Risk Factor For The Development Of Chronic

Question:

Discuss about the risk factors that lead to chronic.

Answer:

Percutaneous coronary interventions, or Coronary Angioplasty is a procedure that opens clogged blood vessels.

A small balloon is temporarily inserted and inflated at the site of the blockage.

This aids in widening an artery.

This is also a treatment procedure that can be used to treat stenotic coronary arterioles that are located within the heart.

The onset of Artherosclerosis can cause the formation of stenotic segments within blood vessels.

This therapeutic intervention has been shown to reduce angina or chest pain in patients.

However, myocardial damage can still occur.

Following Elizabeth Green’s report of pain in her left shoulder and chest, she was referred for coronary angioplasty.

Hematoma is a possible problem after coronary angioplasty.

The essay will explain anatomy and physiology in order to help with the possible problems.

Hematoma refers specifically to the accumulation of blood within the blood vessels.

This can occur due to trauma, disease, and injury from surgery.

A physiological abnormality is the seepage of blood through broken capillaries.

Hematoma is most common after coronary bypass angioplasty. The hemoglobin forms in liquid form and then spreads to other tissues.

After reaching the tissue spaces, coagulation, solidification, and resorption of blood into the vessels often occur.

Although most hematomas are visible below the skin’s surface, they are more commonly known as bruises. Some hematomas may be felt as lumps and masses (Almenawer and al.

The presence of lumps is a direct result of blood loss to spaces in the subcutaneous or intramuscular tissues that are separated by certain fascial planes.

Therefore, lump formation can be considered a major anatomical feature. It prevents severe injuries from causing huge blood losses.

These hematomas that grow in the form a blood vessel are most likely to dissolve in most cases (Rodriguez.Luna and al.

Studies have shown that hematomas can grow continuously due to blood loss (Sanidas, et al.

Surgery that cleans or repairs the blood sac can often be used to treat a failed blood sac.

Another possibility is slow reabsorption, which allows blood pigment hemoglobin to move along with the broken cells towards the connective tissue (Pancholy and al.

A major concern after coronary bypass surgery is hematoma. Hematoma can be a problem because of its ability to reduce mobility and cause a misdiagnosis.

Hematoma formation following coronary bypass angioplasty is the most common problem.

Studies show that hematoma sufferers have a lower quality of living.

Additionally, hematoma can cause a variety of inconveniences. The most common include walking impairment, mobility problems, and an unpleasant or tingling sensation in your legs (Saw and al.

8 hours after coronary angioplasty, an aortic intramural haematoma may develop in the patient.

The largest blood vessel (artery in the human body) is the aorta.

It is thought to originate in the left ventricle (or major chamber) of the heart, which pumps blood from it.

Patients with aortic intramural haematoma are at risk because the condition often causes blood to leak through the walls (Bakhshi et. al.

The blood leakage might not be due to a tear in your aortic wall.

This makes it difficult to identify any abnormalities in the patient.

A buildup of hemomatoma could also cause disruption to blood supply to other parts of the body. This can lead to oxygen deprivation which can worsen the patient’s condition. (Chhatriwalla, et al.

The possibility of internal bleeding or hematoma after catheterization in Elizabeth Green’s case is considered a major health risk. This is due to the fact that it could lead to groin discomfort at the site of acess. This will then be accompanied with focal bruising and swelling.

It is frequently related to hypotension and/or tachycardia.

Additional complications could result from this hematoma such as compression of the Femoral Nerve due to its proximity (Tweet, et al.

You must take steps to reduce the likelihood of the formation of hematomas. This includes paying careful attention to the site of entry and the surrounding area with fluoroscopy.

Sometimes, hematoma may also be caused by blood thinners.

Anticoagulants, also known blood thinners, are chemical substances that are used to decrease or prevent blood coagulation. This can increase the time it takes to clot (Ozcan and al.

Most often, an anticoagulant therapy will be used in unstable angina cases. The aim is to prevent subocclusive thrombus from developing and thereby reduce the risk of myocardial damage and death.

Research has shown that people who are taking medication such as coumadin, warfarin, and plavix can have an increased risk of developing blood vessel hematomas than people who don’t use these medications (Aspegren, et al.

They play an important part in hematoma formation by inhibiting the blood’s ability clot.

De Bonis et. al. (2013). This makes it more difficult to repair any minor damage that has occurred in the blood vessels.

Research evidences also emphasize the link between extensive anticoagulant therapy for cardiovascular disorders with subdural bleeding and subdural blood clots.

Evidence suggests that aspirin at low doses is associated with a lower risk of hematomal injury (Kuramatsu, et al.

Elizabeth Green, a patient who had complained of discomfort in her chest area and shoulder, underwent an angioplasty. Several nursing care procedures were required to prevent any complications from hematoma, myocardial injury, or arrhythmia.

Direct pressure should be applied for at least 15 minutes to the site where the catheter was inserted after removing the tube/stent from the legs or arms.

This is to minimize the chance of internal bleeding (Greenberg, Kornowski, 2013).

After checking for hepatic inflammation, the patient will be placed in an artery in the groin that has a direct link to the liver.

The patient will be assessed for any signs and symptoms that may indicate intravascular loss.

Intravascular volume is the amount of blood in the circulatory systems. It usually includes the blood plasma component of the body (Bateman, et al.

Evaluations will be performed to rule out any physiological abnormalities such as hypotension, tachycardia, delayed CRT or widened pulse.

The internal sounds of the body will be listened to to determine if there is any systolic buzz or pulse.

This would indicate the presence of pseudoaneurysm. (Rodriguez Leor and al.

The catheter insertion site will be subject to pressure. For haemostasis purposes, gauze will be used.

Haemostasis is a process that prevents bleeding from blood vessels that have been damaged.

Monitoring the vital signs of patients will focus on blood pressure, heart rate and other important factors.

You will be alerted to orthostatic hypotension and a drop in systolic (or diastolic) pressure of 20mmHg and 10mmHg, respectively.

Orthostasis can be defined as a decrease of the circulating fluids.

Fludrocortisone (midodrine and pyridostigmine) will be administered to manage the condition (Ricci and Fedorowski 2015).

A plan of immediate care will include the prevention of medication from affecting hemostasis.

Internal bleeding can be prevented by stopping the use of anticoagulants, NSAIDs or salicylates.

The activity of the cyclooxygenase 1- or COX-1 enzyme, which promotes platelet accumulation, has been inhibited by NSAIDs.

To counteract the effects of blood thinners, vitamin K and protonamine sulfate are administered.

This will decrease the risk of embolism (Koster, et al.

A patient’s coagulation status will be evaluated by laboratory tests.

A patient’s coagulation status will be assessed by laboratory tests. These include the platelet count and PT/INR ratio (prothrombin times/international normalised), bleeding, fibrinogen counts, vitamin K, and thromboplastin timing (aPTT).

This is due to the fact that blood clotting cascades are complex systems that require many intrinsic and extrinsic factors.

A person’s ability to clot can be affected by any of the above factors.

Conduction of these clotting test after coronary intervention is crucial in determining the bleeding potential of Elizabeth Green and the coagulation status.

For occult bleeding, the urine (hemastix), and stool (guaiac), will be checked.

These tests will allow you to identify bleeding in the urinary and gastrointestinal tracts.

Skin and mucous membranes will be evaluated for any signs of brusing or petechiae. Blood oozing and hematomas will also be identified.

Mrs. Green will be given emollient and normal saline nasal sprays.

This will prevent the mucous membrane from drying out and cracking, which can reduce bleeding risk (Nunes Rego and Nunes 2014).

Rectal suppositories will not be used, as well as thermometers and vaginal duos. This is to avoid trauma to the mucous membranes.

The RBCs will have an increased oxygen carrying capacity due to blood products like plasma derivatives and blood component that have been prepared in blood transfusion centres.

Educate the patient’s family members and relatives about the risks.

Standard 7 of Standards of Practice for Registered nurses focuses on the evaluation of patient outcomes. This will provide for an informed nursing practice that can be used to implement many changes within a healthcare environment.

The standard of practice includes the monitoring and evaluation of a patient’s progress toward the goals or outcomes.

After coronary angioplasty, the above nursing care plan involves the identification and monitoring of vital signs and the evaluation of skin and mucous membrane for the detection of internal bleeding.

This nursing care plan conforms to the first standard.

Monitoring the patient’s heart rate and blood pressure will assist in determining the effectiveness of the angioplasty procedure. It will also improve the patient’s quality of life and provide evidence for progress in health.

The nursing care plan mentioned earlier stated that hematoma signs or symptoms will be checked and that all anticoagulant therapies will be stopped.

In order to prevent health complications, the nursing plan will be reviewed after an examination of internal bleeding.

This care plan also conforms with the second standard.

Elizabeth Green and her children will be more aware of the care plan, which will help them to understand the actions that are necessary to remove any risk factors that could lead to her death.

It can be concluded that Mrs. Green must undergo a thorough evaluation in order to treat her angina symptoms.

To remove blood vessel blockage, it was crucial to perform a Coronay Angioplasty.

The nursing care plan is a clear indication of compliance with the standard of practice.

The nursing care plan should be tailored to the individual’s needs.

Refer to

Chronic subdural haematoma management: A meta-analysis and systematic review of 34829 patients.

Romner, B.

Anticoagulation therapy as a risk factor for chronic subdural haematoma.

Clinical neurology and Neurosurgery, Chapter 115(7), pp.981-984.

Bakhshi F. Namjou Z. Namjou A. Panabadi A. Panabadi A. Bagherinasab M. Sarebanhassanabadi M.

Single-blind randomised controlled trial of the effects of positioning on coronary angiography patient outcomes.

Journal of Nursing Research, 22(1), 45-50.

Paganelli, W.

A report from the Multicenter Perioperative Outcomes Group Research Consortium.

National Cardiovascular Data Registry, 2013.

Association between bleeding events, in-hospital mortality and percutaneous coronary interventions.

Trevisi G. Tre Bonis, P. De Waure C. De Waure A. Sferrazza A. Volpe M. Pompucci A. Anile C. Mangiola A.

PLoS One 8, p.e68732.

Greenberg, G. and Kornowski R. (2013).

The Journal of invasive Cardiology, 25(7), pp.361-363.

Local paclitaxel causes late lumen swelling in the coronary arteries following balloon angioplasty.

Clinical Research in Cardiology 104(3), pages 217-225.

Koster A., Borgermann J. Borgermann J. Gummert J. Rudloff M. Zittermann A. Schirmer U.

Results of a double-blind controlled pilot study on protamine overdose.

T. Makikallio. Holm, N.R. Lindsay, M.S. Spence M.S. Erglis A. Menown, I.B. Trovik T. Trovik T. Eskola M. Romppanen H. Kellerth T. Ravkilde J.

Percutaneous coronary surgery versus coronary bypass grafting for unprotected left major stenosis. A prospective, randomised open-label, noninferiority trial.

The Lancet 388(10061), pages 2743-2752.

Nunes S.T. Rego G. and Nunes R., 2014.

Experience with an information system in nursing practice: The role of nursing records for the management of care plans.

Nursing and Midwifery Board of Australia. Registered nurse standards.

Omori S., Miyake J. Hamada K. Hamada K. Hamada N. Araki N. and Yoshikawa H.

Transcatheter or angioplasty can lead to a compartment syndrome of the arm.

Ozcan K.S. Osmonov D.

Hematoma complicating permanent ratemaker implantation: The role and limitations of periprocedural antiplatelet therapy or anticoagulant therapy.

Journal of cardiology 62(2): pp.127-130.

Pancholy, S.B., Ahmed, I., Bertrand, O.F.

Frequency of radial vessel occlusion in patients who have received warfarin therapy and are undergoing coronary angiograms.

American Journal of Cardiology 113(2), pages 211-214.

Ricci F., De Caterina R., and Fedorowski A. (2015).

Orthostatic hypotension. Epidemiology and prognosis. Treatment.

Journal of the American College of Cardiology. 66(7). pp. 848-860.

Rodriguez-Leor O. Fernandez-Nofrerias E. Mauri J. Carrillo X. Salvatella N. Curos A. Serra J. Oliete C. Rivas C. Bayes-Genis A.

Integrating a local action plan in a regional primary angioplasty network (the Catalan Codi Infart system) speeds up reperfusion.

International journal cardiology, 164(4), pp.4354-43557.

Rodriguez?Luna D. Pineiro S. Rubiera M. Ribo M. Coscojuela P. Pagola J. Flores A. Muchada M. Ibarra B. Meler P. Sanjuan E.

In acute intracerebral hemorhage, blood pressure and course have an impact on hematoma growth.

European journal for neurology, 20 (9), pp.1277-1283.

Diagnostic transradial cardiac catheterization results in intramural hematoma and dissection of the left main coronaryartery.

Hellenic J Cardiol. 55(1): pp.65-69.

Saw, J. Mancini G.B. Humphries K., Fung A. Fung A. Boone R. Starovoytov A., and Aymong E., 2016.

Intracoronary imaging shows the angiographic appearances of spontaneous coronary arterial dissection.

Catheterization, Cardiovascular Interventions,87(2), pp.E54–E61.

Gulati, R.

Spontaneous dissection of the coronary artery: Revascularization versus conservative treatment.

Circulation: Cardiovascular interventions, 7(6), pages.777-786.