Nursing care of patient with cardiac disease

Nursing care of patient with cardiac disease
Main concern for the patient
 Bleeding from the angioplasty (femoral and radial)
 Arrhythmia
 Risk of infection
 obstruction of the artery (Clot formation)
 Allergic reactions to dye or nephrotoxicity
 Damage or rupture of blood vessel
 Heart Attack (Chen et al. 2010).
Rationale for the concerns
 Bleeding from the angioplasty site (femoral and radial)
Bleeding from the angioplasty site is the common complication after the procedure. Elderly
people and female are at risk of bleeding after coronary angioplasty. Procedure done on the
femoral artery increase the risk of bleeding as the blood flow in the femoral artery is
increased (Beek, Nijveldt, & van Rossum, 2010 p 49). Bleeding is a common event during
the procedure due to the puncture done in the artery. The major cause of bleeding after the
coronary angioplasty procedure is the chosen site. Physiology of the femoral artery confirms
that the blood flow is prominent. Puncturing the artery for the procedure can cause bleeding
during the event and after the procedure (Lai et al. 2017 p458-461).
 Arrhythmia
Arrhythmia is the complication that is generally associated with all the cardiac procedures.
Causative factor for arrhythmia is a disorder of conduction in the heart (Chen et al. 2010).
The stent is the foreign object that is placed in the blood vessels of heart for the improved
blood circulation. Insertion of the foreign object can disturb the conduction system of the

heart. Disturbed conduction in the heart muscle can lead to arrhythmia. About 1.5 – 4.4% of
the cardiac patients undergo a complication called arrhythmia after coronary angioplasty.
 Risk of infection
Coronary angioplasty is associated with an increased risk of infection. The procedure
involves the insertion of the balloon to widen the narrowed blood vessel. It is also associated
with the placement of a stent for better results. Balloon and stent are the foreign objects that
can introduce micro-organisms in the patient (Bosman et al. 2014 p. 87-99). As the stent is
placed in the artery, newly entered micro-organism can spread and multiply rapidly which
may increase the risk of infection. Coronary angioplasty is an invasive procedure and risk of
infection increases if the Aseptic technique is ignored. Elderly patients are prone to infection
after the procedure.
 Obstruction of the artery
Coronary angioplasty is a combination of two procedures. Insertion of balloon and stent
placement both is applied for some patients. Implementation of stent placement is associated
with the risk of obstruction (Garg et al. 2015 p106-12). The procedure is done in the femoral
artery for the patient. Femoral artery has increased blood flow which may increase the risk of
bleeding and clot formation is common during the procedure. Clot formation can occur in the
stent and block the blood flow. Incidence confirms that the risk of clot formation after the
procedure is 10 -20% when metal stents are used.
 Potential hypersensitivity to dye or nephrotoxicity
Contrast dyes are used in a coronary angioplasty procedure. Hypersensitivity can induce
allergic reactions (Song et al. 2017 p281-285). The dye used in the procedure can generate
various allergic reactions like itching, rashes, chills, and fever. The allergic reactions can
disturb the functions of the heart. Kidneys are the only organ that can eliminate the dye from

the bloodstream. The process of elimination can increase the risk of nephrotoxicity in patients
with renal disease (Marraccini et al. 2010 p1179-1184).
 Damage or rupture of blood vessel
Coronary angioplasty involves the insertion of balloon and stent placement. Balloon insertion
can damage the blood vessels during the process of insertion and inflation (Chen et al. 2012
p. 344-348). Balloon inflation alters the elasticity of the artery and injures the blood vessel.
Stent placement is accompanied by the complication of rupturing the blood vessel which may
lead to a fatal condition. Injury or rupture of the artery can cause severe bleeding.
 Heart Attack
Coronary angioplasty is implemented to prevent heart attack. The incidence confirms that 1%
- 2% of patients have the risk of a heart attack after coronary angioplasty (Lee et al. 2010
p219-229 ). Bleeding and clot formation are the major causative factors for heart attack after
the procedure. The risk of clot formation and heart attack is high in the first few days after the
coronary angioplasty procedure.
Interventions in order of priority
Bleeding from the angioplasty site - Assessment and prevention of bleeding
Assessment is the primary intervention in the prevention of bleeding. The nurse has to do
primary assessment in the site of the procedure for bleeding. The nurse has to monitor the
patient’s vital signs and blood pressure (Beek, Nijveldt, & van Rossum, 2010 p 49).
Observation of signs and symptoms of internal bleeding is the secondary assessment which
needs to be implemented by the nurse. Anti-platelet agents are the medication administered to
prevent clot formation. These medications can cause bleeding and further complications
(Kwok et al. 2015). The nurse has to apply pressure over the insertion site to stop external
bleeding and apply the firm dressing.
Obstruction of the artery – Observation and medication

The Nurse needs to monitor the patient continuously. Primary assessment includes the
observation of vital signs and saturation (Garg et al. 2015 p106-12). The nurse has to do the
secondary assessment by observing the blood pressure, extremities for circulation and
alertness of the patient. Obstruction of the artery is caused by the blood clot. Antiplatelet
drugs are medications commonly administered to prevent clot formation and obstruction.
Damage or rupture of artery – Assessment and Management
Damage or rupture of the artery is the serious complication. The nurse has to monitor the
patient for the signs and symptoms of clinical deterioration. Primary assessment for the
condition includes continuous monitoring of the vital signs and saturation (Chen et al. 2012 p.
344-348). Secondary assessment includes monitoring of blood pressure. Rupture of the artery
is the medical emergency which needs immediate action. Bypass surgery is the surgical
management implemented to treat the patient.
Heart Attack – Observation and pharmacological management
Clot formation and the blockage is the major cause for heart attack after coronary
angioplasty. The primary assessment for the patient includes the continuous monitoring of the
vital signs. The secondary assessment includes assessment for the chest pain, shortness of
breath and blood pressure. The nurse has to check the ECG for the patient periodically.
Obstruction of blood clot can be prevented by administering Anti-platelet medications as
prescribed.
Arrhythmia – Monitoring and medications
Arrhythmia is said to be irregular heart rate associated with tachycardia. Primary assessment
for the patient includes continuous monitoring of heart rate, rhythm, and phase. Secondary
assessment includes the monitoring of ECG. The medications that can be administered for the
patient with arrhythmia include beta-blockers and calcium channel blockers (Chen et al.

2010). Beta-blockers balance the workload of the heart and help in improving the conduction.
Calcium channel blockers help in maintaining the normal heart rate.
Risk of infection – Assessment, Aseptic technique and antibiotics
Risk of infection is common in all invasive medical procedures. Primary assessment includes
monitoring of vital signs. Secondary assessment can be implemented by lab investigations to
rule out the potential causes (Bosman et al. 2014 p. 87-99). The nurse has to follow strict
aseptic technique while caring for the patient. The nurse has to administer the antibiotics as
prescribed by the physician.
Potential hypersensitivity to dye or nephrotoxicity
Allergic reactions are the common adverse effects of the dyes used in the coronary
angioplasty. Primary assessment for the patient includes monitoring of allergic reactions.
Secondary assessment for the patient needs to do by monitoring the signs of toxicity of dye.
The nurse has to administer antihistamines to reduce allergic reactions. Commonly kidneys
are affected by the dyes used in the cardiac procedures (Marraccini et al. 2010 p1179-1184).
Nephrotoxicity can be assessed by continuous monitoring of urine output. Colour, amount
and odour of the urine need to be monitored. IV fluids can be administered as per the doctor’s
advice.
Rationale for the interventions
Bleeding from the angioplasty site - Assessment and prevention of bleeding
Bleeding is the common complication of coronary angioplasty. The cause for bleeding can be
the procedure or Antiplatelet agents. The femoral artery is one of the largest blood vessels
with high blood flow (Beek, Nijveldt, & van Rossum, 2010 p 49). Applying pressure can
reduce bleeding. Continuous monitoring of vital signs and saturation helps in identifying the
increased bleeding and clinical deterioration of the patient. Vital signs and saturation are the
primary indicators of the blood circulation of the body (Ndrepepa et al. 2013 p534-540).

Obstruction of the artery – Observation and medication
Obstruction of the artery occurs due to blood clot. The coronary angioplasty is an invasive
procedure which may induce both internal and external bleeding (Garg et al. 2015 p106-12).
The continuous assessment helps the nurse to address the changes and abnormal findings.
Normal circulation can be confirmed by saturation, blood pressure, warm extremities and
consciousness of the patient. Anti-platelet agents are administered to prevent clot formation.
Platelets are the fundamental unit for coagulation. Controlled platelet count and function can
prevent clot formation and obstruction of the artery.
Damage or rupture of artery – Assessment and Management
Damage or rupture of the artery is the severe clinical condition. Internal damage of blood
vessel is revealed in the vital signs and saturation. Continuous monitoring of breathing, heart
rate, temperature and saturation helps the nurse confirm the internal condition of the patient.
Rupture of the artery can cause severe internal bleeding which exhibited are in breathing,
heart rate and blood pressure (Chen et al. 2012 p. 344-348). Only intervention for the rupture
of an artery in the heart is bypass surgery. Bypass surgery aids in repairing the damaged
artery and helps to bypass the circulation.
Heart Attack – Observation and pharmacological management
Continuous monitoring is the only tool that helps the nurse to confirm the condition of the
patient. The blood clot is the only causative factor for heart block and heart attack. Prevention
of clot formation helps in preventing heart attack. ECG helps to assess the changes in heart
functions (Brilakis et al. 2012 p. 373-389).Anti-platelet agents are administered to prevent
clot formations which are considered to be the major cause for heart attack. Controlled
platelet count and function can prevent clot formation and obstruction of the artery.
Arrhythmia – Monitoring and medications

Altered conduction of heart is Arrhythmia. Disturbance in the conduction can impact the
function of the heart. Regular assessment of the heart rate, rhythm and phase help the nurse to
identify the condition of arrhythmia (Chen et al. 2010). ECG reveals the changes in the
conduction of the heart. Beta-blockers balance the workload of the heart and help in
improving the conduction. Calcium channel blockers help in maintaining the normal heart
rate
Risk of infection – Assessment, Aseptic technique and antibiotics
Coronary angioplasty is an invasive procedure which increases the risk of infection.
Elevation of temperature, respiration and heart rate reveals that patient is at of infection. It
also helps the nurse to plan nursing care for the patient (Bosman et al. 2014 p. 87-99). Blood
and urine investigation aids in identifying the infection. The aseptic technique reduces the
chances of infection. Antibiotics are medications that fight against micro-organism and
prevent further complications (Elieson, Mixon, & Carpenter, 2012 p884–889).
Potential hypersensitivity to dye or nephrotoxicity
Intensity, signs and symptoms of the allergic reactions can be identified by continuous
monitoring. Antihistamines are the drugs that reduce the reactive functions of the system
whereby the allergic reactions are reduced (Mangiacapra et al. 2015 p1179-1184).
Nephrotoxicity can be assessed by continuous monitoring of urine output. Nephrotoxicity
changes the colour, and odour of the urine. Administration of IV fluids helps in removing the
contents of dye from the blood.

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