NSB016 Clinical Practice Capstone
Question:
Identify and demonstrate principles related to effective communication in changing patient situations.
Answer:
I participated in a simulation of clinical experience to learn about some objectives. One of such objectives was to identify the principles of post-operative assessment and demonstrate the ways to achieve it.
Reporting: During the simulation, I met a 65-year-old male patient Mr Bright who had undergone an angioplasty procedure. Mr Bright has a history of hypertension and DM-II and he is a smoker of about 20 cigarettes/day. He underwent the angioplasty procedure to his right coronary artery. The doctors placed a drug releasing stent within his body with 10% residual stenosis (Bonati et al., 2012). The angioplasty procedure was difficult and the patient showed some sign of myocardial ischemia. He showed improvement as there was no sign of swelling or haematoma and the wound site released a very small amount of ooze. The first set of post operational procedure was done before he came under my care and I was supposed to do the second. His immediate post-op ECG report was normal.
Responding:I was involved at the service of Mr Bright during his recovery period as the RN left him under my care. Mr Bright complained a chest pain, which was relieved after receiving sublingual Nitro glycerine spray. I was interested in this case because this was a case of classic coronary heart disease and I had to follow the textbook procedure of the angioplasty pathway (Martinez & Bucher, 2008).
Relating: As Mr Bright was allocated under my care, I had to do his next set of post-operation observations. The patient was given N-saline IVT infusion of 1000 ml at the rate of 100ml/ hour. The patient was connected to the monitor to keep his vitals under constant observation, albeit there was no sign of bleeding.
Reasoning: I had to ensure that in case the patient presented any signs of complications I was responsive and addressed the concerns by suitable interventions. Many patients with similar history have shown complications such as retroperitoneal bleeding and ischemic chest pain (Tollefson, 2010).
I had to monitor the possible symptoms like arrhythmia, tachycardia, hypotension, wide pulse pressure, agitation, and decreased haemoglobin level. Thrombus is a common sign in such cases that is marked by Cardiac Resynchronization. Cardiac Resynchronization can be treated by Cardiac Resynchronization Therapy (Martinez & Bucher, 2008).
Reconstruction: The present experience was a valuable one teaching me how to care for patients undergoing angioplasty. In future, my care for a patient with similar condition would be guided by the learnings from the discussed scenario. The possible complications post angioplasty are infection, haemorrhage and cardiac ischemia. In case the patient bleeds from the femoral puncture site, active arterial closure devices such as collagen plug closure devices would be useful (Shoulders-Odom, 2008). For preventing infection, regular dressing of wound site is imperitive. Cardiac ischemia is to be addressed by the administration of beta-blockers and blood thinners (Martinez & Bucher, 2008). Proper changing of the dressing of the surgery wound is necessary as it can be infected which can cause further damage to the body (De Luca et al., 2013). The patient would also be educated on self-management techniques for wound dressing.
References:
Bonati, L. H., Lyrer, P., Ederle, J., Featherstone, R., & Brown, M. M. (2012). Percutaneous transluminal balloon angioplasty and stenting for carotid artery stenosis. The Cochrane Library.
Retrievedfrom- https://onlinelibrary.wiley.com/doi/10.1002/14651858.CD000515.pub4/full
De Luca, G., Dirksen, M. T., Spaulding, C., Kelbæk, H., Schalij, M., Thuesen, L., …&Chechi, T. (2013). Impact of Diabetes on Long-Term Outcome After Primary Angioplasty. Diabetes Care, 36(4), 1020-1025.
Martinez, L & Bucher, L. (2008). Nursing management: Coronary artery disease and acute coronary syndrome. In D. Brown & H. Edwards (Eds.), Lewis’s Medical-Surgical Nursing, 3590-3734
Retrieved from – https://nursekey.com/nursing-management-coronary-artery-disease-and-acute-coronary-syndrome/
Retrieved from- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3609523/
Shoulders-Odom, B. (2008).Management of patients after percutaneous coronary interventions. Critical Care Nurse, 28(5), 26.
Retrieved from- https://ccn.aacnjournals.org/content/28/5/26.long
Tollefson, J. (2010). Clinical Psychomotor Skills: assessment tools for nursing students, (4th edn.),
Retrieved from- https://books.google.co.in/books?hl=en&lr=&id=jmKnfvbdvacC&oi=fnd&pg=PR5&dq=Clinical+Psychomotor+Skills:+assessment+tools+for+nursing+students&ots=0iEUrjMoHe&sig=Sxl2y0QZvxUiCIpVm1yGfMacrxQ#v=onepage&q=Clinical%20Psychomotor%20Skills%3A%20assessment%20tools%20for%20nursing%20students&f=false
The 5 R reflection framework.
Retrieved from: https://www.studenteportfolio.qut.edu.au/staff_resources/resources/The%205%20Rs_Framework.pdf
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