Question

A 75-year-old man experiencing rest pain and diagnosed with stenosis of his external iliac artery is scheduled for an angiogram and endovascular management. He is prescribed dabigatran for atrial fibrillation and has a serum creatinine of 2.0 mg/dL.

What factors would you consider when planning pre-and post-procedure care for this patient?

Would his care be different if he had normal sinus rhythm with normal renal function? Why or why not?

Identify a nursing diagnosis and a rationale for the nursing diagnosis based on the needs of this patient.

Answer 1

What factors would you consider when planning pre-and post-procedure care

Before the procedure:

• Instruct the patient to be nil by mouth from midnight.
• Stop or alter the medication dabigatran as per doctor's advice to avoid bleeding during the procedure.
• check for any allergies to drugs or dye.
• Check serum creatinine and urea level.
• Explain the procedure to the patient.
• Shave the arm axilla, chest and groin areas.
• Take ECG prior to the procedure.
• Check vital signs.
• Remove all the jewels.
• Empty the bladder prior to the procedure.

After the procedure:

• Advised for bed rest for 6-8 hours.
• Check for peripheral pulses.
• Connect to the monitor.
• Check vital signs for every 15 minutes up to 2hours and then by every half-an-hour.
• Advised to immobilize the part(radial or groin).
• Administer IV fluids as per doctor's instruction.
• Monitor intake and output chart to maintain a positive balance.
• Encourage for voiding
• Check the site for any bleeding.
• Check the urine for any hematuria and other complications.

Would his care be different if he had normal sinus rhythm with normal renal function? Why or why not?

Yes. I care will be different for the renal impaired patient. Because the contrast dye may worsen the patient condition. The dye can be chosen as per the condition because it should be eliminated only through urine post procedure. Dabigatran has withdrawn prior to because it acts as an anticoagulant and atrial fibrillation increases the risk during the procedure. So this patient needs special care Compared to the patient with normal sinus rhythm and renal function.

Identify a nursing diagnosis and a rationale for the nursing diagnosis based on the needs of this patient.

Acute pain related to angiogram as evidenced by pain scale.

Intervention:

• Assess the level of pain using pain scale.
• Use mild analgesics and avoid NSAIDs as he is the risk of kidney failure.
• Immobilize the body part and encourage active positioning.

Fluid volume excess related to angiogram as evidenced by poor renal function

• Assess the fluid status.
• Maintain fluid and electrolyte balance.
• Maintain IV fluids.
• Check for urination.
• Maintain intake and output chart.
• Check serum creatinine level and information to a physician.