Exploring Expectations Needs Of Patients Undergoing
Question:
Answer:
Nursing assessment is indeed a key component of clinical nursing practice as it helps in identifying problems in order of their clinical significance and determined priorities for nursing intervention (McSHERRY et al., 2012). Mr. Harry bright had been admitted to the hospital, following which he underwent an angioplasty in the right coronary artery. During pre admission, the patient was asked about his age, and past medical history. Further, he was inquired about the medications that he was currently on and his smoking and alcohol consumption. This was followed by conduction of a height and weight assessment. The hospital staff successfully performed the comprehensive assessment on the individual who was seeking care for angina or chest pain. The assessment was successfully conducted to determine restrictive alternative for the individual, in order to maintain his independence and satisfy his care needs.
Research studies state that pre-procedural orientation is imperative in nursing care as it involves providing support and information (Aazami, Jaafarpour & Mozafari, 2016). Such procedures provide clinicians with adequate time for exploring the knowledge gap and concerns of the patient and carers. Mr. Bright and his wife were found to be extremely satisfied with the information that was given regarding the probable complications associated with, and precautions that should be taken by them. Evidences also support conduction of comprehensive assessment regarding social psychological and physical factors (Rolley et al., 2011). The patient’s right and consent forms the foundation of professional clinical practice and considers deliberate contribution of patients in decision making process of utmost importance.
Developing awareness about the therapeutic procedure’s side effect has been identified essential. Often patients are uncertain about the outcome or performance of an intervention (Aazami, Jaafarpour & Mozafari, 2016). Such uncertainty was observed in Mr. Bright in his discussions conducted at his home. However, the patient preparation steps were effective enough to convince them. Relying on the family and social support is also considered essential. The same was followed by discussing minute clinical details with the patient’s wife, thereby helping her provide necessary support to her husband. Principles of postoperative care management of an include regular monitoring of vital signs and an assessment of the concerns that might create adverse health outcomes. There are two basic routes for vascular access related to angioplasty namely, the femoral and radial routes (Young, 2014). Femoral access has been identified by most studies as major, because it is a larger vessel and helps in providing a direct route to the heart (Von Schmilowski & Swanton, 2012). Furthermore patients need to remain flat for 2 to 6 hours after the procedure. In the case scenario angioplasty had been performed through the femoral route and Mr. Bright was observed to lie down flat. Thus, appropriate steps were taken in preventing adverse effects such as internal bleeding, post-operation and the nurses were able to maintain supine position (Mills, Wright & Newell, 2012).
They had also discussed major issues related to the operation with the patient’s wife, thereby facilitating a hopeful and supportive self-care agency (Saeidzadeh, Darvishpoor Kakhki & Abed Saeedi, 2016). The nurses are also required to identify potential complications related to angioplasty such as site hematoma, and pseudoaneurysm and monitor changes in the patient during recovery phase. The nurse was found to inquire on presence of pain and also talked about administration of sublingual GTN to facilitate effective heart functioning. Presence of bruises and blockage were also closely monitored. Studies also support use of ECG for monitoring be heart rate during and after, operational procedures to identify presence of arrhythmia or ischemia (Rolley et al., 2011). Post-procedural nursing practice also includes observation of vital signs, comfort and pain management, and sheath removal pain management. Most of these procedures had been accurately followed during postoperative nursing care. However, failure was demonstrated in emphasizing on the need of patient education, cardiac rehabilitation, and chest pain action plan. They also failed to provide adequate information on lifestyle modifications that must be followed in case of angioplasty and artery diseases. It would have helped the patient in recovering sooner. Provisions for conducting urgent bedside echocardiography on suspecting tamponade and returning the patient to cardiac catheter laboratory for pericardial drain insertion were also not discussed. The staff missed out providing necessary information on a life-threatening emergency.
ISBAR tool forms an essential part of communication during patient handover and prevent health complications (Klim et al., 2013).
Identity |
· Name- Harry bright · Age-67 · Sex- Male · Admitting person- His wife |
Situation |
· The patient has been referred by the GP on reporting recurrent chest pain while Waking, Gardening, or watching television. · His medical history of hypertension and diabetes has been considered as major risk factors for the prevailing health condition. · He also has a history of smoking 20 cigarettes per day and occasional alcohol consumption. |
Background |
· The patient has a history of hypertension, which might increase risk for angina pectoris when blood exits great force on the arteries. · Presenting complaint of the patient includes chest pain that can be caused due to angina or heart attack. · The patient is also found to be diabetic, which might increase the likelihood of suffering from diabetic heart disease or angina. · High blood glucose levels have probably triggered the pain and made the person susceptible to chest pain. |
Assessment |
· Current vital signs indicate presence of RR 9-20, SPO2 >95% , BP 150/80, pulse 98, temperature 36.3°C, and alert state in pain assessment. · BGL show an approximate value of 12.3mmol/L. · Presence of hypertension is identified as the major risk factor that might have increased likelihood of the patient from suffering a chest pain. · High blood pressure puts stress on the cardiac muscles and results in lower blood flow and subsequent high oxygen demand. · The patient has been administered aspirin, metformin, and clopidogrel at present. · Aspirin and clopidogrel will reduce risk of stroke and cardiovascular diseases. · Metformin will help in reducing elevated blood glucose level. · Metoprolol will also reduce the blood pressure. |
Recommendation |
· An appropriate management plant is required for the patient where necessary steps will be taken to prevent health adversities due to complications that can arise post-angioplasty. · Provisions will be created to provide sufficient patient education on the health risks and precautionary measures. · Information will also be provided on certain dietary and lifestyle modification that must be followed to lead a healthy life. |
References
Aazami, S., Jaafarpour, M., & Mozafari, M. (2016). Exploring expectations and needs of patients undergoing angioplasty. Journal of Vascular Nursing, 34(3), 93-99.
Klim, S., Kelly, A. M., Kerr, D., Wood, S., & McCann, T. (2013). Developing a framework for nursing handover in the emergency department: an individualised and systematic approach. Journal of clinical nursing, 22(15-16), 2233-2243.
McSHERRY, R. O. B. E. R. T., Pearce, P., Grimwood, K., & McSherry, W. (2012). The pivotal role of nurse managers, leaders and educators in enabling excellence in nursing care. Journal of Nursing Management, 20(1), 7-19.
Mills, C., Wright, C., & Newell, C. (2012). Care of the post percutaneous coronary intervention patient. Australian Nursing and Midwifery Journal, 19(7), 26.
Rolley, J. X., Salamonson, Y., Wensley, C., Dennison, C. R., & Davidson, P. M. (2011). Nursing clinical practice guidelines to improve care for people undergoing percutaneous coronary interventions. Australian Critical Care, 24(1), 18-38.
Saeidzadeh, S., Darvishpoor Kakhki, A., & Abed Saeedi, J. (2016). Factors associated with self?care agency in patients after percutaneous coronary intervention. Journal of clinical nursing, 25(21-22), 3311-3316.
Von Schmilowski, E., & Swanton, R. H. (2012). Essential Angioplasty. John Wiley & Sons, 8-24.
Young, S. (2014). Coronary angioplasty: Patient management and nursing care. British Journal of Cardiac Nursing, 9(9), 430-435.
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