Assessment Subjective: Kinakabahan ako, safe ba yan? as verbalized by the patient.

Objective: Patient frequently asks questions about the procedure Looks worried Poor eye contact Increased BP, RR, PR

Diagnosis Anxiety r/t fear of interventional treatment process, outcomes and potential complications.

Planning Short term goal: Within 30 minutes of nursing interventions, the patient will verbalize understanding of the procedure. Long term goal: Within an hour of nursing interventions, the patients anxiety will decrease as evidenced by relaxed state and effective coping skills.

Intervention Independent: Monitor vital signs and observe patients behaviour. Assess patients level of anxiety. Determine past coping skills used. Acknowledge patients anxiety; do not reassure that everything will be alright. Allow the patient to verbalize his feelings and concerns. Be available to the patient for listening and talking. Explain to the patient the procedure (preoperative, intraoperative, and postoperative) by giving accurate information and using clear and understandable words. Use therapeutic communication; allow the patient to ask questions. Teach and provide patient comfort measures such as: modifying environment, back rub, guided imagery, listening to music, focussed breathing. Encourage patient to develop positive thinking. Encourage relatives to provide support and positive feedback to the patient.

Rationale To identify physical responses associated with the situation. To determine the severity and factors causing anxiety. To identify appropriate strategies that might be helpful in the situation. To avoid giving false hopes. To assure patient that the nurse is well aware to what hes experiencing; giving emotional support. To establish therapeutic relationship. Increased knowledge about the procedure will help decrease patients anxiety and promote what is reality. To promote effective communication with the patient. To deviate patients anxiety and promote a relaxed state.

Evaluation Goals are met.

Dependent: Administer sedative and pulse oximeter as ordered. Collaborative: Introduce the staff who will assist in the procedure.

To help patient to be relaxed. To decrease patients anxiety.

Assessment Subjective: Sumisikip dibdib ko as verbalized by the patient. Objective: Increased BP, RR, PR Shortness of breath Pain lasts less than 20 minutes in ischemic events

Diagnosis Acute chest pain r/t coronary artery occlusion secondary to procedure.

Planning Short term goal: During the procedure, the patient will be able to tolerate procedure verbalizing decreased in chest pain episodes. Long term goal: During and after the procedure, further complications of chest pain will be prevented and vital signs are within normal range.

Intervention Independent: Strictly monitor patients vital signs and neurologic status. Record nature, type, location, intensity and duration of chest pain. Remind patient that pain can be felt once balloon is inflated.

Rationale To have a baseline data and to identify significant alterations that can contribute to chest pain. This is normally felt during the procedure because the balloon briefly blocks blood supply to heart; however it should disappear when blockage is compressed. These may suggest that coronary artery is reclosing.

Evaluation Goals are met.

Encourage patient to report episodes of chest pain or other symptoms such as back pain, shortness of breath, tight squeeze in the chest, dizziness or change in vision. Encourage patient to keep calm. Advise patient to do deep breathing and coughing exercises. Monitor laboratory results such as cardiac enzymes.

Pain and anxiety increase pulse rate, oxygen consumption and cardiac workload To stabilize vital signs within normal ranges. Elevation in cardiac enzymes may indicate myocardial ischemia.

 Continuously monitor patients condition until absence of chest pain or other discomfort is reported. Dependent: Administer analgesics as ordered. Administer IV medications as ordered. Administer oxygen as ordered.

To detect complications for early interventions.

To promote rest, decrease oxygen consumption caused by pain, and aids patient in performing deep breathing and coughing exercises. To monitor ECG changes, especially arrhythmias accompanying pain.

Collaborative: Perform ECG by cardiologists.

Assessment Objective: Scanty bleeding on the incision site Slightly diminished pulse on the left groin area (grading of 3) Presence of bruise on the left groin area

Diagnosis Risk for bleeding r/t the use of blood thinning medications and blood vessel injury secondary to procedure.

Planning Short term goal: Within 30 minutes of nursing interventions, patients risk for bleeding will be controlled. Long term goal: After several hours of ongoing assessment and nursing interventions, the patient will be able to demonstrate behaviours and safety measures to prevent episodes of bleeding.

Intervention Independent: Monitor vital signs.

Rationale Bleeding can cause increased in heart rate and decreased in blood pressure. Active bleeding, pain, tenderness, swelling, hematoma are all signs of bleeding. It gives information on the coagulation/clotting status of the patient. Direct pressure on the incision site promotes haemostasis. To minimize the risk of bleeding from the incision

Evaluation Goals are met.

Assess the incision site for evidence of bleeding. Monitor Partial thromboplastin time, Prothrombin time and platelet count. Provide manual pressure for 515 minutes or application of compression device on the femoral artery. Encourage patient to minimize movement of the affected

extremity and advised patient to maintain bed rest in supine position for at least 6 hours. Instruct patient to apply minimal pressure on the incision site upon sneezing and coughing. Dependent: Administer heparin via infusion pump as prescribed.

site. To minimize the risk of bleeding and to facilitate clot formation.

To ensure prescribed dosage depending on the result of partial thromboplastin time. To minimize the risk of bleeding in accordance to the use of blood thinners.

Collaborative: Consult the physician on adjusting the dose of anticoagulant agents, when possible, taking into account the patients weight, age, and kidney function.