Percutaneous Coronary Intervention

Essay Case :  Adult following Percutaneous Coronary Intervention: Balloon Angioplasty and Intracoronary Stent
Michael is a 56 year old male who has returned to the high dependency acute cardiac care unit following a Balloon Angioplasty and insertion of an Intracoronary Stent.  He has a history of Type 2 Non-insulin dependent diabetes and manages this with Metformin.  He is on telemetry and is to lie flat for 3 hours post procedure.  The femoral artery sheath was removed in theatre, the site compressed and an opsite dressing applied  to the site on his left inguinal region.  He is currently on half hourly circulation observations.  He has an IV of 0.9% Sodium Chloride (1L) / 24 hourly infusing.  His initial return to ward observations were HR 80/min, RR 18/min, BP 120/80, Temp 36.9°C.  When you perform your next set of observations 30 minutes later Michael’s observations are HR 110/min, RR 20/min, BP 100/70 and Temp 37° C.  He reports that he has pain in his groin and has a pain score of 4/10.  He also says “I really want to pee but I can’t while I’m lying down.”  His feet and hands feel pale, clammy and cool. You lift up the sheet to inspect the catheter site and there is a large pool of fresh blood all over the sheet under Michael and a visible leakage from the site.

Once you have selected:
There are at least three (3) priority problems that the patient is experiencing currently. List three priority problems you have identified from the above data and history. For each problem identified, list as many nursing interventions as you have discovered in your research of the literature. Include a one to two line rationale for each intervention. Submit this one page list with your essay.
Please be aware that the main focus should be the essay itself and not this one page list which is essentially a map or plan of your thinking about the case. We have asked for this page as sometimes students choose incorrect priority problems so this page will allow us to see if it was a problem with identification or prioritisation. As with any academic writing it should be referenced and you can include these references in your main essay reference list. Your main focus should be the essay.
For your essay, you must prioritise the problems you identified and select the two highest priority problems from your list.

The 2000- word essay

• State an overview of the patient’s condition and identify the TWO priority nursing problems. Give a brief plan for the essay topics.
•        For the first problem (850 words): Briefly explain how it relates to the patient’s assessment data. You will need to draw on your understanding of pathophysiology to explain the link between the problem and the patient’s signs and symptoms. Identify TWO priority nursing interventions to address the problem. Discuss briefly the nursing interventions you will implement (explain what is involved in implementing the intervention, why it is suitable, any relevant positive or negative aspects/considerations) and support/justify the use of these interventions with reference to current evidence-based literature.  Outline the evaluation criteria/data that would indicate that each intervention is improving or resolving the identified problem.
•        For the second problem (850 words): Briefly explain how it relates to the patient’s assessment data. You will need to draw on your understanding of pathophysiology to explain the link between the problem and the patient’s signs and symptoms Identify TWO priority nursing interventions to address the problem. Discuss briefly the nursing interventions you will implement (explain what is involved in implementing the intervention, why it is suitable, any relevant positive or negative aspects/considerations) and support/justify the use of these interventions with reference to current evidence-based literature.  Outline the evaluation criteria/data that would indicate that each intervention is improving or resolving the identified problem.
•        Conclusion (150 words): Briefly restate the patient’s condition and problems and how the nursing interventions can benefit the patient’s health.

You need to discuss at least one independent nursing intervention in your essay.  For any collaborative nursing interventions you use you must discuss the nursing responsibilities and actions in relation to this collaborative intervention. Medications cannot be both of your chosen collaborative interventions for a problem.  If a medication is one of your collaborative interventions you must identify an appropriate drug that is likely to be/or has been prescribed by the doctor (in the case options some medications have already been prescribed). You must also consider and discuss the nursing responsibilities associated with the medication (action, dose, side effects, prevention and management of same, administration requirements, evaluation).