Wound Care and Bleeding - Elizabeth Rose Green - Essay Example

Case world Scenario Name Date Course Case World Scenario Introduction Elizabeth Rose Green had experienced unrelieved pain on her central chest and left shoulder for ten minutes. She was living alone but was in the company of her dog at the time. On calling the ambulance, she was taken to hospital where an angiogram was performed to determine the cause of her pain. It was found that she had a blockage at her left anterior descending artery which was successfully stented. The other cardiac vessels had 10-20% occlusion. After being monitored, she was discharged and provided with medication. Elizabeth was also introduced to a cardiac rehab which she has been attending two weeks after being discharged. Although she is feeling much better, she still requires more information about her condition and how she can deal with different situations. Cardiac diseases are considered long term conditions that require management. The patient requires information in order to manage the conditions. Challenges may also be faced due to social issues including age. Since Elizabeth is living alone, it is important that she is provided with all the information in order to manage the condition. The information that she has been provided with at the hospital is not enough. External factors such as bleeding may have negative impacts on the cardiac patient and hence the need for information about its management (East Sussex Healthcare, 2012:4). A social worker may also be required since is living alone and is of an advanced age. The paper thus highlights more information that Elizabeth may require since she has already been discharged from the hospital. Discussion Medication Coronary angioplasty is not a cure for the narrowing of the arteries (Merriweather & Linda, Sulzbach-Hoke, 2012: 22). In some instances, the arteries may narrow again near the site of the angioplasty or in new areas of the arteries. The patient should therefore continue taking the medicine as prescribed. Elizabeth has been prescribed paracetemol as well as clopidogrel. Paracetemol should be taken in case of sharp pain which is common among the patients after the operation (Merriweather & Linda, Sulzbach-Hoke, 2012: 22). The use of paracetemol is important in countering the sharp or stabbing pain although the drug should only be taken more than three times a day. To prevent the risk of clots from forming in the newly inserted stents, clopidogrel should be taken on a daily basis (Merriweather & Linda, Sulzbach-Hoke, 2012: 22). This form of medication should be taken on a daily basis for a period of at least 12 months. However, in case of any complications or side effects that may arise as a result of taking the drug, it is important for Elizabeth to seek medical advice from the General Practitioner. She may be provided with Aspirin which carry out the same function. As with the other medication, it should be taken based on the directions of the physician. Since Elizabeth lives alone, it is important to ensure that she uses an alarm to remind and alert her about the time that she is required to take her medicine. Taking the medication as prescribed in important in ensuring that the risks the arteries narrowing again are reduced (Merriweather & Linda, Sulzbach-Hoke, 2012: 22). Wound care and bleeding It is common for a bruise to form at the insertion site after the procedure (Vicenzi, 2006: 687). This may create a wound that may make the patient uncomfortable for the next few days. If the wound ends up becoming swollen, very red and painful, it will be important for Elizabeth to seek medical attention. It is also important to ensure that the stitches are kept dry and covered with clean dressing at all times. This will play an essential role in ensuring that infection does not occur. It is also important to avoid lifting heavy objects and carrying out strenuous activities (Rassaf, Steiner & Kelm, 2013: 75). This is because it may apply the pressure at the wound leading to negative impacts. Since Elizabeth is living alone, she may be required to seek the services of a house help more often. High standards of hygiene should also be maintained at all times as a measure to care for the wound (East Sussex Healthcare, 2012:4). After the procedure, it is normal for the patients to feel tender at the wrist and groin area. This may lead to the development of a bruise that may extend down the knee or arm. The patient should however be concerned if hard tender lumps develop under the skin around the area of the incision (East Sussex Healthcare, 2012:4). It is unlikely that the groin or wrist wound ma start bleeding. However, if it does or incase of any other form of bleeding, the first thing is to lie flat. Pressure can then be applied at the area of bleeding for a period of up to ten minutes (East Sussex Healthcare, 2012:4). Elizabeth would have to do this by herself since she is living alone. However, if the bleeding starts in the presence of her family members or any other person, they can assist in applying the pressure at the point of bleeding. If the bleeding does not stop after applying pressure for ten minutes, it is advisable to call an ambulance (East Sussex Healthcare, 2012:4). Although this occurrence is rare among the patients, it may occur in some of the patients. Elizabeth will also be required to stay overnight with a care giver incase of bleeding even in the event that it stops. This is mainly for the purposes of ensuring that the wound can be monitored. The patient is advised to avoid taking hot baths in case of bleeding as it may encourage it (East Sussex Healthcare, 2012:4). Elizabeth will therefore be required to take bath with cold water in the next few weeks. Risk factors and lifestyle changes The risk factors make coronary diseases more likely to develop and it may also affect the recovery process of the patient. The risk factors may either be modifiable or non-modifiable. The non modifiable factors include family history, age, gender and ethnic origin (Merriweather & Linda, Sulzbach-Hoke, 2012: 25). This may end up affecting the recovery process of Elizabeth. Her mother who is deceased had a history of cardiac problem. The risk factor increases by 15% when one parent has a history of cardiac disease. This is therefore an indication that the disease may recur even after the treatment of the patient. This risk factor cannot be modified but the patient has to have the information. Elizabeth is 78 years old which is an advanced age and this increases the risk factor. The risk of coronary heart diseases increases as people become older (Merriweather & Linda, Sulzbach-Hoke, 2012: 25). At her advanced age the disease she is suffering from is common and this is a factor that cannot be modified. In terms of gender, it is men who are however at a higher risk as compared to women. The Asian population is more likely to suffer from cardiac diseases as compared to any other population. The non-modifiable factors are useful in enable the patient to understand their condition (Merriweather & Linda, Sulzbach-Hoke, 2012: 25). The Modifiable risk factors are those that the patient can do something about it to manage the diseases and reduce likelihood of reoccurrence (Seides & Corso, 2007: 5). The modifiable factors include smoking, cholesterol, high blood pressure, diabetes, stress, inactivity, excessive alcohol consumption and being overweight. Elizabeth quit smoking 5 years and this means she has modified the risk factor and is no longer a threat to her. In terms of cholesterol, it should be below 7 mmol/I (Seides & Corso, 2007: 5). High levels of cholesterol cause the blood vessels supplying the heart with blood to fur up. It is usually saturated in fat in the diet and this is a risk factor. Elizabeth will therefore need to reduce the intake of fats and use medication to main the cholesterol levels within the required limit. Elizabeth is suffering from type 2 diabetes and hypertension. These are factors that can be modified by the patient. The blood pressure has to be maintained below 30/80 mmHg (Seides & Corso, 2007: 5). High blood pressure damages the lining of the arteries and it also forces the heart to use more energy to pump the blood (Oxford Radcliffe Hospitals, 2011: 10). Medication can be used to control the blood pressure and it is also advisable for Elizabeth to visit a general nurse frequently to check the blood pressure. Diet modification will also be required in order for Elizabeth to control type 2 diabetes. Stress is a modifiable factor that the patient has to control. Stress increases the heart rate as well as the blood pressure which may cause blood to clot (Oxford Radcliffe Hospitals, 2011: 10). Although it is difficult to quantify stress, relaxation techniques can be used for the purposes of alleviating stress. Elizabeth has to ensure that she is not stressful as it may trigger the condition. It is also recommended that she should avoid alcoholic beverages as it increases the risks. Excessive consumption of alcohol may lead to weight gain which may also trigger high blood pressure (Oxford Radcliffe Hospitals, 2011: 10). It is also important for Elizabeth to ensure that she does not gain weight as it is not good for her condition. Elizabeth will also be required to modify her diet in order to reduce the risk factors. A healthy diet will be required at all time as it may be useful in ensuring that the levels of cholesterol are not increased and she does not gain weight. It is recommended that Elizabeth should eat two portions of fish every week with one portion being oily fish. A high consumption of vegetables is also required for the patients with coronary diseases (Caldwell, et al, 2014: 363). Elizabeth has to consume 5 portions of fruits and vegetables on a daily basis. The patient has to be strict on the aspects of diet to avoid the problem reoccurring. Less salt is required for people with risk of developing coronary diseases or those who have suffered from the condition. Salt may trigger an increase in blood pressure and hence impacting negatively on the management of the disease (Caldwell, et al, 2014: 363). Maintaining a proper diet will also be useful to Elizabeth to manage diabetes. Any food with a high amount of cholesterol must therefore be avoided completely. This means that Elizabeth will have to stop the consumption of fatty foods. The management of diet is not restricted to any period of time but she should do so for the rest of her lifetime. Elizabeth will also be required to carry out exercises on a daily basis. However, the nature of the exercises has to be change. Exercises that require lifting of heavy equipment such as visiting the gym or engaging in the morning run is not recommended for the cardiac patients. Elizabeth should instead take a walk for at least 30 minutes on a daily basis (Oxford Radcliffe Hospitals, 2011: 9). She may do so at any time of the day and it may also provide her with an opportunity to take her dog for a walk. Exercises enable the heart to be stronger and hence enabling it to work more efficiently. If Elizabeth feels shortness of breath while undertaking the exercise, it is important to contact a general practitioner or she should call an ambulance. This is a precautionary measure that is aimed at ensuring that the problem does not escalate. The coronary patients must not make any assumptions in case they notice anything unusual regarding their body functioning and health (Oxford Radcliffe Hospitals, 2011: 9). Action to take in case of chest pain After undergoing the procedure, some of the people may end up experiencing chest pains or discomfort even after they have been discharged from the hospital. This problem is not uncommon and it can be attributed to various factors including bruising during the procedure (Turkish Society of Cardiology, 2007: 24). The pains usually lessen and disappear with time among the patients. However, in case of pain, the patient must follow a certain procedure that may be useful in alleviating it. The first step is to stay calm and sit down. It is advisable to stop whatever task or activity that one was performing. One or two puffs of GTN spray under the tongue should then be taken. The patient should wait for up to five minutes while still resting. If the pain continues to persist, another puff of GTN should be taken (Turkish Society of Cardiology, 2007: 24). If the pain continues to persist after fifteen minutes when GTN puffs have been taken twice, it is advisable to call an ambulance. This is important in ensuring that the immediate medical attention is sought. The spray has side effects such as dizziness and headache but it usually disappears after a short period of time. The persistent pain could be an indication that the problem has reoccurred and treatment is required in such instances (Turkish Society of Cardiology, 2007: 24). Elizabeth should therefore be caution in case she experiences chest pain at any time. Post hospitalization visits Elizabeth is living alone and is also in an advanced age. She may end up facing challenges including forgetting her medication. Home visits thus required for the purposes of monitoring her conditions as well as how she is fairing on. A social worker is therefore required for the purposes of ensuring that she is monitored (Papworth Hospital, 2014: 11). A social worker should visit her frequently to provide her with information as well as ensure that she is taking her medication. The visits by the social worker are required during the post hospitalization as the patient is still susceptible. A social worker may also be in a position to detect any anomalies with regards to the living conditions of the patient. In other instances, the social worker may be useful in providing the patients with support and assistance in terms of movement and moving objects (Papworth Hospital, 2014: 11). At an advanced age, it may be difficult for the patient to move freely and this has seen most of the patients opting to spend more time in bed. A social worker can also right a report that may be useful to the nurses in the course of providing treatment after the hospitalization. It is also advisable for the family members to frequently visit and communicate with the patient. Her children should make an effort of visiting her on a weekly basis. This is useful in providing the patient with support after being discharged from the hospital. Activity Elizabeth should not resume her normal activities immediately but should wait for at least three to four weeks. During the first few days, it is important to avoid strenuous activities that involve lifting or pulling heavy objects (Rassaf, Steiner & Kelm, 2013: 75). It is important to start with activities such as walking for 30 minutes daily. When climbing stairs, it is advisable to tart by doing so slowly. This is for the purposes of avoiding any strain to the body. It is also important for Elizabeth to continue avoiding activities such as driving in the first three weeks. She should continue taking a taxi for a period of up to four weeks after the procedure. However, after four weeks she should be able to resume her normal activities which mainly involve the household chores. After resuming her normal work, she should continue observing the diet, carry out exercises and take the required medication (Rassaf, Steiner & Kelm, 2013: 75). After the expiry of the four weeks, she can go to any destination for holidays but must avoid heavy loads. The visit to the cardiac rehabilitation center should also continue. The patient can obtain more information at the cardiac rehabilitation center as well as make more friends with similar problems. Joining a social support groups is also important to the patient as the condition is lifelong (Rassaf, Steiner & Kelm, 2013: 75). Conclusion In conclusion, it is evident that post hospitalization requires the patient to make some changes and observe some procedures. Coronary angioplasty is not a cure for the narrowing of the arteries and it may reoccur if some of the risk factors are not avoided. It is evident that Elizabeth will be required to engage in exercises, change her diet and avoid the consumption of food containing high levels of cholesterol. A visit to the general practitioner may also be required for the purposes of ensuring that the blood pressure is checked. A high blood pressure is a risk factor for the people at risk of cardinal diseases or those who have undergone the operation. All the medication should be taken correctly and at the right time. It is recommended that Elizabeth should follow the outlined procedure in case of pain in the chest. Wound care and bleeding information is also required during the post hospitalization. A visit by the social worker is important for Elizabeth as she is living alone. It is evident that she can only resume her normal duties after a period of four weeks after the procedure. Caution will however be required at all times when performing her duties. Bibliography Caldwell B., et al. 2014. A way to reverse CAD? Though current medical and surgical treatments manage coronary artery disease, they do little to prevent or stop it. Nutritional intervention, as shown in our study and others, has halted and even reversed CAD. Journal of Family Practice, 63(7). 356-364. Seides, S., & Corso, P. 2007.Two choices for CAD: stents and bypass surgery. Cardiovascular physician, 3(1), 1-8. Merriweather, N. & Linda, M., Sulzbach-Hoke, L. M., 2012. Managing Risk of Complications at Femoral Vascular Access Sites in Percutaneous Coronary Intervention. Critical Care Nurse, 32(5), 16-28. Rassaf, T., Steiner, S., & Kelm, M., 2013. Postoperative Care and Follow-Up After Coronary Stenting. Dtsch Arztebl Int, 110(5), 72−82. Turkish Society of Cardiology., 2007. Nursing care guidelines in percutenous coronary and valvular interventions. Turkish Society of Cardiology, 3-30. Vicenzi, M. N., 2006. Coronary artery stenting and non-cardiac surgery—prospective outcomes study. British Journal of Anaesthesia 96 (6), 686–93. East Sussex Healthcare., 2012. Advice for patients undergoing coronary angioplasty and stents. NHS Trust, 1-10. Oxford Radcliffe Hospitals., 2011. Discharge advice after your coronary angiogram, angioplasty or stent insertion, NHS Trust, 3-12. Papworth Hospital., 2014. Returning to fitness after a coronary stent procedure. NHS Trust Foundation, 1-13. Read More