Nursing Case Study: Assessment Framework for Post-Angioplasty Care

Running head: NURSING CASE STUDY
NURSING CASE STUDY
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Question 1
Taking insights from the case, the correct assessment framework required for nurses to
perform as a part of the post angioplasty care for Mr. Bright, include the following:
1. Assessment of Puncture site for the presence of Wounds: One of key risks of
performing an angioplasty is the emergence of an impairment in tissue perfusion which
may indicate the possibility of an hematoma. Hence the nurse must firstly assess the site
of the wound for any presence of bleeding or oozing (noting that the presence of slight
oozing has already been mentioned in the initial nursing handover). For the presence of
any bleeding, the nurse must ensure marking of the area if possible so as to highlight the
same on the clinical handover (Nakama et al., 2017). Additionally, the nurse must also
assess the puncture site for the presence of any hematoma by assessing the puncture for
detection of swelling, redness and pain. It must be note by the nurse that the presence of
any swelling may be indicative of an internal bleeding due to impaired perfusion
(Albadawy et al., 2018). Additionally, the nurse must also evaluate the site for any
Ecchymosis (purple discoloration) and microbial infection which may be indicated by
pain, redness and heat surrounding the wound area and an alteration in terms of patient’s
vital signs such as rigor, temperature increase and tachychardia (Nakama et al., 2016). In
case of the presence of hematoma the nurse must immediately act to hinder the bleeding
by applying compression, since this applied pressure will result in alleviation of
hematoma by initiating homeostasis. To further stop the progress of hematoma due to
thrombus, the nurse must prevent further intravenous administration of coagulant heparin
and notify the physician or chief medical officer immediately. To further halt any

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aggravation in bleeding, the nurse must apply a pressure bandage until further supervisor
assistance arrives (Honda et al., 2017).
2. Assessment for Thrombus: Considering ischemia to be a key complication after the
performance of any angioplasty, the nurse must check the presence of thrombus – a blood
clot which may prevent blood flow progression and hence initiate ischemic stroke. This
will involve neurovascular assessments in the form of nursing evaluation for the presence
of monitoring the limb for color abnormalities, temperature or warmth, sensation,
strength of pulse and capillary refill time (Angerås et al., 2018). The nurse can detect the
presence of arterial access clot by identifying the presence of paleness, cooling and loss
of pulse and sensation in the insertion site due to lack of essential oxygenated blood
supply from the arteries. Likewise, the presence of a venous access blood clot can be
indicated by nursing detection of swelling, redness, increased pain and delaying in CRT
as a result of pooled blood accumulation (Burke & Atluri, 2019).
3. Vital signs: In addition to the above, the nurse must also perform an assessment of the
vital signs of the patient, which involves evaluation of physiological parameters like
respiratory rate, body temperature, blood pressure, heart rate, pain and oxygen saturation
(Khan et al., 2016).
4. Cardiovascular assessment: Considering that an ischemia due to the conductance of an
angioplasty may be indicated by a thrombus induced changes in heart rhythm, and
echocardiogram (ECG) of the patient must be done to detect the presence of any
arrhythmia (Yeboah et al., 2016).
5. Neuro-observation and Glasgow Coma Scale: The emergence of an ischemia due to
the performance of an angioplasty can result in an ischemic stroke, which, if occurs in the

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cerebral area, can result in the loss of cognitive functioning, orientation and
consciousness (Reith et al., 2016). Hence to assess the state of consciousness and
orientation in Mr. Bright after post angioplasty performance the nurse must conduct a
GCS and Neuro-obs which will involve evaluation of facial symmetry (for presence of
facial paralysis), monitoring of patient pupil rounding, reaction to light, accommodation
and identification of patient’s level of consciousness such as the presence of coma,
lethargy, stupor, obtundation and consciousness (Chou et al., 2017).
6. Assessment of blood glucose level: It is worthwhile to consider that the patient has a
history of diabetes, an assessment of the patient’s blood levels of blood sugar must be
conducted since high blood sugar levels can result in hypertension, increased endothelial
adiposity, atherosclerosis and the resultant emergence of plaque formation, ischemia and
stroke (Sarrafzadegan et al., 2017).
Taking insights from the case study, it can be observed that the above assessments had
been conducted as evident in the provided handover mentioning that Mr. Bright’s puncture site
had no presence of oozing, bleeding and hematoma, his vital signs, state of orientation and
consciousness in normal, and ECG has been provided and his diabetes has been kept under
control. However, it must be noted that a number of assessments are still requited to be
conducted as per the patient’s health condition, which have been outlined below:
1. Assessment of Medical history: The nurse must conduct a thorough patient centered
assessment of the medical history of the patient as per Standard 1 of the Nursing and
Midwifery Boars of Australia (2019) and evaluate the age and gender of the patient, as
well as the presence of any past medicine usage, treatment adherence and detrimental
lifestyle or disease conditions. Taking insights from the case, it must be noted that the