Role of Medical Angioplasty and Stents

The assignment discusses the role of medical angioplasty and stent placement in treating coronary artery disease. It reviews various studies and articles on the topic, highlighting the benefits and risks associated with this procedure. The importance of nursing practice standards is also emphasised to ensure quality care services for patients undergoing angioplasty and stent placement.

CRITICAL ANALYSIS ON MRS. GREEN
INTRODUCTION
Present study is based on case study of Mrs Green. Current project will discuss
problem within the lady. This will focus on first 8 hours post coronary angioplasty. It will
discuss application of nursing practices. Report will discuss aspects of anatomy and
physiology, pathophysiology and pharmacology with reference to Mrs. Green case study.
Furthermore, it will discuss relevant care plan for lady in order to improve her condition. It
will explain effectiveness of patients care plan in improving condition of person. In addition,
registered Nurse Standards for Practice will be described in this research paper.
UNDERSTANDING PROBLEM
Potential problems that could occur in first 8 hours of post coronary angioplasty
Though angiography is the safe process but sometimes, it may create issues in the
patient (Gross, Thomas and Frerichs, 2014). As Mrs Green was 78year old lady, this process
can cause potential problem of kidney damage because people those who are gone through
angiography can face issue of kidney damage. It is likely issue for Mrs. Green. This is serious
complication of angiography process (Bukala, Kwiatkowski and Malachowski, 2016). If this
operation gets failed because of old age of the patient, then it may impact negative on kidney
of the person. As doctors works to illuminate the arteries and blood vessels but this can cause
kidney damage. As in the case of Mrs. Green she is old and in this age individual's kidney
fails to perform work well. If in this age she takes treatment of Angioplasty then kidney
damage is major risk that might cause within her. It is generally taken place in person those
who have pre-existing kidney problems. As Mrs. Green was smoker in past and smoking
affect negatively on kidney of individual. That is why there are high chances that she might
face this risk. Many doctors have skimmed that angioplasty can be risky after 50 year they
have mentioned possibility of occurring kidney damage or failure. That might be potential
problem in Mrs. Green.
Actual case
Elizabeth Rose Green is 78-year old lady. While working in the kitchen, she has
experienced 10 minutes of unrelieved central chest pain. She was admitted to hospital for
diagnosis. Past medical history of the lady reflect that she was former smoker and is suffering

from Gastro-oesophageal reflux disorder (GORD), hypertension (Dukkipati and et.al., 2015).
30 year ago, she has gone through hysterectomy surgical process. She is a widow and living
alone. Due to her medical condition, she is unable to drive thus, she prefers to use taxi for
going to other places. From the entire study, it is found that Mrs Green is suffering from
blockage in her left anterior descending artery. It has been diagnosed by using femoral artery
approach. Apart from this, it has been identified that she had 10-20% occlusion. She has been
shifted to Cardiac care ward at 1250. Medical staff members have stated that Mrs Green has
unremarkable recovery post procedure. On arrival in the cardio care ward at 1250, she has
been observed: 145/90HR beats per minute BP. RP is 24 per minute, her temperature is 35.8C
SpO2. On post sheath removal, she can sit for 2 hours up 30degree (Sapontis and et.al.,
2017). At that time, BP rate beats per minute is 155/90HR, RP 26 respirations per minute.
She has been pointed out by cardiologists that her left foot remains pale and cool and pedal
pulse rates are present in her body. Medical professionals have performed Doppler ultrasound
on left foot and they have found that blood flow in feet are adequate, but they have sent Mrs
Green for neurovascular observations for next two hours for monitoring changes within her
body (Bashar and et.al., 2014). Due to pale and cool foot, Mrs Green had to attend
cardiologist round. At 1400 observations, it is found that her BP is 140/80 HR 88 SaO2 99%
on 6L via CIG pain. It has been identified that her left foot is pale and cool, her movements
are normal.
Rational of choosing the problem and implications
An angioplasty is the surgery in which doctors open blood vessels so that blood
supply can be smooth to heart muscles. These blood vessels are known as coronary arteries.
It occurs because of contrast agents such as iodine and barium. Both these agents can injure
kidneys (Velibey and et.al, 2017). As Mrs Green is 78-year old lady and she had a past
history of smoking. Such type of patients can face this potential problem within 8 hours of
post coronary angioplasty.
Doctors are specialists in performing angioplasty. They provide appropriate medicines
so that pain of the patient can be minimized, and individual can get relaxed (Chakraborty and
et.al., 2015). Medical professionals take x-ray so that actual picture of this process can be
monitor at the same time. Once catheter tube has been inserted then practitioners inject
contrast dye in order to highlight blockages. They have detected blockage then doctors use
percutaneous coronary intervention so that blood flow can be improved in the person (Heart
Disease Treatment With Angioplasty and Stents, 2018).

After completing angioplasty RN has to remove catheter and they use closures device
for stopping or closing blood vessel. They cover it with bandage on opening area of arm,
neck or groin. During this process, medical professionals have to observe heart rate and blood
pressure of patient. This observation helps doctors in stopping bleeding from hole where they
have inserted catheter (Angioplasty After a Heart Attack: Risks and Benefits, 2018). As Mrs.
green is 78 year old lady thus, in this age recovery of the person takes time that is why
complication of kidney damage may get arise. Pharmacology process in the angioplasty is
very complicated because RN has to look at the medical condition and accordingly they have
to provide medicines during process. Aspirin is small dose and other anti-platelet are being
provided to patients. Intracoronary streptokinase infusion while operating person can prevent
patient from infarctions. At that time, glucose and oxygen are given through mask so that
condition of the person can be controlled during surgery. Furthermore, aspirin like drugs are
given to the patient (New RN standards for practice released, 2016). All this process needs to
be implemented in an appropriate manner so that overall condition of the person can be
improved soon.
APPLICATION OF NURSING PRACTICE
Patient plan of care
People who are going through angioplasty can face huge complications. In such
condition, it is very important for the practitioners to observe their medical situations time to
time and provide them proper care so that their health condition can be improved soon. As in
the case study of Mrs Green, it is found that doctors have provided angioplasty. She is old
lady and was smoker thus, her kidney was not healthy (Angioplasty After a Heart Attack:
Risks and Benefits, 2018). In such condition there is high chances of having kidney damage
issue due to this surgery. This occurs due to contrast media that are used by medical
professionals in order to improve blood flow in the human body. Mrs Green has been
diagnosed with blood blockage. People those who suffer from blood clotting issues they may
face allergy to contrast media. Due to use of iodine in process candidates may face issue
which may impact negative on their medical condition (Dukkipati and et.al., 2015).
In order to prevent people from such type of allergies doctors have to use non-ionic
toxics that do not cause side effects in the human body. As Mrs Green needs to get non-ionic
contrast media so that problem of kidney damage can be avoided properly. During
angioplasty, doctors have to check their movement through x-rays so that actual impact of the
surgery can be identified during the procedure. This can help medical professional in

minimising complications. That have to inject contrast medium within Mrs Green that makes
blood vessels visible to x-ray. RN those who are involved in the surgery process they have to
suggest the Mrs Green about stop eating and drinking for at least eight hours prior to the
operation (Hirai and et.al, 2017). Professionals have to arrange glucose trip for them so that
patient can be prepared for the operation and individual can go through this procedure.
Furthermore, care providers have to administered sedative in order to relax Mrs Green. IV
line needs to be inserted into vein and it is very important to make arrangement of same
blood group because during the process blood is required (Bukala, Kwiatkowski and
Malachowski, 2016).
During the angioplasty, doctors have to observe Mrs Green in every 2-4 hours.
Doctors have to provide them diet plan in which they have to take care that she eats such food
that do not enhance her fat and even do not reduce her weight. Involvement of percutaneous
coronary interventions can be considered as effective because this reduces risk of
consequences in the angioplasty (Chakraborty and et.al., 2015). If doctors apply preventive
angioplasty process, then risk can be reduced by 65%.
Application of nursing practices
NMBA (Nursing and Midwifery Board of Australia) standards have been made by the
concern department. These standards ensure that each patient get quality care in the hospitals
so that death rate can be minimised. Standard 7 reflect that medical professionals are required
to evaluate outcome. This standard reflects that RN have to take responsibility of patient
(New RN standards for practice released, 2016). They have to provide them treatment as per
goal, plan. They have to monitor their progress so that actual results can be measured. As in
the case of Mrs Green, nursing professional is required to ensure progress of the lady. If in
case, they find there is no progress or improvement in health condition, then they have to take
immediate action so that her condition can be improved soon. Practitioners have to revise
their plan on the bases of their evaluation. Furthermore, this standard 7 reflect that medical
professionals have to communicate the care plan with the patient so that care user can follow
this care plan properly without any mistake. It is duty of the care providers to provide correct
treatment to the patient (Velibey and et.al., 2017). If they get failed to provide them accurate
treatment then, it may affect health condition of the person to great extent. In order to fulfil
responsibility in an effective manner, each medical professional have to follow standards of
nursing practices. NMBA 2016 reflects standards that help the professional in achieving the
goal of improving health of the patient. Standard 7 emphasise on evaluating outcome. They

have to look at advantage and consequences of this treatment process so that actual outcome
can be obtained. 7.2 standard states that if existing plan is not appropriate of having some
weakness, then practitioners have to immediately apply revise plan so that risk of the person
can be minimised (Dukkipati and et.al., 2015). 7.3 is about documents and communication.
There needs to be clear communication with the person. Doctors have to disclose all issues
that might face after applying angioplasty on Mrs Green. Once they have given their written
concern, then they have to start procedure.
CONCLUSION
From the above study, it can be concluded that angioplasty is the surgical process that
is applied when person is facing heart issue and supply of blood to the heart is restricted.
Through this surgery, they improve blood flow and eliminate blood blockage in the patient.
But while providing any kind of treatment to the care users, doctors have to ensure
consequences that might arise during the process and they have to prepare accurate plan that
can support them in minimising these issues. Practitioners are required to follow nursing
practice standards so that they can offer quality care services to the patients and can improve
their health conditions.

REFERENCES
Books and Journals:
Bashar, K. and et.al., 2014. Role of far infra-red therapy in dialysis arterio-venous fistula
maturation and survival: systematic review and meta-analysis. PLoS One. 9(8). p.
e104931.
Bukala, J., Kwiatkowski, P. and Malachowski, J., 2016. Numerical analysis of stent
expansion process in coronary artery stenosis with the use of non-compliant balloon.
Biocybernetics and Biomedical Engineering. 36(1). pp.145-156.
Chakraborty, R. and et.al., 2015. Trimetazidine in the prevention of contrast induced
nephropathy following coronary angiography/angioplasty. Indian Heart Journal. 67.
pp. S59.
Dukkipati, R. and et.al., 2015, January. Outcomes of cephalic arch stenosis with and without
stent placement after percutaneous balloon angioplasty in haemodialysis patients. In
Seminars in dialysis (Vol. 28, No. 1).
Gross, B. A., Thomas, A. J. and Frerichs, K. U., 2014. Endovascular treatment of
symptomatic moyamoya. Neurosurgical review. 37(4). pp.579-583.
Hirai, T. and et.al., 2017. Impact of subintimal plaque modification procedures on health
status after unsuccessful chronic total occlusion angioplasty. Catheterization and
Cardiovascular Interventions.
Sapontis, J. and et.al., 2017. Early procedural and health status outcomes after chronic total
occlusion angioplasty: a report from the OPEN-CTO Registry (Outcomes, Patient
Health Status, and Efficiency in Chronic Total Occlusion Hybrid Procedures). JACC:
Cardiovascular Interventions. 10(15). pp.1523-1534.
Velibey, Y. and et.al., 2017. Off-Hour Primary Percutaneous Coronary Angioplasty Does
Not Affect Contrast-Induced Nephropathy in Patients With ST-Segment Elevation
Myocardial Infarction. Angiology. 68(9). pp.807-815.
Online:

Angioplasty After a Heart Attack: Risks and Benefits 2018, viewed 28th May 2018,
<https://www.healthline.com/health/heart-attack/angioplasty>.
New RN standards for practice released 2016, viewed 28th May,
<http://anmf.org.au/news/entry/new-rn-standards-for-practice-released>.
Heart Disease Treatment With Angioplasty and Stents. 2018. [Online]. Available through
<https://www.webmd.com/heart-disease/guide/treatment-angioplasty-stents>