🫀 Case Study on Coronary Angioplasty (PTCA with Stenting)

Medical-Surgical Nursing | NANDA Nursing Care Plan Format

Cardiology Nursing | Practical File Ready

⚠️ Educational Purpose Only: This case study is for nursing academic practical file preparation. Not for actual patient care or clinical decision-making.

📋 Student Information

Student Name	[Your Name]
Course	BSc Nursing / GNM / ANM
Subject	Medical-Surgical Nursing / Cardiology Nursing
Case Study Topic	Coronary Angioplasty (PTCA with Drug-Eluting Stent)
Format	NANDA-I Nursing Care Plan Format
Date of Submission	[Enter Date]
Clinical Instructor	[Instructor Name]

📄 Page 1 — Patient Identification Data

Name	Mr. Rajendra Prasad Sharma
Age	58 Years
Sex	Male
Address	Vaishali Nagar, Jaipur
Occupation	Bank Manager (Sedentary Job)
Marital Status	Married
Religion/Category	Hindu
Annual Income	₹8,00,000/-
Diagnosis	Coronary Artery Disease (CAD) — Single Vessel Disease
Type of Family	Nuclear
Family Size	4 Members
Ward/Bed No.	Cardiac Care Unit (CCU) / Bed 8
Doctor Incharge	Dr. S. K. Sharma (Interventional Cardiologist)
Date of Admission	10/05/2026
Hospital Name	SMS Medical College & Hospital, Jaipur

📄 Page 2 — Chief Complaints & Clinical History

CHIEF COMPLAINT

The patient was brought to the hospital with the complaints of:

Chest pain (Angina) — retrosternal, heaviness type, radiating to left arm
Shortness of breath on exertion (NYHA Class II)
Palpitations — occasional, associated with chest discomfort
Excessive sweating (diaphoresis) during pain episodes
Fatigue and weakness — generalized, affecting work performance
Exercise tolerance decreased — dyspnea after walking 200 meters

HISTORY OF PRESENT ILLNESS

The patient, Mr. Rajendra Prasad Sharma, a 58-year-old male bank manager with a sedentary lifestyle, presented with a 2-week history of progressive exertional chest pain. He describes the pain as retrosternal heaviness radiating to the left arm, occurring during walking, climbing stairs, and during stressful work situations. Each episode lasts 5-10 minutes and is relieved by rest and sublingual nitrates (Sorbitrate 5mg).

An ECG done at a local clinic showed ST-segment depression in anterior leads (V2-V6) suggestive of myocardial ischemia. He was referred to the cardiology department. A 2D Echocardiogram revealed mildly reduced LVEF (52%) with anterior wall hypokinesia. Coronary Angiography performed via right radial approach revealed 90% tubular, eccentric stenosis in the proximal LAD artery. PTCA with Drug-Eluting Stent (DES — Sirolimus-eluting, 3.0 × 23 mm) deployment was successfully performed. The patient is currently in CCU for post-procedural monitoring and care.

PAST MEDICAL HISTORY

Hypertension — 10 years; on Telmisartan 40mg OD
Diabetes Mellitus (Type 2) — 5 years; on Metformin 500mg BD; HbA1c 7.8%
Dyslipidemia — on Atorvastatin 20mg OD
No history of thyroid disorder
No history of tuberculosis
No previous cardiac events — first episode of angina

PAST SURGICAL HISTORY

No history of any major surgery prior to PTCA
No history of blood transfusion
Local anesthesia (Lignocaine 2%) at radial access site — uneventful
No prior angiography or intervention — first catheterization

📄 Page 3 — Family History & Composition

FAMILY HISTORY

The patient belongs to a nuclear family.
There are 4 members in the family.
Strong family history of premature CAD.
Father — Myocardial infarction at age 52; expired at 65.
Brother — CAD diagnosed at 50; underwent CABG at 52.
Sister — Healthy; age 54.
Mother — Hypertension; alive at 80.

FAMILY COMPOSITION

Name	Age/Sex	Education	Occupation	Marital Status	Relationship	Health Status
Mr. Rajendra Sharma	58/M	Graduate	Bank Manager	Married	Self (Patient)	CAD — Post PTCA
Mrs. Sunita Sharma	52/F	Graduate	Housewife	Married	Wife	Healthy
Mr. Amit Sharma	28/M	MBA	Software Engineer	Unmarried	Son	Healthy
Ms. Priya Sharma	24/F	MBBS Student	-	Unmarried	Daughter	Healthy

FAMILY TREE

□ Mr. Sharma Sr. (Father — MI at 52, expired at 65)
○ Mrs. Sharma (Mother — HTN, alive at 80)
□ = Male  |  ○ = Female  |  ○ = Patient
□○ Mr. Rajendra Sharma (Patient — CAD, Post PTCA)
│
├── □ Mr. Amit Sharma (Son — Healthy)
└── ○ Ms. Priya Sharma (Daughter — Healthy)

📄 Page 4 — Dietary, Personal, Socio-Economic & Environmental History

DIETARY HISTORY

The patient takes a mixed diet.
Diet is high in saturated fats, fried foods, and salt.
Low fiber intake with irregular meal timings due to work.
High caffeine intake — 4-5 cups tea/coffee daily.
Adequate intake of fluids.
No history of food allergy reported.

PERSONAL HISTORY

Sleep: 6 hours; disturbed sleep due to work stress; occasional insomnia
Appetite: Normal; slightly reduced since admission
Bowel: Regular; once daily — normal consistency
Bladder: Normal; post-procedure frequent urination due to IV fluids
Habits: Ex-smoker (quit 2 years ago — 20 pack-years); occasional alcohol
Activity level: Sedentary; no regular exercise; desk job 8-10 hours/day
Allergy: No known drug or food allergies; contrast dye tolerated without reaction
BMI: 29.2 kg/m² (Overweight); abdominal obesity (waist circumference 104 cm)

SOCIO-ECONOMIC HISTORY

The patient belongs to a middle-class family.
Total annual family income is approximately ₹8,00,000 per year.
The family lives in a nuclear family setup.
Patient has access to medical facilities and health insurance.
Worried about financial implications and prolonged leave from work.

ENVIRONMENTAL HISTORY

The family lives in their own house with adequate ventilation.
No exposure to industrial pollutants.
Uses LPG for cooking.
Safe drinking water supply available.
Living environment is clean and hygienic.

📄 Page 5 & 6 — Physical Examination

GENERAL CONDITION

Patient is conscious, oriented and cooperative. Patient appears anxious about heart condition and procedure outcome. Resting comfortably in bed with right wrist immobilized.

VITAL SIGNS (Post-Procedure Day 1)

Temperature: 98.6°F (Normal)
Pulse: 74/min (Controlled — on Metoprolol)
Respiration: 16/min (Normal)
Blood Pressure: 130/82 mmHg (Improved from pre-procedure 148/92)
SpO₂: 98% on room air
Pain Score: 0/10 (No chest pain; access site minimal tenderness)

GENERAL APPEARANCE

Built: Endomorphic; overweight with central obesity
Posture: Comfortable; right wrist immobilized
Activity: On bed rest per post-PCI protocol
Speech: Clear and coherent
Signs of distress: Mild anxiety present; no acute distress

SYSTEMIC EXAMINATION

Cardiovascular	S1, S2 normal; no murmurs, gallops, or rubs; peripheral pulses palpable and equal; right radial pulse strong; CRT <3 sec; no JVD
Respiratory	Bilateral air entry equal; clear lung fields; no crackles, wheezes; RR 16/min; SpO₂ 98%
CNS	Conscious; oriented to time, place, person; GCS 15/15; no focal neurological deficit; anxiety present
Gastrointestinal	Abdomen soft, non-tender; bowel sounds present and normal; mild nausea reported
Renal	Voiding adequately; urine output >50 mL/hr; monitoring for contrast-induced nephropathy
Access Site (Right Radial)	TR Band removed; site clean, dry; no hematoma, bleeding, or oozing; right hand warm, pink, CRT <3 sec
Integumentary	No pallor, cyanosis, icterus, clubbing; xanthelasma present on upper eyelids
Psychological	Anxious about stent, need for lifelong medications, fear of re-blockage

📄 Page 7 — Vital Signs Monitoring Record

DATE/TIME	TEMP (°F)	PULSE (/min)	RESP (/min)	BP (mmHg)	SpO₂ (%)	PAIN (0-10)
10/05/2026 (Pre-procedure)	98.4°F	78/min	18/min	148/92	97%	2/10
11/05/2026 (Post-procedure)	98.8°F	72/min	16/min	126/78	98%	1/10
12/05/2026 (POD 1)	98.6°F	74/min	16/min	130/82	98%	0/10
13/05/2026 (POD 2)	98.6°F	72/min	16/min	128/80	99%	0/10
14/05/2026 (POD 3)	98.4°F	70/min	15/min	124/76	99%	0/10

📈 Nursing Trend: Excellent recovery — BP normalized from 148/92 to 124/76; heart rate controlled; pain resolved; SpO₂ maintained >97%.

📄 Page 8 — Diagnostic Investigations

SR. NO.	INVESTIGATION	NORMAL VALUE	PATIENT'S VALUE	REFERENCE
1	Hemoglobin	13–17 g/dL	13.8 g/dL	Normal
2	Total WBC Count	4,000–11,000/mm³	7,200/mm³	Normal
3	Platelet Count	1.5–4 lakh/mm³	1,98,000/mm³	Normal (on DAPT)
4	Fasting Blood Sugar	70–110 mg/dL	142 mg/dL	Elevated
5	HbA1c	<6.5%	7.8%	Elevated
6	Serum Creatinine (Pre)	0.7–1.3 mg/dL	1.1 mg/dL	Normal
7	Serum Creatinine (24hr Post)	0.7–1.3 mg/dL	1.2 mg/dL	Normal; no CIN
8	Blood Urea	15–40 mg/dL	32 mg/dL	Normal
9	Total Cholesterol	<200 mg/dL	228 mg/dL	Elevated
10	LDL Cholesterol	<100 (<70 for CAD)	142 mg/dL	Critically Elevated
11	HDL Cholesterol	>40 mg/dL	34 mg/dL	Low
12	Triglycerides	<150 mg/dL	210 mg/dL	Elevated
13	Cardiac Troponin I (HS)	<34 ng/L	18 ng/L	Normal
14	ECG (Pre-procedure)	ST depression V2-V6; T wave inversion		Anterior wall ischemia
15	ECG (Post-procedure)	ST segments normalized; no new Q waves		Successful revascularization
16	2D Echocardiogram	LVEF 52%; mild anterior wall hypokinesia		Mild LV dysfunction
17	Coronary Angiography	90% stenosis proximal LAD; TIMI 3 flow post-stenting		Single vessel disease — treated
18	Chest X-Ray	Normal cardiac size; clear lung fields		Normal

📄 Page 9 — Medical Management (Drug Chart)

SR. NO.	MEDICATION	DOSE	FREQUENCY	ROUTE	ACTION
1	Tab. Aspirin	150 mg	OD (lifelong)	Oral	Antiplatelet — prevents stent thrombosis
2	Tab. Clopidogrel	75 mg	OD (min 12 months)	Oral	DAPT — P2Y12 inhibitor; prevents stent thrombosis
3	Tab. Atorvastatin	40 mg	OD (HS)	Oral	High-intensity statin — LDL lowering; plaque stabilization
4	Tab. Telmisartan	40 mg	OD	Oral	ARB — blood pressure control; target <130/80
5	Tab. Metoprolol	25 mg	BD	Oral	Beta blocker — reduces myocardial O₂ demand
6	Tab. Metformin	500 mg	BD	Oral	Glycemic control; target HbA1c <7%
7	Inj. Heparin (Peri-procedural)	5,000 units	Stat	IV	Anticoagulation during PCI
8	IV Normal Saline	1 mL/kg/hr	12 hrs pre & post	IV	Prevents contrast-induced nephropathy

📄 Page 10 — Disease Introduction, Etiology & Pathophysiology

INTRODUCTION

Coronary Artery Disease (CAD) is a condition characterized by narrowing or blockage of the coronary arteries due to atherosclerosis, leading to reduced blood flow to the heart muscle. It commonly presents with symptoms such as chest pain (angina), shortness of breath, and fatigue. Percutaneous Transluminal Coronary Angioplasty (PTCA) with stenting is a minimally invasive procedure used to open blocked coronary arteries and restore blood flow to the heart muscle.

ETIOLOGY

The primary cause of CAD is atherosclerosis — the buildup of plaque (cholesterol, fat, calcium) in the coronary arteries. Common causes and risk factors include:

Atherosclerosis (most common)
Hypertension
Diabetes Mellitus
Dyslipidemia (high LDL, low HDL)
Smoking
Obesity and physical inactivity
Family history of premature CAD

Predisposing factors include:

Age (>45 years for males)
Male gender
Genetic predisposition
High-stress occupation
Unhealthy diet (high saturated fats, salt)
Alcohol consumption

PATHOPHYSIOLOGY

CAD begins with endothelial injury to the coronary artery wall caused by risk factors like hypertension, smoking, and hyperlipidemia. This injury allows LDL cholesterol to infiltrate the arterial wall, triggering an inflammatory response. Macrophages engulf oxidized LDL, forming foam cells and fatty streaks — the earliest stage of atherosclerosis.

Over time, smooth muscle proliferation, collagen deposition, and calcium accumulation form a fibrous cap over the lipid core, creating a mature atherosclerotic plaque. This plaque narrows the vessel lumen (stenosis), reducing blood flow. When the plaque ruptures, it exposes thrombogenic material to the bloodstream, causing platelet aggregation and thrombus formation — leading to partial or complete vessel occlusion, resulting in myocardial ischemia or infarction.

PTCA with stenting mechanically opens the narrowed artery by inflating a balloon at the stenosis site, compressing the plaque against the vessel wall. A drug-eluting stent (DES) is deployed to maintain vessel patency and slowly release medication to prevent restenosis.

📄 Page 11 — Clinical Manifestations, Diagnostic & Medical Management

CLINICAL MANIFESTATIONS

The patient in this case presented with the following features:

Chest pain (Angina) — retrosternal heaviness radiating to left arm
Shortness of breath on exertion (NYHA Class II)
Palpitations
Excessive sweating (diaphoresis) during pain episodes
Fatigue and weakness
Decreased exercise tolerance
ST-segment depression on ECG (anterior leads)

DIAGNOSTIC EVALUATION

CAD is diagnosed based on clinical features, ECG, cardiac biomarkers, echocardiography, and coronary angiography. Findings in this patient included:

ECG: ST depression in V2-V6 — anterior wall ischemia
2D Echo: LVEF 52%; anterior wall hypokinesia
Coronary Angiography: 90% stenosis in proximal LAD
Troponin I: 18 ng/L (normal — no acute MI)
Lipid Profile: LDL 142 mg/dL (elevated), HDL 34 mg/dL (low)
HbA1c: 7.8% (uncontrolled diabetes)

MEDICAL MANAGEMENT

Dual Antiplatelet Therapy (DAPT) — Aspirin + Clopidogrel
High-intensity statin (Atorvastatin 40mg)
Beta-blocker (Metoprolol) — reduces myocardial oxygen demand
ARB (Telmisartan) — blood pressure control
Metformin — glycemic control
IV Normal Saline — prevention of contrast-induced nephropathy
PTCA with DES deployment — mechanical revascularization
Cardiac rehabilitation program — Phase I to Phase III

📄 Page 12 — Nursing Management, Health Education, Prognosis & Conclusion

NURSING MANAGEMENT

Continuous cardiac monitoring — observe HR, rhythm, ST segment changes
Assess for chest pain — location, severity (0-10 scale), associated symptoms
Monitor vital signs per post-PCI protocol
Administer DAPT strictly on time — Aspirin + Clopidogrel
Assess radial access site — bleeding, hematoma, neurovascular status
Maintain patent hemostasis with TR Band protocol
Monitor urine output — prevent contrast-induced nephropathy
Provide calm environment to reduce anxiety
Educate patient about DAPT compliance, diet, activity, follow-up
Monitor cardiac biomarkers — Troponin I at 6 and 12 hours post-procedure

HEALTH EDUCATION

NEVER STOP Aspirin or Clopidogrel without cardiologist consultation
Take all medications exactly as prescribed at the same time daily
Follow cardiac diet — low saturated fat, low salt (<2g/day), high fiber
Complete smoking cessation — ZERO tobacco
Regular physical activity — start with short walks, gradually increase
Attend cardiac rehabilitation program
Keep follow-up appointments — cardiologist at 2 weeks, 6 months, annually
Report warning signs immediately — chest pain at rest, black/tarry stools, sudden severe headache
Stress management — yoga, meditation, deep breathing
No heavy lifting (>5 kg) with right arm for 1 week

PROGNOSIS

With successful PTCA and DES deployment, appropriate medication compliance, and comprehensive lifestyle modification, the prognosis of single vessel CAD is generally excellent. DES patency rates exceed 90% at 1 year. Long-term outcomes depend on DAPT adherence, risk factor control, and regular cardiac follow-up.

CONCLUSION

This case highlights CAD as a manageable cardiovascular condition when treated with timely revascularization and comprehensive secondary prevention. Effective nursing care — from vigilant post-procedural monitoring to thorough patient education — plays a critical role in preventing stent thrombosis, promoting recovery, and ensuring long-term quality of life.

📄 Page 13 — NANDA Nursing Diagnoses

Risk for decreased cardiac tissue perfusion related to coronary artery disease, possible thrombus formation, coronary artery spasm, and stent thrombosis as evidenced by history of critical LAD stenosis and recent PTCA with stenting.
Risk for bleeding related to arterial access site (right radial artery), use of dual antiplatelet therapy (Aspirin + Clopidogrel), and peri-procedural anticoagulation (Heparin).
Acute pain related to arterial access site trauma, sheath insertion, and compression device (TR Band) as evidenced by patient reporting tenderness at right wrist and pain score 1-2/10.
Risk for impaired renal function (Contrast-Induced Nephropathy) related to administration of iodinated contrast media during coronary angiography and PTCA, pre-existing diabetes, and hypertension.
Anxiety related to diagnosis of coronary artery disease, invasive cardiac procedure, fear of re-stenosis, and uncertainty about future health as evidenced by patient's repeated questioning, restlessness, and expressed worry.
Deficient knowledge regarding post-PTCA care, DAPT medications, risk factor modification, and recognition of warning signs of stent thrombosis/MI.
Activity intolerance related to imbalance between myocardial oxygen supply and demand secondary to CAD and bed rest post-procedure as evidenced by NYHA Class II symptoms and sedentary lifestyle.
Ineffective health maintenance related to inadequate management of modifiable risk factors (uncontrolled diabetes, dyslipidemia, obesity, sedentary lifestyle) as evidenced by HbA1c 7.8%, LDL 142 mg/dL, BMI 29.2.

📄 Page 14-16 — Nursing Care Plans (NANDA Format)

Nursing Care Plan — 1: Risk for Decreased Cardiac Tissue Perfusion

ASSESSMENT	NURSING DIAGNOSIS	GOAL/EXPECTED OUTCOME	PLANNING	IMPLEMENTATION	EVALUATION
Subjective: Patient asks "Can the stent get blocked again?" Reports chest pain history. Objective: 90% LAD stenosis — stented; on DAPT; ECG — ST normalized post-PCI; Troponin I — 18 ng/L	Risk for decreased cardiac tissue perfusion related to CAD, thrombus formation, and stent thrombosis	Short term: Patient will remain free from chest pain, ECG changes, and arrhythmias during hospital stay. Long term: Patient will demonstrate adequate cardiac perfusion as evidenced by no angina, normal ECG, and improved exercise tolerance; will verbalize DAPT compliance.	• Continuous cardiac monitoring • Assess for chest pain every 2 hours & PRN • Monitor vital signs per PCI protocol • Record 12-lead ECG if chest pain occurs	• Administer DAPT strictly on time • Educate on DAPT — never stop without cardiologist approval • Monitor cardiac biomarkers • Report any ST changes immediately	• No chest pain reported post-procedure • ECG — NSR; no ST changes • Troponin I — 18 ng/L (normal) • Patient verbalized DAPT understanding

Nursing Care Plan — 2: Risk for Bleeding

ASSESSMENT	NURSING DIAGNOSIS	GOAL/EXPECTED OUTCOME	PLANNING	IMPLEMENTATION	EVALUATION
Subjective: Patient reports mild tenderness at right wrist. Objective: Right radial access site — TR Band in situ; on Aspirin + Clopidogrel + Heparin; Platelet count — 1,98,000	Risk for bleeding related to arterial access site, dual antiplatelet therapy, and peri-procedural anticoagulation	Short term: Access site will remain free from bleeding/hematoma during hospital stay. Long term: Right radial artery will remain patent; patient will demonstrate bleeding precaution knowledge.	• Assess access site per protocol • Mark hematoma borders if bleeding noted • Assess right hand neurovascular status with each check	• Maintain patent hemostasis with TR Band • Keep right wrist straight and immobilized for 6 hours • Educate — avoid lifting >5 kg with right arm for 1 week	• TR Band removed at 6 hours — patent hemostasis achieved • No bleeding, hematoma, or oozing • Radial pulse strong • Patient demonstrated bleeding precautions

Nursing Care Plan — 3: Deficient Knowledge

ASSESSMENT	NURSING DIAGNOSIS	GOAL/EXPECTED OUTCOME	PLANNING	IMPLEMENTATION	EVALUATION
Subjective: Patient asks "How long do I need these blood thinners?"; "Can I eat normal food now?"; "When can I return to work?" Objective: Unable to list medications correctly; unaware of dietary restrictions; uncertain about follow-up schedule	Deficient knowledge regarding post-PTCA care, DAPT medications, risk factor modification, and recognition of warning signs	Short term: Patient will verbalize medication regimen, dietary guidelines, and activity restrictions within 3 teaching sessions. Long term: Patient will demonstrate correct medication administration; will adopt heart-healthy lifestyle; will attend cardiac rehabilitation.	• Assess readiness to learn • Prepare written medication schedule (Hindi/English) • Plan 3 structured teaching sessions	• Teach medication regimen with written schedule • Explain DAPT — Aspirin lifelong, Clopidogrel min 12 months • Provide dietary education — low fat, low salt • Teach warning signs requiring immediate ER visit	• Patient named all 8 medications by discharge • Demonstrated DAPT understanding • Listed 5 dietary modifications • Verbalized warning signs • Confirmed follow-up dates

📄 Page 17 — Discharge Summary

Mr. Rajendra Prasad Sharma, 58 years old male, was admitted in SMS Medical College & Hospital, Jaipur with complaints of chest pain (angina), shortness of breath, palpitations, and fatigue. The patient had a history of hypertension (10 years), type 2 diabetes mellitus (5 years), and dyslipidemia with a strong family history of premature CAD.

On evaluation, ECG showed ST-segment depression in anterior leads. 2D Echocardiogram revealed LVEF 52% with anterior wall hypokinesia. Coronary angiography via right radial approach revealed 90% stenosis in proximal LAD artery. Same-sitting PTCA with Drug-Eluting Stent (DES — Sirolimus-eluting, 3.0 × 23 mm) deployment was successfully performed with TIMI 3 flow achieved.

On examination, the patient was conscious, oriented and hemodynamically stable. No procedure-related complications were noted. The patient was managed with dual antiplatelet therapy (Aspirin + Clopidogrel), high-intensity statin, beta-blocker, ARB, Metformin, and IV fluids for CIN prophylaxis. TR Band was removed at 6 hours with patent hemostasis.

During the hospital stay, the patient showed excellent recovery. Chest pain resolved completely. ECG normalized. No bleeding or vascular complications. Renal function remained normal. The patient and wife demonstrated understanding of medication regimen, dietary modifications, and lifestyle changes.

At discharge, the patient is advised to:

NEVER STOP Aspirin or Clopidogrel without consulting cardiologist
Take all medications exactly as prescribed at the same time daily
Use a pill box organizer and set phone alarms for medications
Follow cardiac diet — low saturated fat, low salt (<2g/day), high fiber, Mediterranean diet
Complete smoking cessation — ZERO tobacco
Avoid alcohol or limit to occasional 1 drink
Start with short walks (5-10 min, 2-3 times daily) — gradually increase
No heavy lifting (>5 kg) with right arm for 1 week
No driving for 48 hours
Attend cardiac rehabilitation Phase II program
Keep follow-up appointments — cardiologist at 2 weeks, lipid profile at 4-6 weeks
Report IMMEDIATELY to ER if: chest pain at rest, black/tarry stools, sudden severe headache, rapidly expanding wrist swelling

📄 Page 18 — Health Education

Medication Compliance (MOST CRITICAL) —
Patient was emphatically advised to NEVER STOP Aspirin or Clopidogrel without cardiologist consultation. Stopping these medications can cause sudden stent thrombosis, which can be fatal. Use a pill box organizer. Set phone alarms. Keep a medication card in your wallet listing all drugs and dosages. Inform any doctor/dentist about the heart stent and blood thinners before any procedure.

Dietary Advice —
Advised to follow Mediterranean diet — low saturated fat, low salt (<2g/day), low sugar. DO's: Fruits, vegetables, whole grains, fish (2-3 times/week), egg whites, nuts, olive/mustard oil. DON'Ts: Fried foods, butter/ghee, red meat, processed foods, bakery items, excess salt, sugary drinks. Remove salt shaker from table.

Lifestyle Modification —
Complete smoking cessation — ZERO tobacco. Alcohol — maximum 1 drink occasionally. Maintain adequate rest and sleep. Practice stress management techniques such as yoga, meditation, deep breathing. Maintain a regular daily routine.

Exercise and Activity —
Start with short walks — 5-10 minutes, 2-3 times daily, gradually increasing. No heavy lifting (>5 kg) with right arm for 1 week. No strenuous exercise or vigorous sports for 1 week. Attend cardiac rehabilitation Phase II program — supervised exercise, education, and counseling.

Disease Awareness —
Explained about CAD and the importance of the stent. DES patency rates exceed 90% at 1 year with proper care. Educated about importance of DAPT compliance — premature discontinuation is the #1 cause of stent thrombosis (20-40% mortality). Advised to recognize warning signs of stent thrombosis, bleeding, and stroke.

Follow-up Care —
Advised to attend regular follow-up visits — cardiologist at 2 weeks after discharge. Repeat lipid profile and HbA1c at 4-6 weeks. Stress test/ECHO as advised (usually 3-6 months). Dental check-up important. Annual cardiac check-up lifelong. Advised to immediately report to ER if: Chest pain at rest, sudden shortness of breath, black/tarry stools, blood in urine, sudden severe headache, weakness on one side, slurred speech, rapidly expanding swelling at wrist, fever >100.4°F with chills.

📄 Page 19 — Bibliography

Brunner, L.S. & Suddarth, D.S. (2022). Textbook of Medical-Surgical Nursing (15th ed.). Wolters Kluwer. Chapter 27: Management of Patients with Coronary Vascular Disorders.
NANDA International. (2024). Nursing Diagnoses: Definitions and Classification 2024-2026. Thieme.
Levine, G.N., Bates, E.R., & Blankenship, J.C. (2023). 2023 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization. Journal of the American College of Cardiology, 82(4), e51-e200.
Thygesen, K., Alpert, J.S., & Jaffe, A.S. (2024). Fourth Universal Definition of Myocardial Infarction. Circulation.
Mauri, L., Kereiakes, D.J., & Yeh, R.W. (2024). DAPT Duration After Drug-Eluting Stents — Current Evidence and Recommendations. New England Journal of Medicine.
Mehran, R., Dangas, G.D., & Weisbord, S.D. (2023). Contrast-Associated Acute Kidney Injury — Prevention and Management. New England Journal of Medicine.
European Society of Cardiology. (2025). ESC Guidelines on Chronic Coronary Syndromes.

⚕️ Medical Disclaimer: This case study is prepared for educational and academic purposes only as part of nursing practical file work (ANM, GNM, BSc Nursing). It is not intended for actual patient care, clinical decision-making, or medical diagnosis.

Case Study on Coronary Angioplasty (PTCA with Stenting)