Bullet Point list your Main Concerns for this Patient

Assignment 4 Template
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Bullet point list your main concerns for this patient
 The patient is suffering from chest pain.
 The patient has undergone Coronary angioplasty via the left femoral
artery.
 A previous attempt of coronary angioplasty via the left radial artery
failed.
 Increased risk of complications due to two surgeries.
 The blood pressure reading of the patient is 100/75 mmHg
 The patient’s heart rate is 98 beats per minute.
 Increased respiratory rate of 22 breaths per minute.
Provide a rationale/reason for this concern
 Chest pain is more prevalent in older patients and indicates the risk
of cardiovascular diseases in patients.
One of the most causes of chest pain in older patients is CAD
or Coronary Artery Disease. This health condition is determined by
the blockage of blood vessels of the heart, which reduces the flow of
blood and oxygen to the muscle cells of the heart. The chest pain
caused by this condition is known as angina, and this condition
often leads to the development of myocardial infarction in patient if
left untreated (Khera & Kathiresan, 2017).
According to the NRMI- National Registry of Myocardial
Infarction, out of the total reported incidences of myocardial
infarction, over 40% of older patients suffering from myocardial
infarction reported chest pain as their chief symptom. This provides
a conclusive indication that the myocardial infarction. Myocardial
infarction is also known as a heart attack in common words, is
determined by the death of heart cells caused due to reduced blood
flow to the heart cells through heart blood vessels. In this situation,
the patient may suffer from crushing pain in the left side or centre
of the heart, and this kind of chest pain is not relieved by taking
rest.
 The intervention of coronary angioplasty confirms the condition of
atherosclerosis in the patient. Atherosclerosis is the condition of
building up of plaque inside the blood vessels of the arteries,
leading to blockage and reduced flow of oxygen and blood to the

organs (Gisterå & Hansson, 2017). This plaque is usually made up of
calcium, cholesterol and fat present in the blood.
The condition cause narrowing of the arteries which requires
intervention of medical procedure called coronary angioplasty. The
medical procedure involves the use of a tiny balloon catheter to
widen the blood vessels and improve or completely restore the glow
of blood through it (Mäkikallio et al., 2016). Coronary angioplasty is
one of the most effective intervention during the situation where
angina is worsening.
However, there are several risks associated with this medical
procedure. These risks include stroke, due to breaking loose of
plaque during the procedure, kidney problems- caused by the
contrast dye used for angioplasty procedure, coronary artery
damage due to rupturing of coronary artery during procedure,
abnormal heart rhythms and increased risk of heart attack during
the conduct of procedure. Association of such risks raises concern
for the health outcome of the patient (Lawson et al., 2018).
 Several consequences due to the failed attempt of coronary
angioplasty via the left radial artery can occur in the patient. Failed
percutaneous coronary intervention is required to be followed up by
an urgent coronary artery bypass graft. Further test for
hemodynamic stability is required, as it is a crucial predictor of
survival. Increased risk of myocardial infarction is the main concern
for the patient due to the failed attempt of coronary angioplasty via
left radial artery.
 Most often medical procedures are associated with some risk and as
the patient is very old and has underwent two surgical intervention
in short span of time, there is increased risk of complications
occurring in the patient. Two attempts of coronary angioplasty
indicates two different points of insertion which increases the risk of
bruising, clotting or bleeding at the point of insertion, arrhythmia or
irregular heartbeat, infection issues, restenosis and kidney damage
(Hirata, Koga & Iseki, 2018).
 The patient’s blood pressure reading is slightly lower than the
normal blood pressure level. The normal blood pressure level ranges
from 80 to 120 mm Hg in systolic and 60 to 80 mm Hg in diastolic.
Even though the patient’s blood pressure readings are within the
normal range, the patient is at high risk of attaining hypotension
post two surgical interventions. A further drop in blood pressure can
increase the risk of hypotension, identified by symptoms such as
fainting, dizziness, nausea, depression, blurred vision, and fatigue
(Holschen & Agneskirchner, 2020). Cerebral perfusion may be
affected by a dramatic decrease in diastolic pressure leading to an
increased risk of dementia in the older patients. Even though it is a
minor concern, the patient should be kept at strict supervision to
analyse any further incidence of complications.

 The resting heart rate of the 75 year old female patient is above 98
beats per minute, which is above the standard maximum indicative
level of 85 beats per minute. This is indicative of poor heartbeat
results for the patient, and abnormal resting heart beat rate. High
levels of resting heartbeat measures can significantly increase the
risk of cardiovascular disease in the patient and cause early death.
The patient may be suffering from the condition of tachycardia, and
few other associated risks are health conditions of injury, anaemia,
poor circulation, congenital heart disease and shorter life
expectancy (Sapp et al., 2016).
 The normal respiration rate for an adult ranges between 12 to 20
breaths per minute. The patient has a slightly higher respiration rate
of 22 breaths per minute, which is acceptable (Takayama,
Nagamine & Kotani, 2019). However, taking into consideration the
surgeries the patient underwent and the associated risk of heart
failure, it is important that the respiratory rate of the patient is
regularly monitored, as further increase could lead to the condition
of tachypnoea. Moreover, increased respiratory rate is an indication
of abnormal heart functioning, as it is not able to pump sufficient
oxygen to the organs.
List all the appropriate interventions in order of priority
(be specific).
 Prescribing medications post coronary angioplasty.
 Prescribing medications for angina
 Cardiac rehabilitation for the patient for 4 to 8 weeks post discharge
from the hospital.
 Ensuring the patient to ensure lifestyle changes.
 Educating the patient about their health condition and relevant risk.
Provide a rationale/reason for these interventions in
order of priority
 Coronary angioplasty is required to ensure smoother blood flow
along with oxygen, to prevent tissue death. However, a major risk
associated with post coronary angioplasty is the formation of blood
clots. Blood thinning is one crucial intervention to prevent the
formation of blood clots, reducing the risk of further blocking of
blood vessels. Blood thinning medications such as prasugrel
(Effient), ticagrelor (Brilinta), and clopidogrel (Plavix) should be
administered by the nurses to the patient in combination with low-
dose aspirin (Goodman et al., 2016). This medication treatment
should be recommended to the patient for a minimum of one year.