Mr. Harry Bright Case Study

This case study focuses on the health condition of Mr. Harry Bright, who underwent angioplasty and experienced severe chest pain. The study discusses the assessment of his condition, including vital signs, ECG, and renal assessment. It also highlights the importance of handover tools and the management of his health conditions for faster recovery.

Running head: MR. HARRY BRIGHT CASE STUDY
Name of the Student
Name of the University
Author Note

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MR. HARRY BRIGHT CASE STUDY
Question 1:
The case study represents the severe chest pain of harry bright who was recently
undergone angioplasty. He was admitted in the hospital at 6:00 in the morning under the
supervision of Mr. Black. He was admitted in the emergency ward because of severe chest pain.
During the vital sign assessments his pulse rate was 90 and respiratory rate was 18. His blood
pressure was 150 /90 when he was monitored for vital signs which further unindicated he had
hypertension which is high blood pressure. He had unstable angina which is frequent and he had
40% of occlusion when he was administrated with coronary artery injections. When he was
monitored for cardiac condition during the stent placement, the condition indicated myocardial
ischemia. In the current scenario, it is priority of nurses to assess the health condition of the Mr.
Bright in order to provide accurate post-surgical care. The nurses are required to assess the
health condition of a patient so that the patient receives accurate and safe care. According to
NMBA standard of nursing, the standard 4 highlighted that a registered nurse is required to
conduct a comprehensive and systematic assessment in order engage patient in the
comprehensive care procedure. In the current context, after angioplasty patient chest x-ray was
performed in order to assess the chest pain. The common problem associated with the
angioplasty is a hematoma which can be detected through the chest ECG for cardiac assessment.
As discussed by Kuno et al. Manos, et al. (2018), diagnosis of hemorrhage is very difficult to
detect. Therefore, ECG can be a good assessment which provides the idea of heart rhythm. The
researchers showed the effect of ECG on patient through a case study of an old man who
undergone angioplasty. This case emphasizes the clinical importance of recognizing the
electrocardiographic pattern of left septal. Although ECG cannot directly detect the internal
bleeding but indirectly give the indication of heart rate. In the current context, if internal

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MR. HARRY BRIGHT CASE STUDY
bleeding is observed in the patient after angioplasty, ECG shows the electrical graph of
abnormal heart rhyme. ECG records the electrical activity generated by heart depolarization
which propagates in pulsating electrical waves through the skin. Therefore, if blood vessels are
damaged during angioplasty, it will affect the heart muscles since injured heart muscle failed to
conduct electrical impulses normally, then it can be detected indirectly through ECG. Therefore,
although ECG failed to provide the direct result of hematoma it can provide the idea of
hematoma by through abnormal electro gram. Hwoever, paper also highlighted several
challenges regarding the ECG through the case study. Vital assessments were also performed by
nurses in order to see the health condition of the patient.
In the current context, angiography was not performed in order to see the internal
hematoma. In the current context, the assessment would be renal assessment which would
provide the idea of internal bleeding. After internal bleeding, hematuria can be observed in
patient. If heart failed to supply blood to the kidney, shortages of blood give rise to the kidney
injury. It would be difficult for kidney to keep the accurate fluid balance of inside the body. A
study conducted by Caspi et al. (2017), and they conducted study with 2025 patients with ST-
segment elevation of myocardial infarction who underwent pPCI as well as 1025 patients
receiving fibrinolysis or no reperfusion was observed for the patients who were not exposed to
contrast material during the first 72 hours of hospital stay. The purpose of the researchers is to
evaluate acute kidney injury after primary angioplasty is observed or not. The result suggested
that the development of acute kidney injury in patient with myocardia infraction is mainly
depending on the age of the patient, heart failure and base line estimated glomerular infiltration
rate. Therefore, in order to gain the understanding of the internal bleeding of the patient after
angioplasty, it is crucial to check the glomerular infiltration which would further provide the

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concise idea of renal functioning. The glomerular functioning can be measured by measuring
creatinine clearance as well as timed urine collection. The nurses are required to gain the skills to
measure the filtration rate which would further help to design the accurate interventions for the
patient and support the patient in faster recovery.
Question 2:
Handover tool Script
I  A 67 years old man , Mr. Harry bright
 Admitted in the hospital at 6:00 in the morning under the
supervision of Mr. Black
 Admitted in the emergency ward because of severe chest pain
 Address: 2, park st. Ashgroove
S Mr. Brown recently undergone angioplasty which is associted with
ischemic stroke
 I examined personally Mr. bright when he arrived at the post
anesthesia care unit ( PACU) because of his chest pain. I
engaged him into the therapeutic communication in order to
gain the understanding of his health conditions, especially
severity of his chest pain.
 After examination it was observed that he had 40% of
occlusion when he was administrated with coronary artery
injections. The catheter was placed in the coronary artery.
He was presented in the ward and in the right coronary artery

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MR. HARRY BRIGHT CASE STUDY
he had angioplasty where the drug eluting stent was placed into
the femoral artery which was quite difficult procedure. The
sheath was removed from the femoral artery after the
procedure.
 Prior to this process, a 2.25× 12 nm voyage balloon was
inflated into the place prior to the stent placement. 10% of the
residual stenosis was observed for the patient
 When he was monitored for cardiac condition during the stent
placement, the condition indicated myocardial ischemia.
 When it was handover from the cath lab to the doctor, he said
he had some difficulty during monitoring.
 The medical observer immediately contacted the health
professionals when he was complaining about his serve chest
pain which made him uncomfortable.
B The key issue: impaired tissue perfusion related to hematoma
formation or bleeding.
 He was suffering from hypertension for 10 years
 He had unstable angina which is frequent
 He is currently a chain smoker and smokes 20 cigarette on
the daily basis.

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MR. HARRY BRIGHT CASE STUDY
 His allergies status was not known
 He had well controlled diabetes mellitus type II which was
controlled by oral glycemic. His Bls status was 12.3 mmol/L.
 Apart from diabetes mellitus, he also had
hypercholesterolemia
The medication he was provided with :
 Aspirin 300mg daily
 Metropolo 50mg bd
 Metformin 500 mg bd
 Simvastatin 20mg daily
A  Mr.bright was 100kg with the height of 170 centimeter
 During the vital sign assessments his pulse rate was 90 and
respiratory rate was 18
 His blood pressure was 150 /90 when he was monitored for
vital signs which further unindicated he had hypertension
which is high blood pressure
 During assessment no oozing from wound was observed during
assessment procedure
 His oxygen saturation was 98% which further highlighted

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MR. HARRY BRIGHT CASE STUDY
normal level
 No radiation was detected in further detailed assessment
procedure which is chest radiograph
 After assessment of the chest pain, central chest pain was
observed for the patient and the pain score was 6 out 10 on 1 to
10 scale of pain assessment, which was further indicating
moderate pain status and immediate action was required to
take
 After contacting the medical observer , medical observer
administrated nitroglycerin spray to him sublingually in order
to resolve the chest pain which resolved his pain issues and he
became less tearful about it
 In order to see his neurological functioning, his Central
nervous system assessment was done by the health
professionals.
 In order to examine his functionality of arteries, his chest air
entry was assessed by health professionals.
 Electrocardiography was done in order to evaluate the
electrical activity of his heart’s rhythm. After assessment , no
chest pain was observed for the patient

R  Considering his health condition the first priority would be
management of health conditions in order to promote the

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MR. HARRY BRIGHT CASE STUDY
wellbeing and faster recovery
 After admission in the post anesthesia care unit ( PACU) it is
required to evaluate the signs and symptoms of ischemic
stroke
 Assessment of ECG is required for patient in order to examine
the normal functionality of heart
 It is required to notify and assess continuously if the patient
was suffering from chest pain
 It is recommended to document all episode of chest pain he
will experience. This would be assessed later to see the health
conditions.
 He was required to provide the care after his surgery according
to PTC pathway so that he can live a normal life.
 It is required to collaborate with the multidisciplinary team in
order to evaluate his other needs in order to evaluate other
health problems.
 It is required evaluate his emotional and psychological needs in
order to provide him care so that he can live best possible lives.

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MR. HARRY BRIGHT CASE STUDY
References:
Caspi, O., Habib, M., Cohen, Y., Kerner, A., Roguin, A., Abergel, E., ... & Aronson, D. (2017).
Acute kidney injury after primary angioplasty: is contrast‐induced nephropathy the
culprit?. Journal of the American Heart Association, 6(6), e005715.
Manos, E. J., Marchetti, G. E., Seleme, M. M., Iravedra, J., Bodoira, M. M., Caldiroli, S., ... &
Pocovi, A. (2018). CRT-16 Correlation Between Myocardial Perfusion Grade And St
Segment Among Patients With Normal Coronary Epicardial Flow After Primary
Angioplasty In Acute Myocardial Infarction. JACC: Cardiovascular Interventions, 6(2
Supplement), S6.