations
Primary  Case Scenario #1 -- 20 minutes
care o A detailed case scenario featuring multiple -- 1 primary care
clinician + common issues & decision points clinician
assistance - or – -- 1 victim actor
of other o A victim actor interviewed and assessed -- 1 additional
faculty by a nurse practitioner or other clinician faculty member
with multiple clinical issues & decision -- Pre-prepared
points scenario “scripts”
 Making and successfully executing a plan of care
 Typical issues and problems with CHF patients
 Case Scenario #2
o A CIP student plays the victim role (5-
minute prep with “script”)
o Two CIP students play role of CIP care
providers – interview and assessment the
patient, and decide on appropriate actions
 Case Scenario #3
o A CIP student plays the victim role (5-
minute prep with “script”)
o Two CIP students play role of CIP care
providers – interview and assessment the
patient, and decide on appropriate actions
Page 5 CARDIAC MODULE Lesson Plan

REVIEW, SUMMARY, & CLOSURE


(10 minutes)
1. Review the decision elements of the CHF, Recent MI, and HTN base-hospital CIP algorithms.
2. Key knowledge elements of recent MI home recovery.
3. Key knowledge elements of CHF self-management in the home.
4. Principle challenges and objectives of recent MI care in the home to avoid hospitalization.
5. Principle challenges and objectives of CHF care in the home to avoid hospitalization.
6. Q & A.
7. Next module:
 Date & time of class on next module
 Readings and/or assignments
POST-TEST
1. Complete written post-test on cardiac A&P, pathophysiology, CHF, recent MI, relevant medications, and treatment
algorithms. (30 minutes)
2. Individual practical / verbal exam to demonstrate skills and patient management competence (optional).