Mr. Bright's Limb Circulation: A Case Study

During the simulation an assessment of Mr. Bright’s limb circulation were performed. Performing circulatory observations on an individual who has recently undergone a PCI is crucial for detecting any localised vascular complications such as bleeding, hematoma, swelling, ecchymosis and pseudo-aneurysms. When learning in the hand over that Mr. Bright had “cold” feet post-op, it became clear that a prompt assessment for the colour, warmth and sensation of Mr. Bright’s feet and lower limbs was necessary to ensure that he was afebrile and there was sufficient circulation to his lower extremities. While assessing the colour, warmth and sensation of Mr. Bright’s lower limbs, an assessment of Mr. Bright’s peripheral pulses were taken and compared against his baseline observations prior to the procedure to detect any notable changes in his peripheral circulation.

Grave complications arising from surgical vascular access sites though rare, can lead to major complications in the recovery of a post-PCI patient. Assessment of the puncture site for localized complications allows for observation of the wounds integrity and monitor for external and internal bleeding. A common puncture site complication such as a hematoma may often present as swelling and discolouration beneath the epithelium. During the simulation, an assessment of the wound site
was performed to accurately detect whether a complication such as a hematoma was present. This was done by observing the wound site and palpating for swelling and identifying any distinctive discolouration present.

Furthermore, to accurately and effectively assess the status and well-being of Mr.
Bright, an assessment of his vital signs was taken. Having monitored and documented an accurate, up to date recording of Mr. Bright’s vital signs during the simulation, we were able to better evaluate the necessary course of action and appropriate treatment options to promote a stable recovery for our client. Performing regular assessments of a patient’s vital signs, who has recently undergone a PCI plays a critical role in the management and early diagnosis of any possible complications post-PCI and to evaluate Mr. Bright’s overall physiological
welfare.

A more simplistic and direct patient related response to any post-surgical complications, is of course experiencing pain. During the simulation, Mr. Bright expressed a sudden onset of chest pain which radiated to his left arm and jaw. Upon Mr. Bright expressing this sudden pain, an assessment was performed following the PQRST model. By doing this, we were able to gather all relevant essential information relating to the severity, location, sensation and time frame of his chest pain and were able to promptly offer therapeutic alleviation and immediately alerted his doctor to advise of his current pain. Assessing for pain in post-PCI patient, allows the healthcare team responsible for the well-being of the client to identify any complications and deterioration in health.

A necessary assessment when caring for a post-PCI patient which was not performed during the simulation, was an ECG. Following Mr. Bright’s report of acute chest pain, performing an ECG reading would have played a vital role in discerning the aetiology of his angina. An ECG assessment is an important method of assessment when used to observe patients who have undergone cardiovascular surgeries to assess for any signs of possible infarction, ischaemia, arrhythmias or other complications closely associated PCI.

When assessing for comorbidities such as impaired tissue perfusion relating to cardiovascular complications such as a hematoma, observing a post-PCI patient’s airways and breathing can aid in the identification of any underlying issues. An assessment using the ABCDE model, would have likely determined any respiratory deviations present and identified any signs of dyspnoea or abnormal respiratory sounds. Early detection and assessment of dyspnoea is crucial in the care of a post-PCI patient as it may often signify thromboembolic pulmonary complications.