NURSURGICAL Case Study: Mr. Bright's Angioplasty Complications

This case study focuses on Mr. Harry Bright, a 67-year-old male who underwent angioplasty for a right coronary artery issue. The assignment delves into the potential complications of the procedure, particularly ischemic stroke, and the necessary nursing interventions. It highlights the importance of patient assessment, including vital signs monitoring, blood pressure management, and neurological evaluations. The case study also emphasizes the use of the ISBAR framework for effective communication among healthcare professionals. The provided solution addresses the assessment of Mr. Bright's condition, the identification of risk factors such as hypertension and smoking, and the recommended treatments, including medication administration and continuous monitoring. The assignment also explores the importance of considering differential diagnoses and preventing peri-procedural stroke. Overall, the case study provides a comprehensive analysis of the nursing care required for a patient experiencing complications after a percutaneous coronary intervention.

win-7
[COMPANY NAME] [Company address]
PERCUTANEOUS CORONARY
INTERVENTION

NURSURGICAL CASE STUDY 1
Contents
QUESTION 1.................................................................................................................................................2
QUESTION 2.................................................................................................................................................5

NURSURGICAL CASE STUDY 2
QUESTION 1
ANSWER 1
Medical complications post-surgery is not common or mandatory, however cannot be ruled out
in cases of complex surgery. Cardiac catheterization is such a process that results in some severe
complications (Carlson, & Fitzsimmons, 2019). Cardiac catheterization or angioplasty is a
process where a stent is placed in an artery to open the block and allow free flow of blood. In the
present case, the client underwent angioplasty and pre-surgery evaluation shows angina pain.
Angina pain is not indicative of acute myocardial infarction or stroke, however they can be the
risk factors or manifestations of a MI. Research shows, the chances of ischemic stroke increases
post cardiac catheterisation that includes placing of advance catheter wires in aorta through
transfemoral or transradial pathway (Dalal, Dalal, H. Voukalis, & Gandhi,, 2017). During the
placing of catheter, dislodging of debris can occur that is made up of thrombus. The other
particles that might get dislodged includes calcific material, artherosclerotic plaques, cholesterol
particles that are present in proximal carotid, aortic arch or vertebral arteries. Fresh formation of
thrombus at the catheter has been reported too. The majority of ischemic stroke post angioplasty
or stenting is due to thromboemboli (Dunkley, Siefers, & Tagney,, 2016). Thus, it is important to
assess Mr. bright for ischemic stroke post angioplasty.
Age is a risk factor for stroke post cardiac catheterisation. Retrospective studies shows older
adults ( more than eighty years of age) are more likely to have stroke post catheterisation if the
risk factors of cardiac disease and vascular disease is high. In the present case, Hary is 67 year
old which doesn’t place him in this category. But he smokes 20 cigarettes per day that

NURSURGICAL CASE STUDY 3
significantly increases the cardio-vascular disease. Therefore, the risk of stroke must not
neglected in the present case and proper precautionary or interventional approach to be taken
(O’Gallagher, Byrne, & MacCarthy,, 2018). The second assessment should be any previous
medical condition that increases the chances of stroke. Literature shows hypertension, diabetes,
renal insufficiency increases the chances of stroke. Therefore, the patient’s blood pressure must
be regularly monitored along with salt intake restrictions, the medications for blood pressure
must be administered in time (Head et al., 2018). The chances of stroke in present case increases
as he has hypertension too. The blood sugar level need to be evaluated in the present case, as it is
a risk factor for the current issue (Khalid et al., 2018).
The type of catheter used and stenting itself can be a risk factor for ischemic stroke. In the
present case, Hary has already been into such issue where the procedure was called off by MO.
Therefore, haemodynamic instability and cardiac output must be measured to rule out the
chances of stroke. In case it occurs, it will worsen tissue perfusion and cardiac embolism.
Thrombus formation at tips of catheter can also lead to stroke. Stroke occurrence due to cardiac
catheterisation warrants proper evaluation of associated co-morbidities, flushing of catheter,
minimally displacing the catheter, and use of minimal contrast. In case, the stroke occurs,
thrombolytic agents must be used (Levine et al., 2013).
In the presented case, the nurses have carried out all necessary evaluations and sheath removal.
But the issue that remains unaddressed is blood pressure. Blood pressure can lead to stroke issues
in case of patients undergoing angioplasty. The vital sign measurements including oxygen
assessment must be done, while addressing Mr. Bright’s post-surgical complications. To prevent
peri-procedural stroke, the reversible causes or differential diagnosis must be applied.
Hypoglycemia, migraine attacks, seizure and encephalopathy must be ruled in this case.

NURSURGICAL CASE STUDY 4
Secondly, the drugs and analgesics provided to him during the procedure might lead to
respiratory depression. Therefore, assessment of respiratory depression must have been done to
find out the real cause of stroke (Lima, de Carvalho Queluci, & Brandão,, 2019).
Therefore, ischemic stroke is a major issue post catheterisation that requires proper assessment of
root cause and nursing intervention to prevent the complication.
QUESTION 2
Introduction (I)
Hello doctor. Myself Miss Sarita registered nurse stationed at post-operative ward currently.
Currently, I am looking after Mr. Harry bright 67 year old male who has been admitted to the
ward post angioplasty. He seems to have developed ischemic stroke post angioplasty.
SITUATION (S)
The patient was admitted to the post-surgical ward after angioplasty. Due to an unstable angina,
Mr. Bright will be under routine observation.
BACKGROUND
From the initial ( pre-angioplasty clinical visit) reveals he had hypertension and type II diabetes.
The symptoms are well under control due to change in medications and diet. Although , he
occasionally drinks in pubs and social gatherings, unfortunately he smokes around 20 cigarettes

NURSURGICAL CASE STUDY 5
per day. The patient has underwent angioplasty for right coronary artery and 10% stenosis was
left. The sheath was removed from the assess site and a less amount of wound ooze was
observed. The patient was complaining about chest pain, therefore he was administered
nitroglycerin. But during transition from Cath lab, the treating nursing professional encountered
the problem and found that the patient is being ischemic. The medical officer was contacted
immediately to address the issue and the procedure was called off immediately. No further
treatment has been commenced.
ASSESSMENT
The patient’s vital signs are assessed for evaluation. The blood pressure reading showed 139/87.
Respiratory rate observed was 18 per minute. The temperature recorded was 37.2, The SpO2 was
99% at room air. The patient pulse read was 72 per minute and blood glucose level recorded is
11.1 ml/L. The 12 lead ECG implicate normal rhythm and saline administered was 1000 ml
hourly. When the patient complained of chest pain, he was administered nitroglycerin via
sublingual route. But patient complained of being nauseaus. The groin area was assessed for any
type of pain or bleeding, but except a minimal wound ooze nothing significant was observed
such as hematoma and no pain too. The pain score was 6/10. The patient has been administered
sublingual GTN helping him to reduce the pain.
RECOMMENDATION
Based on the above assessment, the following recommendation was given for Mr. Harry Bright.
Morphine 5mg/ml need to administered and pain must be assessed in a 15 minute interval. The
pain score must be noted after each assessment. As the patient has complained of feeling
nauseous, therefore metoclopramide need to be administered. Vital signs must be continuously

NURSURGICAL CASE STUDY 6
monitored for detecting any changes. In case of any medical emergency such as pain, medical
officer must be contacted. The neurological assessment must be carried out that involves
checking colouration of extremities, strength in limbs, pulse strength and pain. Constant
monitoring of IV must be carried out and in case of development of ischemic stroke
thromboembolytic agents can be administered.
REFERNCES
Carlson, B., & Fitzsimmons, L. (2019). Shock, Sepsis, and Multiple Organ Dysfunction
Syndrome. Priorities in Critical Care Nursing, 474.
Dalal, F., Dalal, H. M., Voukalis, C., & Gandhi, M. M. (2017). Management of patients after
primary percutaneous coronary intervention for myocardial infarction. Bmj, 358, j3237.

NURSURGICAL CASE STUDY 7
Dunkley, S., Siefers, R., & Tagney, J. (2016). 101 All Patients Immediately Post Primary
Percutaneous Coronary Intervention (PPCI) Are Cared for in An Acute Cardiac Care
Environment. Is it About Time We Reviewed Our Practice?.
O’Gallagher, K., Byrne, J., & MacCarthy, P. (2018). Care following percutaneous coronary
intervention. Oxford Textbook of Interventional Cardiology.
Head, S. J., Milojevic, M., Daemen, J., Ahn, J. M., Boersma, E., Christiansen, E. H., ... &
Hlatky, M. A. (2018). Mortality after coronary artery bypass grafting versus percutaneous
coronary intervention with stenting for coronary artery disease: a pooled analysis of
individual patient data. The Lancet, 391(10124), 939-948.
Khalid, M. F., Khan, A. A., Khattak, F., Ayub, M. T., Bagai, J., Mukherjee, D., ... & Paul, T. K.
(2018). Culprit vessel only versus multivessel percutaneous coronary intervention in
acute myocardial infarction with cardiogenic shock: A systematic review and meta-
analysis. Cardiovascular Revascularization Medicine.
Levine, G. N., Bates, E. R., Blankenship, J. C., Bailey, S. R., Bittl, J. A., Cercek, B., ... & Khot,
U. N. (2013). 2011 ACCF/AHA/SCAI guideline for percutaneous coronary
intervention. Catheterization and Cardiovascular Interventions, 82(4).
Lima, V. C. G. S., de Carvalho Queluci, G., & Brandão, E. D. S. (2019). POST-CORONARY
TRANSLUMINARY ANGIOPLASTY PATIENT'S NURSING CARE. Journal of
Nursing UFPE/Revista de Enfermagem UFPE, 13(3).