Nursing Assignment: Patient Undergoing Non-Cardiac Surgery after Coronary Stent Implantation

Surname
Nursing Assignment
By Student’s Name
Nursing Assignment
Code and Course Name
Professor's name
University Name
City, state
Date
1

Surname
This paper describes the case of a patient who underwent non-cardiac surgery after
coronary stent implantation. It includes the health history of the patient of non-cardiac surgery
which is the basis used to determine the establishment of surgery to the patient. The paper will
also outline the analysis of the patient’s surgical journey starting from the admission in the
hospital, preparation for the operation, operation suite (the preoperative phase) and the surgery
(intraoperative phase). The paper will also give brief descriptions of the care measures of the
patient who underwent non-cardiac surgery procedures and the necessary precautions. The paper
will also discuss the significant safety routines. Since inputs of a team always perform the
surgery, the paper will outline the role of the team is working, the issues which arise during the
actual surgical operation and issues which may have to arise during any time of the period of the
surgical operation. The paper will be presented following the school of Nursing Presentation of
Assignments guidelines, using UTAS Harvard Style referencing, page numbers (in the footer),
and student name (in the header).
Good preoperative care for the patient for the surgery improved the confidence by
minimizing the anxiety. This experience is encouraged in all the surgery cases to improve on
outcome possibilities and thus boost recovery. Anxiety could negatively contribute to the
outcome of an operation. Some of the factors which contribute towards anxiety include; aesthetic
(Devereaux et al., 2014. pp.1504), the procedure to be used in operation and the fear of the
adverse outcomes of surgery. The medics involved in non-cardiac surgery were able to identify
the anxiety signs such as aggression, seeking constant attention, raised vital signs and heightened
senses. Moreover, a therapist helped the patient get ready for the surgery.
2

Surname
The pre-admission assessment was led by a nurse where the surgery patient attended a
pre-admission clinic. The medical history of non-cardiac surgery was critically assessed. It
involved all the tests which were based on the national institute of health and clinical excellence.
The patient was given a chance to visit the ward to reduce any form of discomfort
(Dexter&Epstein, 2015. pp.1469).The non-cardiac surgery patient was fully informed about the
operation procedure, the way of discharge and recovery. The careful preparation ensured that the
patient arrived in the operation department ready for surgery. Nutrition and hydration be taken
care of by the nurse by ensuring that the patient has comfort and hydration (Nicolini et al., 2014,
n. pp). This meant enabling the patient to access food and drinks when it was possible.
The patient cardiac surgery patient had exertional angina for one month. To address the
case, aspirin and ticagrelor in dual antiplatelet therapy. Stenosis of about 80% of the proximal
LAD was revealed by coronary angiography. It followed that a DES being successfully inserted
in the LAD (Kurmann et al., 2014, pp.3047). After one day, the patient was noted to be passing
reddish brown stools where the stool occult blood was positive. After weighing the risk of stent
thrombosis, and bleeding, consultants found it wise to withdraw aspirin but to continue
administering the ticagrelor.
A CT scan was done which revealed a mass in the hepatic flexure of the colon. This
suggested that biopsy and colonoscopy were required for further diagnosis. To reduce the risk of
bleeding, the gastrointestinal consultants suggested that all antiplatelet agents be stooped for
three days. This period was before colonoscopy (Kurmann et al., 2014, pp.3047). It was specially
meant to reduce the perioperative risk of bleeding. Tirofiban infusion was then administered to
bridge the therapy which was a few hours before the colposcopy.
3

Surname
Biopsy and colonoscopy were performed successfully with less blood loss. The processes
of histology and colonoscopy were used to confirm a differentiated adenocarcinoma at the
hepatic flexure of the colon. Ticagrelor and aspirin therapy was resumed some 24 hours after
colonoscopy. After consulting cardiologist, anaesthesiologist and surgeon the surgical resection
was planned (Devereaux et al., 2014. pp.1506). Notably, during the perioperative period, aspirin
was continued. However, ticagrelor was stopped some five days before the surgery. It was meant
to give way for Tirofiban to effect bridging therapy. It was after this when the right
hemicolectomy was performed successfully. In this instance, the only 100ml of blood was lost
during the operation.
It was 48 hours after the operation when the patient was given clopidogrel. The patient
was then discharged five days later. For postoperative care, the patient should be guided with
post-operative notes and orders. The guidelines should have a comprehensive description of vital
signs, any pain which could be associated with the area of operation, evaluating the rate and type
of intravenous fluid, assessing the urine and gastrointestinal fluid output, constant medication
and laboratory investigations.
After any operation, a patient is prone to many complications. It is however possible to
prevent the complications by engaging the patient in a routine of continuous and daily exercise,
joint range motion, coughing and breathing deeply, using walking aids and walkers, advising and
ensuring an adequate nutrition, adopting measures to prevent skin breakdowns and sores brought
about by pressure and prescribing a perfect pain control measure.
A discharge note given to the patient as he leaves the war should have; the diagnosis and
instruction on further management, a list of all the prescribed drugs and details of any necessary
follow up detailed with appointments. The postoperative management is also critical and should
4