(solved) Case Study of Mrs Green

Added on - 04 Oct 2020

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CRITICAL ANALYSIS ON MRS. GREENINTRODUCTIONPresent study is based on case study of Mrs Green. Current project will discussproblem within the lady. This will focus on first 8 hours post coronary angioplasty. It willdiscuss application of nursing practices.Report will discuss aspects of anatomy andphysiology, 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. Itwill 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 PROBLEMPotential problems that could occur in first 8 hours of post coronary angioplastyThough angiography is the safe process but sometimes, it may create issues in thepatient(Gross, Thomas and Frerichs, 2014).As Mrs Green was 78year old lady, this processcan cause potential problem of kidney damage because people those who are gone throughangiography can face issue of kidney damage. It is likely issue for Mrs. Green.This is seriouscomplication of angiography process (Bukala, Kwiatkowski and Malachowski, 2016). If thisoperation gets failed because of old age of the patient, then it may impact negative on kidneyof the person. As doctors works to illuminate the arteries and blood vessels but this can causekidney damage.As in the case of Mrs. Green she is old and in this age individual's kidneyfails to perform work well. If in this age she takes treatment of Angioplasty then kidneydamage is major risk that might cause within her. It is generally taken place in person thosewho have pre-existing kidney problems. As Mrs. Green was smoker in past and smokingaffect negatively on kidney of individual. That is why there are high chances that she mightface this risk. Many doctors have skimmed that angioplasty can be risky after 50 year theyhave mentioned possibility of occurring kidney damage or failure. That might be potentialproblem in Mrs. Green.Actual caseElizabeth Rose Green is 78-year old lady. While working in the kitchen, she hasexperienced 10 minutes of unrelieved central chest pain. She was admitted to hospital fordiagnosis. Past medical history of the lady reflect that she was former smoker and is suffering
fromGastro-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 livingalone. Due to her medical condition, she is unable to drive thus, she prefers to use taxi forgoing to other places. From the entire study, it is found that Mrs Green is suffering fromblockage in her left anterior descending artery. It has been diagnosed by using femoral arteryapproach. Apart from this, it has been identified that she had 10-20% occlusion. She has beenshifted to Cardiac care ward at 1250. Medical staff members have stated that Mrs Green hasunremarkable recovery post procedure. On arrival in the cardio care ward at 1250, she hasbeen observed: 145/90HR beats per minute BP. RP is 24 per minute, her temperature is 35.8CSpO2. 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 pedalpulse rates are present in her body. Medical professionals have performed Doppler ultrasoundon left foot and they have found that blood flow in feet are adequate, but they have sent MrsGreen for neurovascular observations for next two hours for monitoring changes within herbody (Bashar and et.al., 2014). Due to pale and cool foot, Mrs Green had to attendcardiologist 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 movementsare normal.Rational of choosing the problem and implicationsAn angioplasty is the surgery in which doctors open blood vessels so that bloodsupply 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 injurekidneys (Velibey and et.al, 2017).As Mrs Green is 78-year old lady and she had a pasthistory of smoking. Such type of patients can face this potential problem within 8 hours ofpost coronary angioplasty.Doctors are specialists in performing angioplasty. They provide appropriate medicinesso that pain of the patient can be minimized, and individual can get relaxed (Chakraborty andet.al., 2015). Medical professionals take x-ray so that actual picture of this process can bemonitor at the same time. Once catheter tube has been inserted then practitioners injectcontrast dye in order to highlight blockages. They have detected blockage then doctors usepercutaneous coronary intervention so that blood flow can be improved in the person (HeartDisease Treatment With Angioplasty and Stents,2018).
After completing angioplasty RN has to remove catheter and they use closures devicefor 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 bloodpressure of patient.This observation helps doctors in stopping bleeding from hole where theyhave 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 whycomplication of kidney damage may get arise.Pharmacology process in the angioplasty isvery complicated because RN has to look at the medical condition and accordingly they haveto provide medicines during process. Aspirin is small dose and other anti-platelet are beingprovided to patients. Intracoronary streptokinase infusion while operating person can preventpatient from infarctions. At that time, glucose and oxygen are given through mask so thatcondition of the person can be controlled during surgery. Furthermore, aspirin like drugs aregiven to the patient (New RN standards for practice released,2016). All this process needs tobe implemented in an appropriate manner so that overall condition of the person can beimproved soon.APPLICATION OF NURSING PRACTICEPatient plan of carePeople who are going through angioplasty can face huge complications. In suchcondition, it is very important for the practitioners to observe their medical situations time totime and provide them proper care so that their health condition can be improved soon. As inthe case study of Mrs Green, it is found that doctors have provided angioplasty. She is oldlady 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 damageissue due to this surgery. This occurs due to contrast media that are used by medicalprofessionals in order to improve blood flow in the human body. Mrs Green has beendiagnosed with blood blockage. People those who suffer from blood clotting issues they mayface allergy to contrast media. Due to use of iodine in process candidates may face issuewhich 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-ionictoxics that do not cause side effects in the human body. As Mrs Green needs to get non-ioniccontrast media so that problem of kidney damage can be avoided properly. Duringangioplasty, doctors have to check their movement through x-rays so that actual impact of thesurgery can be identified during the procedure. This can help medical professional in
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