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November 12, 2024
The development of a massive groin hemorrhage after the left anterior descending artery angioplasty, stent, and angiography is the main nursing concern. The patient's right femoral artery was used to do this surgery. When the femoral artery cannot be managed after the sheath is removed, a fairly frequent condition that often affects the patient is a groin hemorrhage (DeBruce, 2015). A research by Wasana and Kingkarn found that hospital post-cardiac catheterization treatment had an impact on the development of groin hemorrhage (Wasana & Kingkarn, 2021). After an angioplasty and an angiography, groin hemorrhage may be caused by a variety of reasons. Age over 65, obesity, and the use of certain drugs, such as clopidogrel, aspirin, and glycoprotein IIb/IIIa inhibitors, are some of the variables that contribute to hemorrhage (Themes, 2016).
The patient's bleeding from the groin area is another nursing issue. The femoral sheath, which is made up of the femoral vein, femoral artery, and lymphatics, may have been the site of this bleeding ("Complications of Post Angioplasty Bleeding", 2020). The bleeding may continue beyond the sheath wall and reach the abdominal wall. If not identified promptly, this bleeding may become serious and result in further consequences, such as multiorgan dysfunction ("Complications of Post Angioplasty Bleeding", 2020). According to AL-Momani and AbuRuz (2019), a number of variables, such as a history of hypertension, diabetes mellitus, renal failure, and peripheral vascular disease, are thought to have an impact on blood leakage from the groin location. According to the patient's medical history, he had Type 2 diabetes and hypertension. As a result, these risk factors have made this patient's groin issues worse.
The patient's immune was already weakened after undergoing the angiography and angioplasty. Following the development of a major hemorrhage and bleeding from his groin site, his chance of developing further infections may also rise due to specific diseases such as hypertension, age, diabetes, and cardiovascular issues. Because it might result in the development of other illnesses, a wet bed is also a problem for nursing care. Knowing where the hemorrhage is is crucial to halting the spread of any illness. To accurately determine the extent and location of a hemorrhage, a CT scan may be useful (Brilakis, 2021). An ultrasound may also be used to determine if other issues are present (Brilakis, 2021).
A hemorrhage may develop when exterior bleeding builds up or conceals itself within a tissue. A hemorrhage may be little or massive, and it causes noticeable swelling. Blood leakage is seen as a result of the increased strain on the blood vessels. In addition to being very annoying, this blood leak may cause further inflammatory symptoms including pain, swelling, and redness (Yuliastuti & Rinarto, 2018). One of the main nursing concerns is determining the extent of discomfort and edema brought on by the groin hemorrhage so that the patient may get the appropriate care.
If the groin hemorrhage is not treated right away, it may potentially result in an arteriovenous fistula. One of the main possible nursing concerns is an arteriovenous fistula, which occurs when blood flows from an artery into a vein by passing over certain capillaries. Under normal conditions, blood flows from the artery to the capillaries and then to the veins. Because they may be situated underneath the bypassed capillaries, a number of the patient's tissues may get less blood as a result of this illness. This problem has to be treated right away since it might cause more significant issues. This disorder is caused by a number of risk factors, including as cardiac catheterization, anticoagulant and ant-fibrinolytic drugs, high blood pressure, high body mass index, and advanced age ("Arteriovenous fistula - Symptoms and causes", 2020). Since Mr. Little has some of these risk factors as well, it's critical to treat the groin hemorrhage and bleeding.
Bleeding, a groin hemorrhage, and prolonged use of a moist bed may all cause infection, which can lead to neuritis, or inflammation of the nerves. The most common causes of this illness are autoimmune diseases, infections, and injuries ("neuritis | pathology", 2022). In this instance, the infection may result in neuritis. Tenderness, soreness, decreased sweating ability, hypersensitivity, diminished strength and reflexes, and circulation abnormalities are the main signs of this illness. This disorder may cause inflammation in one or more nerves. With the help of the inflammatory nerves, the symptoms of this disorder are mostly localized to a single part of the body ("neuritis | pathology", 2022).
Blood leaking from the patient's groin area raises the risk of a pseudoaneurysm, a nursing concern. An damage to the blood vessel is the cause of this disorder. Blood oozing from this damaged blood artery may accumulate in the surrounding tissue (Lopez-Jimenez, 2020). Another name for this kind of illness is a fake aneurysm. A real aneurysm is a different kind of pseudoaneurysm that manifests as a weakening and bulging of the artery or vessel, sometimes forming a blood-filled sac (Lopez-Jimenez, 2020). According to some research, this ailment is among the main side effects of cardiac catheterization. Pseudoaneurysms often occur when there is a blood leak, as was the situation with Mr. Little. This situation may be brought on by the buildup of blood outside the artery where the catheter was inserted (Lopez-Jimenez, 2020).
Vessel thrombosis is another possible nursing concern. There occurs the development of one or more clots in the blood arteries in this dangerous medical disease. Blood clots may develop within the blood arteries as a result of this illness, obstructing blood flow ("Thrombosis: Types, Causes, Symptoms & Treatment", 2022). These clots have the ability to travel throughout the body and get lodged in potentially harmful areas, such as the brain or lungs. This illness has the potential to be fatal. People of any age who suffer from illnesses including diabetes, cancer, atrial fibrillation, or heart disease may develop this ailment ("Thrombosis: Types, Causes, Symptoms & Treatment", 2022). The majority of the health issues that might impact this illness are present in the patient.
One of the most crucial early post-operative actions is evaluating the whole body. To ensure that there are no health issues that might cause further disruptions, it is important to get a thorough medical history and do a thorough physical examination (Acquadro et al., 2018). A comprehensive and methodical cardiovascular evaluation is required. All vital indicators, including temperature, oxygen saturation, pulse rate, systolic blood pressure, respiration rate, and state of consciousness, should be checked very away and recorded in accordance with current standards (Contributor, 2013). To comprehend the situation, the location and extent of the hemorrhage must be evaluated (DeBruce, 2015). To determine the bleeding, swelling, discomfort, and redness of a hemorrhage, the puncture site must also be evaluated ("Clinical Guidelines (Nursing): Care of the patient post-cardiac catheterization", 2022).
The primary focus is on managing bleeding from a groin hemorrhage. Applying physical compression on the hemorrhage is necessary to control bleeding ("Clinical Guidelines (Nursing): Care of the patient post cardiac catheterization", 2022). A pressure dressing must be applied after this manual compression. The patient must be in a supine position with the leg raised in order to provide pressure above the puncture site ("Clinical Guidelines (Nursing): Care of the patient post cardiac catheterization", 2022). If the patient is receiving a heparin infusion, it must be discontinued. The pressure bandage also has to be strengthened. "Clinical Guidelines (Nursing): Care of the patient post cardiac catheterization," 2022, states that the doctor must be notified right away.
Any surgical surgery still involves pain, both during and after the treatment. After surgery, the discomfort might sometimes be excruciating. The best way to deal with pain is to assess its level of severity and plan ahead for it (Park & Park, 2019). Bleeding and a groin hemorrhage are often accompanied by discomfort, swelling, and redness that need to be treated right once (Yuliastuti & Rinarto, 2018). Given Mr. Little's severe bleeding and big hemorrhage, pain evaluation and treatment are essential. The goal is to reduce or eliminate pain and suffering while minimizing adverse effects (Laigaard et al., 2021). Analyzing the degree, intensity, and consequences that exacerbate pain is the first step. Both pharmacologic and nonpharmacological aspects of pain treatment, such as painkillers, education, and comfort therapy, should be used while taking the patient's medical history into consideration (Laigaard et al., 2021).
As long as feasible, patients should be advised to remain in bed (Health Times, 2022). After the pain and bleeding are controlled, he has to rest flat for a few hours. A maximum tilt of thirty degrees is possible with the bed (Health Times, 2022). If the patient desires, he may eat right after the hemorrhage and bleeding have been controlled. When the allotted amount of time for bed rest is up, he could get out of bed (Health Times, 2022). The patient has to be helped by a nurse when he gets up for the first time for his safety. Additionally, the nurse has to check the patient's blood pressure when they are standing, sitting, and lying down (Health Times, 2022).
According to Song et al. (2019), this is a concept, evidence-based module, timetable, and preliminary information that helps identifying, categorizing, and treating patients' challenges, problems, and outcomes in order to restore wellbeing. When the evaluation is chosen as an intervention, it helps identify changes in the patient's health and prevents them from becoming worse. In order to rule out potential consequences related to the hemorrhage, it is crucial that Mr. Little's vital signs be evaluated.
Internal bleeding is the main cause of trauma-associated death worldwide. If left untreated, it may result in external bleeding, coma, organ failure, and ultimately death (Huizen, 2017). In order to prevent the situation from becoming worse, bleeding must be controlled. A cold compress is ideal for this condition since it reduces the amount of blood that reaches the puncture site (Plan, 2015). Additionally, physical compression reduces inflammation and edema in the affected area of the hemorrhage. Severe bleeding must also be stopped by stopping the heparin infusion (Plan, 2015).
To lessen the patient's suffering, pain management is necessary. Increased discomfort may indicate a growing risk of groin hemorrhage (Yuliastuti & Rinarto, 2018). Therefore, it's critical to gauge the degree and severity of the pain in order to begin medication and appropriate therapy.
Promoting bed rest may increase blood flow and lower the risk of developing other issues that might increase the likelihood of a clot forming. To determine if standing has caused a decline in health, blood pressure must be measured. If necessary, it will also assist in starting the treatment of the difficulty (Health Times, 2022).
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AL-Momani, M., & AbuRuz, M. (2019). Incidence and predictors of groin complications early after coronary artery intervention: a prospective observational study. BMC Nursing, 18(1). doi: 10.1186/s12912-019-0349-8
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