NSB231 Integrated Nursing Practice 2: Assessment Report on Mr. Bright

This report presents a comprehensive nursing assessment of Mr. Bright, a patient who underwent an angioplasty and subsequently experienced chest pain. The assessment delves into the potential causes of his symptoms, including reactions to the eluting stent, myocardial ischemia, and other possible complications. The report emphasizes the importance of thorough patient screening to determine the root cause of the chest pain, monitoring vital signs, and assessing for potential bleeding or hematoma. It incorporates the ISBAR framework to outline the patient's situation, background, assessment, and recommendations. Furthermore, the report highlights the significance of considering the patient's history of hypertension and smoking, which could contribute to his condition. The report also provides recommendations for further investigation, including chest examinations and monitoring for myocardial ischemia and potential hemorrhaging. This report is designed to provide a detailed overview of patient care, assessment techniques, and effective communication strategies in a post-angioplasty scenario.

NURSING ASSIGNMENT 1
Nursing Assignment
Student Name
Institutional Affiliation
Date
Author’s Note

NURSING ASSIGNMENT 2
Nursing Assignment
Question 1
Mr. Bright is a patient who is at a local hospital. The patient has recently undergone an
angioplasty and the wound is healing well. However, during the recovery stay at hospital he
developed chest pain. An assessment was conducted and the nurses at the facility implemented a
nursing assessment to help manage the chest pain. Some of the assessment were done
appropriately however, there are other assessment which can be included.
The patient underwent an angioplasty on his right coronary artery. The main reason for the
angioplasty was to unclog a clogged artery. Angioplasty has proven to be successful in treating
heart complications such as weak heart muscles or a narrow aorta. It is also recommended for
patients who suffer from diabetes and have had serve blockages in their arteries. In MR Bright’s
case. The patient has had a history of hypertension which has been treated with medication.
However, increased chest pains triggered the by the hypertension resulted in the patient
undergoing surgery (Sapontis et al., 2017)
The patient was had an eluting stent which was inserted. During cardiac monitoring, it was
observed that there was 10% residual stenosis at the site of placement (José et al., 2017). In
addition, there was myocardial ischemia. The surgeon commented that there were some
complications arising during the procedure with the patient. It is possible that the patient is
having a reaction to the eluting stent or the stent has failed resulting in chest pains. There could
also be another underlying complication for example heart failure, or a clot may have occurred in
one of the major blood vessels. It is also possible that there could be a hemorrhage occurring due
to blood vessels rupturing. The doctor in charge ordered that the pain to be resolved and no

NURSING ASSIGNMENT 3
further treatment to be conducted. Resolving the pain help the patient to become more
comfortable, however the underlying problem was not resolved. The patient still had myocardial
ischemia and it was not clear what had triggered the chest pain (Hiremath et al., 2019)
In the assessment, it is recommended that the MO should have scheduled an appointment with
the patient. The patient should have been screened to determine the root cause of the chest pain.
The surgical procedure that was done should have been confirmed if the stent was in the right
place and that the wound was healing properly. A screening would also determine if there are
any ruptured blood vessels and if there is bleeding in the blood vessels (Key, Neelakantan, Jain,
Diaz, & Lorbeer, 2019).
It is also recommended that during the assessment the patients’ pressure level should be
monitored. the patient has had a history of hypertension which is managed using medication.
However, screening should eb done to rule out any underlying issue caused by hypertension.
Also, assessment should be done to continue monitoring the myocardial ischemia (Hirai et al.,
2018).
The patient has also been a smoker. He smokes about 20 cigarettes in a day. It is possible that the
chest pain experienced by the patient could be as a result of an issue in the lungs. Smoking
affects the health of individuals especially elderly (Tarighatnia, Alian, Ghojazadeh, &
Farajollahi, 2016). Mr. Bright is 67 years and it is not clear how long he has been smoking. It is
possible that the smoke could have damaged one of the lungs casing a lung infection which could
trigger the chest pain among other symptoms. In addition, lung failure often results in death. It is
recommended that the patient assessment should include a chest examination to rule out possible
complications caused by smoking (Salisbury et al., 2019)

NURSING ASSIGNMENT 4
Question 2 -ISBAR
Introduction
Hello. This is John smith from QUT surgical ward looking after Mr. Harry Bright who is
currently in bed 4
Situation
- The patient is currently suffering from chest pain
- The patient is also experiencing shortness of breath and ischemia
- He has recently undergone angioplasty surgery
- The patient was inserted an eluting stent
- The patient had a sheath removed during recovery and there has been very little bleeding
or oozing.
- However, the chest pain is getting worse
- The patient was administered nitroglycerin spray sublingually to help to resolve the pain.
- The patient also has myocardial ischemia
Background
- The patient has had a history of hypertension
- The patient has been managing the hypertension using medication and this has been very
effective
- The patient is also a smoker. He smokes 20 cigarettes in a day
- The patient recently had an angioplasty at the same hospital. An eluting stent was
inserted into his coronary artery

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- There was 10% residual stenosis at the site of infection
- The sheath was removed during recovery and there has been minimal wound oozing or
bruising
Assessment
- The patient as administer nitroglycerin spray sublingually to help ease the symptoms of
the pain
- The patent is being monitored for myocardial ischemia
- The MO ordered that no further treatment should be done to the patient after resolving
the pain
Recommendation
- It is recommended that the patient should be monitored closely for myocardial ischemia
- The patient should also be monitored for hemorrhaging due to ruptured blood vessels
(Patel et al., 2017)
- The patient blood pressure should also be monitored to ensure that it is within a safe
range (Tzanis, Tsetis, Kehagias, Ioannou, & Damilakis, 2019).
- It is also recommended that the eluting stent should be observed to determine if there are
any complications and to confirm that it is in the right position
- Another recommendation is that the patient should be have a chest x ray to screen his
lungs. The patient ais a smoker and it’s possible that the chest pain could be from a lung
problem (Deokar, & Klamecki, 2017).
- Another recommendation is to continue resolving the pain using nitroglycerin spray until
the pain is controlled.

NURSING ASSIGNMENT 6

NURSING ASSIGNMENT 7
References
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damage analysis of angioplasty and orbital atherectomy interventional
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R. M. (2018). Impact of subintimal plaque modification procedures on health status after
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Hiremath, G., Qureshi, A. M., Prieto, L. R., Nagaraju, L., Moore, P., Bergersen, L., ... &
Meadows, J. (2019). Balloon Angioplasty and Stenting for Unilateral Branch Pulmonary
Artery Stenosis Improve Exertional Performance. JACC: Cardiovascular
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José, M., Brugaletta, S., Hospital, J. A. G., Baz, J. A., de Prado, A. P., Palop, R. L., ... & Díaz, J.
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Key, P., Neelakantan, M., Jain, K. M., Diaz, M., & Lorbeer, E. (2019). Questioning The Validity
Of Published Data On Percutaneous Transluminal Angioplasty As A Benchmark For
Infrainguinal Endovascular Procedures.
Patel, A. S., Griessenauer, C. J., Gupta, R., Adeeb, N., Foreman, P. M., Shallwani, H., ... &
Thomas, A. J. (2017). Safety and Efficacy of Noncompliant Balloon Angioplasty for the