NSB016 Clinical Practice Capstone


Identify and communicate principles for effective communication with patients to improve their situations.

Answer to Question: NSB016 Clinical Practice Capstone

To help me understand some objectives, I participated in a simulation based on clinical experience.

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One of these objectives was to identify the principles and methods of post-operative assessment.

Reporting: During the simulation I met Mr Bright, 65 years old and who had just undergone an angioplasty procedure.

Mr. Bright has a history DM-II, hypertension, and he smokes approximately 20 cigarettes per day.

He underwent an angioplasty procedure on his right heart.

The doctors placed a drug-releasing device stent in his body, with 10% residual stasis (Bonati, et al. 2012).

The angioplasty procedure proved difficult for the patient, who showed signs of myocardial damage.

He improved, as there was no evidence of swelling or haematoma. Also, the wound site only released a small amount of ooze.

I was to complete the second postoperative procedure. The first was performed before he was brought under my care.

His immediate post-op ECG reports were normal.

Responding: I was involved in the care of Mr Bright during his rehabilitation period. The RN had taken him out of my care.

The chest pain Mr Bright suffered from was alleviated by sublingual Nitroglycerine spray.

I was very interested in this case as it was a case involving classic heart disease. I had to follow a textbook angioplasty route (Martinez & Bucher 2008.

Relating to: Because Mr Bright was under my supervision, I had the responsibility of his next post-operative observation.

N-saline IVT injection of 1000 ml was administered at 100ml per hour to the patient.

The monitor was attached to the patient’s body to monitor his vitals, but there was no sign that he was bleeding.

Reasoning. I had to make sure that if the patient showed any signs of complications, I was responsive and dealt with them by the appropriate means.

Many patients who have similar histories have had complications, such as retroperitoneal bleeding (Tollefson 2010).

I had to watch for possible signs like arrhythmias.

Thrombus is a common sign and can be treated with Cardiac Resynchronization.

Cardiac Resynchronization Therapy may be used (Martinez & Bucher, 2008).

Reconstruction: This was an invaluable experience that taught me how to properly care for patients undergoing angioplasty.

I would use the information from this scenario to guide my future care for a similar patient.

After angioplasty, there are potential complications such as infection, haemorrhage (cardiac ischemia), and hemorhage.

Active arterial closure devices like collagen plug closure devices are useful in case the patient bleeds from a femoral puncture spot (Shoulders Odom (2008).

Regular dressing is important to prevent infection.

Administration of beta-blockers (Martinez & Bucher, 2008) is necessary to address cardiac ischemia.

As the wound can become infected, further damage can occur (De Luca et.al. 2013, 2013).

The patient would also learn self-management techniques to help with wound dressing.References:Bonati, L. H., Lyrer, P., Ederle, J., Featherstone, R., & Brown, M. M. (2012).

Percutaneous transluminal balloon angioplasty for carotid vein stenting.

The Cochrane Library.Retrievedfrom- https://onlinelibrary.wiley.com/doi/10.1002/14651858.CD000515.pub4/fullDe Luca, G., Dirksen, M. T., Spaulding, C., Kelbaek, H., Schalij, M., Thuesen, L., …&Chechi, T. (2013).

Diabetes’ Long-Term Impact on Outcomes after Primary Angioplasty.

Diabetes Care 36(4), 1020-1025.Martinez, L & Bucher, L. (2008).

Nursing management: Coronary disease and acute heart syndrome.

D. Brown & H. Edwards. ), Lewis’s Medical-Surgical Nursing, 3590-3734Retrieved from – https://nursekey.com/nursing-management-coronary-artery-disease-and-acute-coronary-syndrome/Retrieved from- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3609523/Shoulders-Odom, B.

(2008). Management of patients after percutaneous Coronary Interventions.

Critical Care Nurse, 28(5) 26.Retrieved from- https://ccn.aacnjournals.org/content/28/5/26.longTollefson, J. (2010).

Assessment tools for nursing students using clinical psychomotor skills, (4th Edn. ),Retrieved from- https://books.google.co.in/books?hl=en&lr=&id=jmKnfvbdvacC&oi=fnd&pg=PR5&dq=Clinical+Psychomotor+Skills:+assessment+tools+for+nursing+students&ots=0iEUrjMoHe&sig=Sxl2y0QZvxUiCIpVm1yGfMacrxQ#v=onepage&q=Clinical%20Psychomotor%20Skills%3A%20assessment%20tools%20for%20nursing%20students&f=false

The 5R framework of reflection.Retrieved from: https://www.studenteportfolio.qut.edu.au/staff_resources/resources/The%205%20Rs_Framework.pdf