Nursing Care for a Post-PCI Patient

Running head: NURSING CARE IN POST-PCI PATIENTS 1
Nursing care for a Post-PCI Patient
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NURSING CARE IN POST-PCI PATIENTS 2
Nursing Care of a Post-PCI Patient
Introduction
The cardiovascular patient requiring nursing intervention is Mr. Philemon Jones. Mr.
Jones is a 74-year-old African-American man who came to the hospital 16 hours ago with
complaints of recurrent chest pain. The patient described the pain as squeezing and was located
in the center of the chest. The pain radiated to the left jaw and the left arm. He also stated that he
had had this pain several times before; the pain came after he engaged in strenuous activities like
gardening and was relieved when he took a rest. However, on this particular occasion, the pain
seemed to get worse even when he decided to rest. Lysing supine made the pain worse and
caused him to become breathless. He had used two sublingual tablets that his family doctor
prescribed to him but the pain had not subsided. He then took several tablets of aspirin before
calling his daughter who called the ambulance. Of significance, Mr. Jones is a known
hypertensive patient for the last 11 years on nifedipine. Mr. Jones also underwent an operation to
evacuate a left parietal subdural hematoma three years ago. The medical team saw the patient
immediately and made a diagnosis of an acute coronary syndrome. An Electrocardiogram (EKG)
done at admission ruled out myocardial infarction. A cardiac enzyme profile also emphasized
this finding. An echocardiogram conducted later showed hypertensive heart disease as evidenced
by left ventricular hypertrophy. The medical team thus determined that the patient had unstable
angina despite treatment with nifedipine, albeit for a different diagnosis altogether. They, thus,
decided to intervene. The medical team first arranged for a coronary angiography to detect any
narrowed segments in the coronary arteries; they determined partial occlusion of the circumflex
branch of the left coronary artery. They prepared for a percutaneous balloon coronary
angioplasty. In the operation, they used the left femoral artery to catheterize the patient. They

NURSING CARE IN POST-PCI PATIENTS 3
then threaded the catheter to the site of the atherosclerotic plaque and used a balloon to expand it.
They then removed the catheter but left the sheath in place to prevent bleeding. In the operation,
they administered intravenous heparin and clopidogrel (Jneid et al., 2012). They then prescribed
morphine for pain and clopidogrel to prevent restenosis (Genereux et al., 2015). The patient was
to continue with their nifedipine.
Nursing Care
The goal of nursing care in a patient who has undergone PCI is to ensure that the patient
recuperates well and that the problem does not recur (Swearingen, 2016). To do this, the nurse
works with several objectives in mind. These objectives include careful tracking of the patient’s
vital signs; optimum control of pain; continuous EKG monitoring on the patient; early
identification of the complications of the procedure; and prevention and early identification of
restenosis (Hamon et al., 2013).
Immediately after the operation, the patient is in the acute phase of rehabilitation and will
need to be in the intensive care unit (ICU). On arrival at the patient, the first step of nursing care
and management is assessment. The assessment has two steps: history taking and physical
examination. In the history, the nurse should look to identify the patient correctly. Also, the
nurse will identify the access site that the medical team used for the Percutaneous Coronary
Intervention (PCI). Also, like in the case of Mr. Jones, the nurse should look to find out the
dosage of anticoagulants that the patient is to receive and whether anticoagulants were
administered during the procedure. Also, the nurse collaborates with the medical team and uses
the patient’s records to find out the intraoperative findings, if any complications occurred during
the procedure, and how these complications were managed (Naidu et al., 2012). Also, through

NURSING CARE IN POST-PCI PATIENTS 4
interaction with the medical team and the patient’s records, the nurse determines any other
medications given to the patient or those that have been ordered and their dosages.
While conducting a physical examination on Mr. Jones, the nurse will focus on the
femoral puncture site. Here, the nurse will be looking for any signs of bleeding like oozing
blood, hematoma formation or adjacent ecchymosis (Mert et al., 2012). Also, the nurse will
assess the puncture site for evidence of infection. In case the nurse will identify any of these
puncture complications, it is their duty to report to the medical team promptly and discuss with
the medical team the best interventions for dealing with the complication. However, in case of
frank bleeding, the nurse will attempt to achieve hemostasis by compressing the bleeding site
and stopping the clopidogrel infusion until the physicians can review the patient (Genereux et al.,
2015). It is also important for the nurse to assess a hematoma further in case they find one; this
assessment will entail auscultating it for arterial bruits to differentiate it from a possible
pseudoaneurysm (Hamon et al., 2013). By the time of the initial assessment, Mr. Jones had a
sheath in situ and did not have any bleeding or hematoma at the puncture site. There was also no
evidence of infection or inflammation at the site. The nurse should assess the puncture site every
30 minutes for the first four hours after the procedure and then hourly for the next few hours.
Next, the nursing assessment focuses on a systemic approach. This examination attempts
to determine the general state of the patient and if there are any systemic complications. The
most important part of this examination is the determination of vital signs. Immediately after the
PCI procedure, it is important to take the blood pressure, pulse rate, and respiratory rate of the
patient every 30 minutes and the temperature every four hours (Mert et al., 2012). Also important
is to assess the SpO2 of the patient and their pain quotient every four hours.