Assignmnt Help Please

Published Jan 28, 2020

4 Posts

I need help with an assignment for Uni, I have the following do far but need to make sure that I am on the right track, have not missed anything etc. I am also having trouble coming up with the rationales for interventions and finding references that are not old. Any help would be appreciated. Before you comment that this is something my tutor would help with, the answer we get is "your on the right track, recheck the scenario".

Task:
- Read the scenario below
- Bullet point list your main concerns for this patient.
- Provide a brief reason (rationale) for these concerns?
- Provide a numbered list in order of priority of the appropriate
interventions that need to be instigated for this patient, consider
the whole MDT.
- Provide a rationale/reason for these interventions. Consider
pathophysiology, pharmacology and evidence-based practice in
your rationale/reason.
- Your rationale/reason must be nursing focused
- Please remember to reference your work
Word count: 2000 words +/- 10%
Please note: This assignment does NOT follow essay format.
Your referencing must follow the APA 6th edition format

Scenario
Mrs Green is a 75-year-old lady who has been admitted to the cardiac
ward where you are currently on placement. She has been admitted with
chest pain and has just undergone a Coronary angioplasty via the left
femoral artery (previous failed attempt via the left radial artery) 1 hour ago.
Her current observations are BP 100/75, HR 98, RR 22, Temp 36.7, SpO2
98% on Room air (RA). She is alert and orientated.

I have the following

Main concerns for this patient

1. Arrhythmia and myocardial infarction:

2: Haemorrhage: monitor patient’s coagulation test results and haemoglobin studies, usually every 4-6 hours post surgery.

3: Neurovascular observations: to assess limb for colour, warmth, CRT, pulse strength, sensation, movement and pain. Peripheral pulses.

4. Observations: Vital signs should be monitored and documented every 15 minutes in the first hour post procedure then every 30 minutes for 2 hours, every hour for 4 hours then 4 hourly observations.

5. Vascular complications: Haematoma or retro-peritoneal bleeding are among the most common complications observed after angioplasty. Haematoma are usually created after removal of the sheath following poorly controlled haemostasis. In-stent restenosis can occur within 48 hours.

6: Incision Site Care: assess patients femoral site, symptoms of oozing, swelling and increasing pain show signs of possible haematoma

7: Pain: the patient will experience acute pain due to tissue trauma from surgery as well as chest pain from the initial presentation.

8. Adverse reactions from contrast media: chemotoxic or anaphylactoid reaction to the media used in the procedure or contrast medium–induced renal failure.

I need help with

Provide a rationale/reason for this concern

1. Arrhythmia and myocardial infarction: (Tatli, Alicik, Buturak, Yilmaztepe & Aktoz, 2013)

2: Haemorrhage or Heamatoma: It is vital that post procedure a patients coagulation test results and haemoglobin studies are monitored; usually every 4-6 hours, as bleeding in the area surrounding the insertion site may occur before and after sheath pull and is usually created after removal of the sheath following poorly controlled haemostasis. Aspects that may affect the potential development of a haematoma include procedural factors such as a larger sheath size, multiple sticks, and increased use of anticoagulants. A patient’s predisposition to the development of a haematoma can also include hypertension, a patient vulnerable to episodes of bleeding, age, obesity and vascular peripheral disease (Hamel, February 2009). Another risk factor is arterial thrombosis and pseudo-aneurysm formation as arteries are high-pressure systems, the risk for significant bleeding after an invasive procedure is high. A retro-peritoneal haemorrhage bleeds in the retro-peritoneal space and can be very severe since the patient can lose a large amount of blood in short amount of time. Symptoms can include a groin haematoma, fall in haemoglobin, hypotension, abdominal or flank pain, nausea and/or vomiting, diaphoresis and bradycardia (Suggs, 2013). Pseudo-aneurism, also known as false aneurysm, is a pool of blood formed between the two outer layers of the artery, the tunica media and the tunica adventitia.

3: Neurovascular observations: to assess limb for colour, warmth, CRT, pulse strength, sensation, movement and pain.

4. Observations: Vital signs should be monitored and documented every 15 minutes in the first hour post procedure then every 30 minutes for 2 hours, every hour for 4 hours then 4 hourly observations. Tachycardia may also mean that the patient is in pain, overloaded or anxious, hypertension may be due to anaesthetic or inadequate pain control ( ).

5. Vascular complications: retro-peritoneal bleeding are among the most common complications observed after angioplasty with vascular access site complications are among the most serious angioplasty complications ( . The clinical analysis involves the auscultation of a bruit, discomfort, swelling and significant bruising at the point of arterial puncture.

6: Incision Site Care: assess patients femoral site, symptoms of oozing, swelling and increasing pain show signs of possible haematoma.

7: Pain: the patient will experience acute pain due to tissue trauma from surgery as well as chest pain from the initial presentation. Increased chest discomfort or pain, which may indicate in-stent restenosis. Evaluate pain regularly,

8. Adverse reactions from contrast media: chemotoxic or anaphylactoid reaction to the media used in the procedure. Contrast media stimulates an anaphylactoid response through histamine release which can cause the patient to have an adverse reaction including hypotension, bradyarrhythmias, pulmonary congestion. Contrast medium–induced renal failure. Allergic reactions to dye based iodine range from hives to anaphylactic shock, which may include hives, rash, edoema, vascular collapse, shock, and respiratory distress.

List all the appropriate interventions in order of priority (be specific).