Question

After reading this case study, complete the exercises following:

Mr. T.Y. is a 51-year-old Caucasian male scheduled for cardiac catheterization. His risk factors for heart disease are prior congestive heart disease, transient ischemic attack involving left arm, former prolonged tobacco use, a diet high in saturated fat, hyperlipidemia, obesity, hypertension, and poorly controlled diabetes. He made some attempts at risk reduction, stopping smoking two years ago and losing 40 pounds. However, he currently enjoys eating red meat at least twice a day. A butcher, he states he has no intention of quitting because he loves meat which is high in saturated fat.

Mr T. Y. has questions about this pending heart catheterization, though he had undergone one in 2002. He was concerned about the risks of possible new percutaneous interventions, and fearful that his disease might be too advanced for any treatment. Mr. T. Y. is coping with his anxiety by reading his Bible and praying, talking to his family on the phone, and asking numerous questions of the staff about the procedure.

His nurse assessed him as eager and motivated to learn about the cardiac catheterization procedure, but only somewhat motivated to learn about the appropriate dietary management of his heart condition. He did ask questions about what would be healthy to eat, but when he was told what an optimal diet would be, he shook his head “No,” indicating that a heart healthy diet as described was unacceptable.

1. Identify at least three high-priority learning needs (as evidenced by need for behavioral changes, not just by knowledge deficit) for Mr. T.Y.

          

2. Using the four indicators of physical, emotional, experiential and knowledge readiness, contrast Mr. T.Y.s readiness to learn about the imminent procedure with his readiness to learn about healthy dietary changes.

           

Answer 1

High priority learning needs are:

1. Cardiac catheterization: Cardiac catheterization is a procedure to examine how well is your heart working. A thin , hollow tube called a catheter is inserted into a large blood vessel that leads to your heart.

• How do i prepare for cardiac catheterization: Patient will be given instructions about what to eat and drink before 24 hours of test.
• Patient will be told not to take anything by muth for atleast 6-8 hours.
• Tell the doctor or nurse if the patient is allergic to anything.

What happens during catheterization:

• Before the cath procedure, a nurse will put an IV line into vein and give sedative
• Particular area will be shaved, usually groin area.
• Anesthesia will be given.
• Doctor will make a needle puncture through your skin into a large blood vessel. A small straw sized tube(called sheath) will be inserted into the vessel.Doctor will insert a guide catheter gently.

What happens after cardiac catheterization?

• Patient will be shifted to recovery room.
• Pressure will be applied to the puncture site to stop bleeding.
• Keep the leg straight aNd will not be able to get out of the bed.
• Vital signs will be monitored closely.
• Report any swelling , pain or bleeding at the puncture site.

A. 1.What happens after the patient get home?

• Take all medicines instructed timely.
• If there is any bleeding from the site then lie down straight and apply pressure at the site.

2. Anxiety before cardiac catheterization:

• To reduce anxiety of the patient counselling of the patient should be done.
• Nurse have to handle the patient physiological needs, such as manifestations of anxiety.
• Should gain confidence.
• Explain the benefits of the procedure.

3. Healthy diet:

• Advise him to reduce the intake of red meat, as it is very harmful, as red meat contains high saturated diet.

A. Mr. T.Y. should eat a healthy balanced diet

• He should control his diabetes for the surgery, as it is risky to do catheterization with high blood sugar.
• Mr. T.Y should decrease the intake of salt in his diet as increased salt intake can lead to hypertension and bleeding can occour after surgery.
• High saturated diet should be avoided because it may lead to blockage of heart. as he has underwent a cardiac catheterization before in 2002, he is at high risk.