Stable Angina Post-Angioplasty: Nursing Assessment and ISBAR Report

Desklib provides past papers and solved assignments for students. This report details a post-angioplasty patient's care.

Contents
INTRODUCTION.......................................................................................................................................1
ISBAR.......................................................................................................................................................3
INTRODUCTION.......................................................................................................................................3
SITUATION...............................................................................................................................................3
BACKGROUND.........................................................................................................................................3
ASSESSMENT...........................................................................................................................................3
RECOMMENDATIONS..............................................................................................................................4
REFERENCES................................................................................................................................................4
INTRODUCTION
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Stable angina is referred to a condition that is characterized by chest pain or discomfort that is
mostly associated with activity and physical stress caused due to reduced blood supply to heart
(Gilbert & Coyne., 2018). In the simulated case patient is having stable angina and has just
received the angioplasty procedure for it. Post operatively the nursing assessment and planning is
crucial for better delivery of care and planning of services. We are supposed to reflect on the
assessments carried out and not carried out post operatively and the importance of those
assessments for angina patient.
The team offered services that included following assessments
Vital signs monitoring is the crucial element that enables one to understand and monitor normal
working of human body’s physiological functions through four vital signs. As the health rate and
pulse are also measured in this assessment routinely it is important to follow the normal
functioning of heart post operatively (Nemani et al., 2017).
According to NICE guidelines the neurovascular assessment was carried out using following
criteria. The peripheral neurological assessment for pain, pallor, paresthesia, pulse and paralysis
is done. This assessment is indicated for the patient undergoing angioplasty as it determines the
proper flow of blood t peripheries. As seen in Mr. Bright’s case the peripheral nerves were
assessed and the function were intact but previously the feet were cold but as the chart
progressed the feet started getting warmer that indicated proper flow of blood to peripheries
through heart indirectly indicating proper heart function (Gilbert & Coyne., 2018).
Assessing pain is another essential factor post operatively. As during the surgery the patient is
under sedation but post operatively when the sedation reduces the pain at surgical site enhances,
assessment of this pain is important factor to plan proper care. PQRST scale is used to assess the
pain in the given case. PQRST stands for provoke, quality, radiates, severity, and time (Kitney et
al., 2018). These parameters are focused while pain assessment that helps identify the extent,
aggravating factor, site and quality of pain the patient is feeling. As the patient also had
myocardial ischemia during the surgery and 10% residual blockage assessment of any further
chest pain is essential to identify any post op complication.
Blood glucose levels are essential for wound healing and repair. It is often seen that diabetics are
more prone to get unhealed or delayed healing wounds. It is essential to monitor the blood
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glucose level n given case as the patient is known type 2 diabetic. For better healing of wound
and recovery the glucose levels of blood should be maintained and in order to do so it is essential
to monitor it ad assess it routinely (Krishnan & Thirunavukkarasu., 2016).
There are other assessments too that are essential post operatively after angioplasty but in given
scenario the assessments were not done. ECG monitoring, neurological assessment and wound
care assessment.
ECG stands for electro cardiogram. It is a technology that enables one to measure the rhythms of
heart and the sequence of heart pumping blood into vessels. This sequence is recorded in form of
electrical waves that are interpreted for various heart issues. ECG postoperative to angioplasty is
suggested within one week after the procedure as a post interventional follow up procedure. ECG
at rest should perform to know the stent inserted is functioning properly. The stress ECG is only
indicated if the symptoms of blockage and angina persist after coronary stenting (Sauër e al.,
2017).
Neurological assessments after angioplasty is not very much recommended as the effects of
sedation and anesthesia persist for few ours but eventually normal neurological functioning is
gained in an average 4.3 hours as per the NCBI research. It I not necessary to evaluate the
neurological functioning after coronary stenting procedure but it is indicated in some high risk
individuals as in given case where the surgery was complicated by myocardial ischemia
(Mangusan, Hooper, Denslow, & Travis., 2015). It provides early identification of any
neurological deficit and gives insight to proper care.
Wound care assessment is primary requirement after any surgery. After angioplasty as the
external wound is not severe yet the wound assessment is to be carried to rule out any infection
or sepsis that can occur. Proper wound assessment results in avoidance of any risk from sepsis or
infection or any other post-surgical complication that may occur (Barrett et al., 2016).
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ISBAR
INTRODUCTION
I am nurse from emergency ward, I am calling to communicate about the
patient Mr. Brigth, a day care patient, reporting of recurrent chest pain and is here to get help for
his condition. I would like you to come and see him immediately.
SITUATION
Mr. Bright is accompanied by his wife Mrs. Bright and he complains of recurrent chest pain over
few day that is pushing and heavy in nature. His pain is pressurizing, pumping in nature and
affects him during physical activity, stress and also sometimes during rest.
BACKGROUND
Mr. Bight came in this morning for health inspection regarding his recurrent chest pain. His
weight is 175 cm and weight is 100 kg. He is known type 2 diabetic and also has history of
hypertension. He is chronic smoker with history of smoking 20 cigarettes a day. He complaints
of chronic recurrent chest pain radiating to left arm and jaw (Pang., 2017).
ASSESSMENT
Assessment is done by taking ECG that indicates stress induced stable angina. Also the
medication is identified as relieving factor as well physical stress and activity aggravates the
pain. His vitals indicate respiratory rate 26 per minute, blood pressure 100/50 mmHg, pulse 110
and oxygen saturation was 93 as recorded.
I also recorded that he was on metformin medication for his well-managed blood glucose levels
(Kitney et al., 2017).
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RECOMMENDATIONS
I would like you to come and visit the patient and follow up the investigations to prepare a care
and treatment plan for him. Also I would like you to communicate with the patient and his family
to make them understand the urgency of the situation and the interventions that can be required
for the treatment and care (Chen., 2017).
REFERENCES
Barrett, C. D., Celestin, A., Fish, E., Glass, C. C., Eskander, M. F., Murillo, R., ... & Hauser, C.
J. (2016). Surgical wound assessment by sonography in the prediction of surgical wound
infections. Journal of Trauma and Acute Care Surgery, 80(2), 229-236.
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Chen, S. L. (2017). Use ISBAR Communication Tool to Reduce the Rate of Unplanned
Endotracheal Extubation in Neonates.
Gilbert, J., & Coyne, E. (Eds.). (2018). Acute Care Nursing. Cambridge University Press.
Kitney, P., Bramley, D., Tam, R., & Simons, K. (2018). Perioperative handover using ISBAR at
two sites: A quality improvement project. Journal of Perioperative Nursing, 31(4), 17.
Kitney, P., Tam, R., Bennett, P., Buttigieg, D., Bramley, D., & Wang, W. (2017). Handover
between anaesthetists and post-anaesthetic care unit nursing staff using ISBAR principles: a
quality improvement study/Le transfert des soins entre les anesthesistes et le personnel infirmier
de l'unite de soins postanesthesiques a l'aide des principes ISAER: une etude sur l'amelioration
de la qualite. ORNAC journal, 35(1), 13-26.
Krishnan, V., & Thirunavukkarasu, J. (2016). Assessment of knowledge of self blood glucose
monitoring and extent of self titration of anti-diabetic drugs among diabetes mellitus patients–a
cross sectional, community based study. Journal of clinical and diagnostic research:
JCDR, 10(3), FC09.
Mangusan, R. F., Hooper, V., Denslow, S. A., & Travis, L. (2015). Outcomes associated with
postoperative delirium after cardiac surgery. American Journal of critical care, 24(2), 156-163.
Nemani, A., Ali, A., Rehan, A., Aboufaris, A., & Ali, J. (2017). AN ASSESSMENT OF INTER-
RATER RELIABILITY IN THE TREATMENT OF CAROTID ARTERY STENOSIS. Pakistan
Heart Journal, 50(3).
Pang, W. I. (2017). Promoting integrity of shift report by applying ISBAR principles among
nursing students in clinical placement. In SHS Web of Conferences (Vol. 37, p. 01019). EDP
Sciences.
Sauër, A. C., Veldhuijzen, D. S., Ottens, T. H., Slooter, A. J. C., Kalkman, C. J., & van Dijk, D.
(2017). Association between delirium and cognitive change after cardiac surgery. BJA: British
Journal of Anaesthesia, 119(2), 308-315.
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