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