I. OBJECTIVES General Objective This case study is for the group to understand Acute Myocardial Infarction and be able to know the appropriate and proper care needed by the patients with such disease. Specific Objectives Knowledge:

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Gain profound knowledge about acute myocardial infarction, its etiology, disease process, signs and symptoms and its treatment. Widen the understanding regarding the nature and management of disease. Impart the information to the concerned individuals especially to those persons with this kind of disease.

Skills: • • • Apply properly the learned skills in actual procedures as part of intervention in the said disease. Enhance critical thinking in making nursing care plans. Improve nursing skills in implementing nursing interventions.

Attitude: • Develop sense of responsibility and proper attitude in dealing with clients. Enhance self-confidence in handling and providing care for the patients. Observe positive behavior in promoting and maintaining wellness among clients.

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II. INTRODUCTION A. Background of the Study This is a case of a 47 year old male who was diagnosed with Acute Myocardial Infarction. He was admitted to Meycauyan Doctor’s Hospital (MDH), June 29, 2010 with chief complaint of chest pain with dizziness, dyspnea, epigastric pain and vomiting. Our group handled the patient for 3 days (July 1-July 3, 2010). Vital signs, physical assessment, appropriate nursing interventions, care and emotional support were given to the patient. We chose to conduct this study to wholly understand the causes of this disease, how it affects the person and how this disease is treated. Moreover, this will serve as an overview for the coming cardiovascular concept that we will be discussing in our Medical-Surgical Nursing. B. Definition of the Case Myocardial infarction (MI) or acute myocardial infarction (AMI), commonly known as a heart attack, is the interruption of blood supply to part of the heart, causing heart cells to die. This is most commonly due to occlusion (blockage) of a coronary artery following the rupture of a vulnerable atherosclerotic plaque, which is an unstable collection of lipids (fatty acids) and white blood cells (especially macrophages) in the wall of an artery. The resulting ischemia (restriction in blood supply) and oxygen shortage, if left untreated for a sufficient period of time, can cause damage or death (infarction) of heart muscle tissue (myocardium). There are two basic types of acute myocardial infarction: Transmural: associated with atherosclerosis involving major coronary artery. It can be subclassified into anterior, posterior, or inferior. Transmural infarcts extend through the whole thickness of the heart muscle and are usually a result of complete occlusion of the area's blood supply.


Subendocardial/Nontransmural: involving a small area in the subendocardial wall of the left ventricle, ventricular septum, or papillary muscles. Subendocardial infarcts are thought to be a result of locally decreased blood supply, possibly from a narrowing of the coronary arteries. The subendocardial area is farthest from the heart's blood supply and is more susceptible to this type of pathology. Most myocardial infarctions are anterior or inferior but may affect the posterior wall of the left ventricle to cause a posterior myocardial infarction. Clinically, an acute myocardial infarction refers to two subtypes of acute coronary syndrome, namely ST elevation MI (STEMI) versus a non-ST elevation MI (nonSTEMI) based on ECG changes which are most frequently (but not always) a manifestation of coronary artery disease. Classification of Myocardial Infarction:

Type 1 - Spontaneous myocardial infarction related to ischaemia due to a primary coronary event such as plaque erosion and/or rupture, fissuring, or dissection Type 2 - Myocardial infarction secondary to ischaemia due to either increased oxygen demand or decreased supply, e.g. coronary artery spasm, coronary embolism, anemia, arrhythmias, hypertension, or hypotension Type 3 - Sudden unexpected cardiac death, including cardiac arrest, often with symptoms suggestive of myocardial ischaemia, accompanied by presumably new ST elevation, or new LBBB, or evidence of fresh thrombus in a coronary artery by angiography and/or at autopsy, but death occurring before blood samples could be obtained, or at a time before the appearance of cardiac biomarkers in the blood Type 4 - Associated with coronary angioplasty or stents: o Type 4a - Myocardial infarction associated with PCI o Type 4b - Myocardial infarction associated with stent thrombosis as documented by angiography or at autopsy Type 5 - Myocardial infarction associated with CABG

C. General Signs and Symptoms The onset of symptoms in myocardial infarction (MI) is usually gradual, over several minutes, and rarely instantaneous. Classical symptoms of acute myocardial infarction include:

Sudden chest pain - a sensation of tightness, pressure, or squeezing. Chest pain due to ischemia (a lack of blood and hence oxygen supply) of the heart muscle is termed angina pectoris. Pain radiates most often to the left arm or left side of the neck, but may also radiate to the lower jaw, neck, right arm, back, and epigastrium, where it may mimic heartburn.

using blood enzyme tests or at autopsy without a prior history of related complaints. causing left ventricular failure and consequent pulmonary edema. These cases can be discovered later on electrocardiograms. without chest pain or other symptoms. . and fatigue. has classically been thought to be predictive of cardiac chest pain. Women may experience fewer typical symptoms than men. but most appear to be clustered around the early hours of the morning. • • Levine's sign .patient localizes the chest pain by clenching their fist over the sternum. view of the chest). a feeling of indigestion. Diaphoresis Weakness Light-headedness Nausea Vomiting Palpitations Sweating Anxiety Loss of consciousness (due to inadequate cerebral perfusion and cardiogenic shock) Sudden death (frequently due to the development of ventricular fibrillation) can occur in myocardial infarctions. Approximately one quarter of all myocardial infarctions are silent. most commonly shortness of breath.occurs when the damage to the heart limits the output of the left ventricle. are associated with demanding physical activity. or both. • • • • • • • • • • An MI may occur at any time of the day. light red = other possible areas. weakness.4|Page Pain zones in myocardial infarction (dark red = most typical area. Shortness of breath (dyspnea) .

especially high low density lipoprotein and low high density lipoprotein) • • • • • • . Kawasaki disease. which increase the demand on the myocardium Aortic dissection. D. probably because the donor heart is not connected to nerves of the host. air. progeria. Etiology The most frequent cause of myocardial infarction (MI) is rupture of an atherosclerotic plaque within a coronary artery with subsequent arterial spasm and thrombus formation. Approximately half of all MI patients have experienced warning symptoms such as chest pain prior to the infarction. Intense exertion. In diabetics.) • Coronary artery emboli.5|Page A silent course is more common in the elderly. especially if the exertion is more intense than the individual usually performs also triggers MI. left ventricular hypertrophy [LVH]. differences in pain threshold. autonomic neuropathy. including aneurysms of the coronary arteries Increased afterload or inotropic effects. and psychological factors have been cited as possible explanations for the lack of symptoms. pediatric coronary artery disease may be seen with Marfan syndrome. and ephedrine • • • Arteritis Coronary anomalies. or the products of sepsis • Cocaine. be it psychological stress or physical. amphetamines. underlying valve disease) • Hypoxia due to carbon monoxide poisoning or acute pulmonary disorders (Infarcts due to pulmonary disease usually occur when demand on the myocardium dramatically increases relative to the available blood supply.the single most important risk factor for ischemic heart disease (IHD) Tobacco smoking Hypercholesterolemia (more accurately hyperlipoproteinemia. idiopathic hypertrophic subaortic stenosis [IHSS]. and cystic medial necrosis. Takayasu arteritis. Other causes include the following: • Coronary artery vasospasm • Ventricular hypertrophy (eg. with retrograde involvement of the coronary arteries Although rare. in patients with diabetes mellitus and after heart transplantation. secondary to cholesterol. Risk factors for atherosclerosis are generally risk factors for myocardial infarction: Diabetes (with or without insulin resistance) .

that 12. • • • • • • E. and third to AIDS and lower respiratory infections in developing countries. father) who suffered a coronary vascular event at or before age 55.000 people in the United States are affected annually.6|Page • • • • High blood pressure Family history of Cardiovascular disease such as ischemic heart disease (IHD) Obesity (defined by a body mass index of more than 30 kg/m². Many of these risk factors are modifiable. in addition individuals acquire another independent risk factor if they have a first-degree male relative (brother. a toxic blood amino acid that is elevated when intakes of vitamins B2. Approximately 50% of all MIs in the United States occur in people younger than 65 years. Women acquire an independent risk factor at age 55. Approximately 800. Myocardial infarction is the leading cause of death in the United States and in most industrialized nations throughout the world. B6. MI continues to be a significant problem in industrialized countries and is becoming an increasingly significant problem in developing countries. . Another independent risk factor is acquired if one has a first-degree female relative (mother. which is thought of as reflecting a genetic predisposition. sister) who suffered a coronary vascular event at age 65 or younger. so many heart attacks can be prevented by maintaining a healthier lifestyle. elevated CRP blood levels and the abuse of certain drugs (such as cocaine and methamphetamine). Other risks are: chronic kidney disease. but its incidence rises with age. WHO estimated in 2002. Age: Men acquire an independent risk factor at age 45. Worldwide more than 3 million people have STEMIs and 4 million have NSTEMIs a year. heart failure. is associated with a lower risk profile. Hyperhomocysteinemia (high homocysteine. MI can occur at any age. sex. Non-modifiable risk factors include age. and family history of an early heart attack (before the age of 60).6 percent of worldwide deaths were from ischemic heart disease with it the leading cause of death in developed countries. Physical activity. for example. B12 and folic acid are insufficient) Stress (occupations with high stress index are known to have susceptibility for atherosclerosis) Alcohol Studies show that prolonged exposure to high quantities of alcohol can increase the risk of heart attack Males are more at risk than females. or alternatively by waist circumference or waist-hip ratio). Incidence Cardiovascular diseases account for 12 million deaths annually worldwide.

and one in six women.000 for men. and 200 per 100. The average incidence of myocardial infarction for those aged between 30 and 69 years is about 600 per 100.000 for women. CHD is responsible for the deaths of approximately one in five men.7|Page • • • Coronary heart disease (CHD) is the most common cause of death in the UK. Mortality rates from CHD are higher for men than women. There is evidence of earlier deaths for men than women after an acute myocardial infarction . people living in deprived areas and in people of South Asian origin.

(-) murmur ABDOMEN. soft GENITALIA. L.8|Page III.Remarkable EXTREMETIES. anicteric sclera CHEST-SCE.Demographic Data Date of Admission: June 29.(-) pallor GCS.Flat.S Tugatog Valenzuela City Status: Married Date of birth: October 6. R. 2010) EENT-Pink palpebral conjunctiva. PATIENT PROFILE A.(-) edema SKIN.15 PAST HISTORY (-) hypertension (-)Bronchial asthma (+) Diabetes Mellitus FAMILY HISTORY . 2010 Name: Mr. Chief Complaint/s Chest pain C. Physical Examination Initial Physical Assessment (June 29.T Age: 47 Gender: Male Address: 4-C Saint Philip St. 1962 Place of Birth: Northern Samar Religion: Roman Catholic Nationality: Filipino Occupation: Fish Dealer B.NRRR. (-) retraction HEART-AP.Remarkable RECTUM AND ANUS.F.

radial pulse Respiration Rate: 19 bpm Temperature: 37. Chest pain persisted only periodic relief hence consult.9|Page Diabetes Mellitus. 2010.1 (overweight) Weight: 72 kg Height: 160 cm GLASGOW COMA SCALE Eye Opening (E) 4=spontaneous 3=to voice 2= to pain 1=none Verbal Response (V) 5= normal conversation 4=disoriented conversation 3=words but not coherent 2=no words only sounds 1= None 5 Total GCS: (E+V+M)= 15 Motor Response (M) 6= Normal 5= localizes pain 4= withdraws to pain 3=decorticate posture 2= Decerebrate 1= none 6 (+) epigastric pain (-) joint pain (+) vomiting 4 . regular. PERSONAL AND SOCIAL HISTORY (-) food & drug (-) cigarette smoking (-) alcoholic SYSTEM REVIEW (-) anorexia (+) dizziness (+) chest pain (+) dyspnea ALLERGY: NO KNOWN ALLERGY Physical Assessment (July 1. patient sought consult at ER and was diagnosed w/ inferior wall MI but HAMA. Hypertension PRESENT ILLNESS 2 days PTA. 1:00pm) VITAL SIGNS Blood pressure: 100/60 bpm Pulse rate: 65 bpm.7°C (axillary) ANTHROPOMETRIC MEASUREMENTS BMI: 28.

trochlear. Hemiplegia: None Extremities: No deformities. pale EARS Hearing: Has no difficulty of hearing Discharge: None . wears glasses Sclera: Clear. Facial symmetry EYES Vision: 150/100. coherent Orientation: Good Signs of distress: None Headache: Mild Mood: Euthymic CRANIAL NERVES CN I: proper sense of smell CN II (optic): Both eyes. abducens): Full extra ocular muscles CN V (trigeminal): (+) corneal reflex CN VII (facial): (+) facial symmetry CN VIII (acoustic): Follows commands CN IX. anicteric Conjunctiva: No discharge. Due to his condition. HEENT HEAD: Normocephalic. symmetric Motor Strength: 5/5 on all areas except his left arm which has an IV line.10 | P a g e PUPIL SCALE Size: 3mm Left and right pupils are reactive to light and has the same pupil size MOVEMENTS R/L Arms: Normal power R/L Legs: Normal power MENTAL STATUS State of consciousness: Conscious. IV. X (glossopharyngeal and vagus): (+) gag reflex CN XI (spinal accessory): Able to shrug both shoulders CN XII (hypoglossal): Normal tongue midline NEUROMUSCULAR Pupils: Pupils equally reactive to light Reflexes: Normal reflexes Activity Level: Requires little assistance from other person or device. he is not allowed to perform ADL yet. VI (oculomotor. alert Speech: Spontaneous. equally reactive to light CN III.

Central (left metacarpal) Nails: Thick and rough Capillary Blood Refill: 3 seconds Wound: None Presence of pressure ulcers: None RESPIRATORY Lung Movement: Symmetrical chest expansion Difficulty of breathing: Absent Retractions: None Cough: Absent Breath Sounds: Clear Oxygen therapy: Nasal Canula CARDIOVASCULAR Heart Sounds: without murmurs Apical Pulse: R/L regular Radial Pulse: R/L regular Brachial Pulse: R/L regular Pedal Pulse: R/L faint Neck veins: .11 | P a g e NOSE Discharge: None Congestion: None Orientation: Symmetrical Nasal flaring: None THROAT: No swelling MOUTH Moisture/color: moist/pink Tongue: pink Lips: intact Teeth: with caries Sore mouth: None INTEGUMENTARY Skin Integrity or Condition: Intact Color: Pale Turgor: Poor Temperature: Cold Moisture: Dry IV access: Intact.

no discharge Genital Pain: Absent Flank Pain: Present NUTRITIONAL STATUS Appetite: Normal Nausea/ Vomiting: None Diet: Low salt. Activity and Exercise Pattern . He doesn’t smoke and drinks alcohol occasionally. 2010. soft Tenderness: None Bowel Sounds: Normoactive Feeds Independently: Can eat independently using right hand but chose to be fed by his wife Nasogastric tube feeding: None GENITOURINARY Urination: Normal Genital Area: No pain. He claimed that before he was confined. Low fat. the group had a face-to-face interaction with Mr. He has a history of DM type 2 and takes Metformin as maintenance drug. RT and his family. soft diet Feeding Precaution: None Food allergy: No known allergies Difficulty of swallowing: Absent PAIN ASSESSMENT Based on pain scale of 0-10: Flank pain: 3/10 Cardiac pain: 2/10 GORDON’S FUNCTIONAL HEALTH PATTERN Health Perception and Management On July 1.12 | P a g e Edema: Absent GASTROINTESTINAL Abdomen: Round. he feels good about his health. Moreover he hopes that he would be well monitored and given attention throughout his hospitalization to improve his condition. When asked what caused his illness he admitted that it was due to eating high cholesterol and fatty foods particulary lechon and crab fat prior to his admission.

Nutritional and Metabolic Pattern Before his confinement. can recall in a few minutes and proclaims to his family whenever he is in pain. sleeping and watching the television. Sleep and Rest Pattern He gets to have an average of 6 hours of sleep before his confinement while in the hospital he experiences 4 hours or less than that due to interventions and medications given to him. He is fed by her wife. In his span of confinement. he even performs household chores during his free time. He also gets to take naps in the morning and afternoon as claimed by the patient. He drinks a lot of water averaging of 8 glasses per day. The student nurses assessed that his flank pain may be due to his sleeping position (semi-fowler’s position). frequently served with nutritious foods such as vegetables and loves to eat fatty foods. He regularly goes to the market to get deliveries of fish and sell them. Self-perception and Self-concept He generally feels good about himself although he experiences chest pain and flank pain. He has a caring and loving wife and has 4 children. At home. He verbalized that these pains where only felt upon movement and characterized as non-throbbing pain. he admitted that he doesn’t have regular check-ups. The . In addition. he usually drinks 3 glasses of water per day and has good appetite. His common leisure activities are eating. he only defecated twice with yellow. RT is a fish vendor at night. He only see the doctor when it is needed. The patient reported that he has no difficulty sleeping and gets to have continuous sleep unless he feels the urge to urinate. slightly watery stools without difficulty. In his span of confinement. His urination in the hospital is just the same frequency and volume before his admission. Walking from their house to the market is his form of exercise every day. Role and Relationship Pattern The family is made up of 24 members living in a compound together with their relatives. 2 girls and 2 boys.13 | P a g e Mr. Elimination Pattern Before he was confined he normally defecates once a day with brown colored stools and urinate an average of four times a day characterized by light yellow color without any difficulty. wears glasses with the vision of 150/100. the patient has a good appetite. Cognitive and Perception Pattern The patient asserted that he has no hearing difficulty.

6 76 32 0 9 120/8 38. “Ah oo sapat.1 84 28 0 3 110/8 36. Value and Belief Pattern The patient finds religion an important part of his life.2 77 30 0 8 120/9 38.14 | P a g e client expressed that his income is enough to support the needs of the family. In times of stress.1 80 29 0 5 120/8 36. Coping and Stress Pattern The patient does not exhibit any tense appearance because of his eagerness to be well.6 80 28 0 4 120/9 37.8 73 26 0 2 120/8 36. D. work and life. Allergies No known allergy VITAL SIGNS (7/1/2010) TIME BP T P R 12(A 120/8 37. nakakakaen nga kami ng 3 beses sa isang araw e. But he admitted that he seldom attends Sunday Mass. Mr. RT is satisfied with his family relationship. The patient’s hospitalization does not interfere with his faith and is very thankful that he is still alive.” In general.3 84 30 . Present History of Illness Inferior wall MI but HAMA F. he interacted happily and precisely to our questions as if he doesn’t have an illness.0 75 28 0 6 120/8 36.9 76 33 0 7 120/8 37. He even verbalized. Past History of Illness Diabetes Mellitus Type II E.0 75 28 M) 0 1 120/8 36. he’s way of coping is through rest and eating his favorite foods.

0 36.8 84 28 0 3 120/8 36.3 36.0 36.15 | P a g e 10 11 12(P M) 1 2 3 4 5 6 7 8 9 10 11 0 120/8 0 120/9 0 110/8 0 120/8 0 120/8 0 120/9 0 120/8 0 110/8 0 120/8 0 120/8 0 110/9 0 R E R R E E 37.1 36.6 37.8 F U F U F U 84 78 80 73 74 83 77 86 84 75 76 S E S E S E 33 26 23 23 28 26 26 24 23 26 28 D D D VITAL SIGNS (7/2/2010) TIME BP T P R 12(A R E F U S D M) E 1 R E F U S D E 2 120/8 36.6 37.6 37.3 76 26 0 .8 36.1 77 24 0 6 120/9 36.3 37.3 80 26 0 4 120/8 36.6 36.0 76 24 0 5 120/8 36.6 82 28 0 7 120/8 36.

FBS.16 | P a g e 8 9 10 11 12(P M) 1 120/8 0 120/8 0 120/9 0 R E 120/9 0 100/7 0 36.check for bleeding 7/1/10 >Monitor vital sign Q1 >Patient was given paracetamol due to an elevated temperature. low fat >refer BP less than 90/60 > HEPARIN .LIPID PROFILE.K. Course in the ward 6/29/10 >IMA.NA.REFER -CBC. 1 tab -Trimetazidine 35 mg tab TID -Heparin bolus 5000 IV -Heparin Drip 25000 u D%W250x 10 mgtts/min -O2 at 2L nasal canula 6/30/10 > Transfer to a private room (406) > Complete bed rest w/out bath room privileges > ST elevation improved > Monitor patient’s vital sign every hour >PO: soft diet.1 76 78 75 S E 77 76 28 29 31 D 28 28 G.PTT .INFERIOR KILLIPS I >Admit to ICU under the supervision of Dr. low salt. (T-38.PT.3 36.Hgt -243 mg/dl .CREA.6 F U 37.7 38.Cureba >Secure consent for administration and management >NPO except meds >IVF-PNSS 1L x KVO >Diagnostic test: -ECG -BUN.REFER >Therapeutics: -Isoket drip: 1 amp isoket + 90 cc D5Lr to run at 10 gtts/min -Simvastatin: 80 mg.1) >Perform TSB >Latest result of PTT was done > Perform CBG to the patient .2 36.

In the systemic circuit. blood leaves the heart through the aorta. since they represent the only source of blood supply to the myocardium: there is very little redundant blood supply. and then returns to the heart through the systemic veins. goes to all the organs of the body through the systemic arteries. These are the coronary arteries. but instead of emptying into another larger vein. The vessels that remove the deoxygenated blood from the heart muscle are known as coronary veins. The coronary arteries are classified as "end circulation". The heart is supplied by its own set of blood vessels. where the blood gives up carbon dioxide and takes on oxygen. which is why blockage of these vessels can be so critical. It is also responsible for pumping blood to the lungs. The vessels that deliver oxygen-rich blood to the myocardium are known as coronary arteries.17 | P a g e 7/2/10 >Patient can seat with dangled legs but still w/out bathroom privileges >Patient’s Vital sign is stable (Q1) IV. It must have its own source of oxygenated blood. The coronary arteries eventually branch into capillary beds that course throughout the heart walls and supply the heart muscle with oxygenated blood. The coronary veins return blood from the heart muscle. There are two main ones with two major branches each. they empty directly into the right atrium. ANATOMY AND PHYSIOLOGY The heart is responsible for pumping the blood to every cell in the body. Coronary circulation is the circulation of blood in the blood vessels of the heart muscle (the myocardium). They arise from the aorta right after it leaves the heart. The heart is no different from any other organ. .

Brain. Kidney. It is a diagnosis at the end of the spectrum of myocardial ischemia or acute coronary syndromes. NON-MODIFIABLE: ►Gender (male) ►Age (47 yrs. old) MODIFIABLE: ► Hypertension ► DM ► Diet (high fat) Ruptured Atherosclerotic Plaque S/sx: ► ↑ HR & BP ►Dysrhythmia S/sx: ►Pai Arterial Spasm & Thrombus Formation (Occlusion of Coronary Artery) Activation of SNS (Release of Catecholamine) ↓Blood supply & ↓O2 Anaerobic Metabolism ↓ Contractility & pumping Metabolic Acidosis S/sx: ► Light-headedness ►Dyspnea ►↓ Urinary output ►SOB ↓ Blood flow to Body Circulation (Lungs. & Digestive .PATHOPHYSIOLOGY ACUTE MYOCARDIAL INFARCTION DEFINITION: Acute myocardial infarction (MI) is defined as death or necrosis of myocardial cells.

In Myocardial Infarction. with permanent loss of myocardial contractility in the affected area. . Ischemia depresses cardiac function and triggers autonomic nervous system responses that exacerbate the imbalance between myocardial oxygen supply and demand. Cardiogenic shock may develop because of inadequate CO from decreased myocardial contractility and pumping capacity. inadequate coronary blood flow rapidly results in myocardial ischemia in the affected area. Persistent ischemia results in tissue necrosis and scar tissue formation.

V. 2. The tests can give doctors information about your muscles (including the heart). 3. Explain the procedure to the client. or it may be done after fasting.8s 1.7s Client Result Nursing Intervention 1. 51. A partial thromboplastin Clinical time (PTT) test significance: measures how The patient has long it takes for elevated a clot to form glucose level in a blood making the sample. 2. Collect the sample and monitor glucose levels. LABORATORY EXAMINATION/DIAGNOSTIC PROCEDURES Date/Lab test June 6. and organs. FBS: The client may be asked to fast for 8 to 12 hours prior to testing. etc. glucose. how does it feel. These mellitus. 2010: Blood Chemistry Normal Value 70-105mg/dL Reason for test Glucose (FBS): The basic 216. tests usually there is are done on elevation of the fluid (plasglucose level. A clot blood thicker is a thick lump than normal of blood that and more the body susceptible to produces to clot formation. The BMP may be performed without any preparation in an emergency. seal leaks.9 metabolic panel (BMP) is a group of tests Clinical that measures significance: different chemThe patient has icals in the diabetes blood. such as the kidneys and liver and may also indicate underlying diseases. ma) part of blood. etc. bones. thus. Tell the client to stop taking certain drugs before the test (with doctor’s advice). Drugs . July 1. *The plasma contains water. 2010: Partial Thromboplast in Time (PTT) 24-38s Control: 29.

how does it feel.20 QT: 400/s Diagnosis: Sinus Bradycardia Acute Inferior Wall Myocardial Infarction Electrocardiograph y provides a graphic recording of the heart’s electrical activity. Tell the client to refrain from drinking cold water immediately before an ECG as it may produce changes in one of the waveforms recorded (the T wave). 2010: Electrocardiogra m (ECG) Rate: 52 Rate Atrial: S2 QRS: . An Nursing intervention: Preparation Pre and Post Procedure Pre: 1. and chlorpromazine (Thorazine).08 Axis: 60’ PR: . If the client has a . Contraction of cardiac smooth muscle produces electrical activity. resulting in a series of waves on the ECG. may cause longer PTT than normal. Explain the procedure to the client. which aids in thinning of the blood. that can affect the results of a PTT test include antihistamines. vitamin C (ascorbic acid). Date/Diagnostic Procedure Client Result Reason for test June 28. more susceptible to clot formation. 4. cuts. or drug. 3. aspirin. Electrodes placed on the skin transmit the electrical impulses to a graphic recorder. etc. With the wave forms recorded. Ask the client if he/she is taking any medications. All metals/jewelries should be taken off prior to the procedure.Heparin. thus. the ECG can then be examined to detect dysrhythmias and alterations in conduction indicative of myocardial damage. wounds. his blood is thicker than normal. 5. Since the client has elevated glucose level. enlargement of the heart. and scratches and prevent excessive bleeding. 2.

Instruct the client to remain silent and relax during the procedure. 7. NSR implies that the impulse originates at the SA node and follows the normal sequence through the conduction system. lot of hair on the chest. 6. The normal sequence on the ECG is called normal sinus rhythm (NSR). . Tell the client to wear a lab gown.ECG monitors the regularity and path of the electrical impulse through the conduction system. a small area may need to be shaved to put the electrodes on.

dark urine. the enzyme necessary for hepatic production of cholesterol SIDE/ADVERSE EFFECTS Side Effects: • Headache • Nausea • Flatulence • Diarrhea • Abdominal pain Adverse Effects: • Liver failure • Acute renal failure IMPLICATIONS NURSING RESPONSIBILITIES/ INTERVENTIONS • Check the drug label: the drug name. Explain to the patient what the drug is for. Check the drug label: the drug name. head trauma. route and if you are administering the drug to the right patient. CLASSIFICATION ROUTE. cerebral hemorrhage. glaucoma. • • • • Generic Name: isosorbide dinitrate Brand Name: Isoket retard Dosage: Class: Antianginal.VI. Vasodilator Action: Relaxes vascular smooth muscle which results to decreased venous return and arterial BP. Nitrate. unusual bleeding. Instruct patient to avoid drinking grape juice while taking the drug. and its side effects. and ACTION FREQUENCY Generic Name: simvastatin Brand Name: Zocor Dosage: 80mg Route: Oral Frequency: once a day Class: Antilipidemic. light-colored stools. and its side effects. DRUG STUDY DRUG. • Explain to the patient what the drug is for. Instruct patient to report severe GI upset. • Contraindicated with severe anemia. route and if you are administering the drug to the right patient. Administer drug in the evening because highest rates of cholesterol synthesis occurs between midnight and 5am. dosage. changes in vision. Side Effects: • Headache • Restlessness • Weakness • Nausea • dizziness • Check for allergy to nitrates. • Contraindicated with fungal byproducts. note • . dosage. HMG-CoA reductase inhibitor Action: Inhibits HMGCoA reductase. • Monitor vital signs. DOSAGE. muscle pain • Check for allergy to simvastatin.

• • • • • • changes in blood pressure. dosage. persistent headache or fainting. note for changes in temperature or for any deviations from the normal. route and if you are administering the drug to the right patient. • • Assess for PTT and other blood coagulation tests and Class: Anticoagulant Side Effects: • Headache • Check for allergy to heparin. Instruct patient to report blurred vision. Provide patient a cool environment and position patient in supine when headache occurs.20mg/tab Route: Oral Frequency: once a day which reduces left ventricular workload and myocardial oxygen consumption Adverse Effects: • Tachycardia • Hypotension • syncope • Use cautiously in patients’ with acute MI or heart failure. Vasodilator Action: Relaxes vascular smooth muscle which results to decreased Side Effects: • Rash Adverse Effects: • Fever • respiratory illness • anemia • Check for allergy to trimetazidine. and its side effects. Nitrate. Check for adventitious sounds. more severe angina attacks. . Check results of CBC and hemoglobin Administer drug sublingually and discourage patient in swallowing. Administer drug 2 hours before meals as ordered by the physician. • Explain to the patient what the drug is for. • Monitor vital signs of patient. Generic Name: trimetazidine Brand Name: Vastarel Dosage: 35mg/tab Route: oral Frequency: once a day Generic Name: heparin Class: Antianginal. Check the drug label: the drug name.

Check the drug label: the drug name. dosage. • Use cautiously with recent surgery. and its side effects. dosage. route and if you are administering the drug to the right patient.Brand Name: Hep-Lock Action: Inhibits thrombus and clot formation by blocking the conversion of prothrombin to thrombin. 2nd generation Sulfonylurea Action: Stimulates insulin release from functioning beta cells in pancreas. Mix well when adding heparin to IV infusion. hyperglycemia. Assess and check the urinalysis results. • • • • • • Dosage: 25. • Abdominal pain • Back pain Adverse Effects: • Bruising • Fever • hyperkalemia • Contraindicated with severe thrombocytopenia. route and if you are administering the drug to the right patient. thyroid or endocrine impairment. Instruct patient to report for abdominal or lower back pain. ketosis. CBC. Side Effects: • Nausea • Epigastric discomfort Adverse Effects: • Diarrhea • Hypoglycemia • Allergic skin reactions.000 Units Route: TIV platelet count. Explain to the patient what the drug is for. Check for signs of bleeding Provide safety measures to prevent bleeding. Administer drug 30 minutes before breakfast and drug must be given before meals. severe headache. and its side effects. Check the drug label: the drug name. • • • • • . • Check for allergy to sulfonylureas. check also blood glucose levels. increases insulin receptors. hepatic and renal impairment. creatinine levels. note for BUN. Explain to the patient what the drug is for. fibrinogen to fibrin. Monitor urine and blood for glucose levels and ke- Generic Name: glipizide Brand Name: Glucotrol Dosage: 2mg/tab Route: oral Frequency: once a day Class: Antidiabetic. severe trauma. • Contraindicated with severe infections. • Use cautiously with uremia.

• Instruct patient to report for sore throat. . rash.tones. dark urine or light-colored stools. • Instruct patient to avoid alcohol when taking the drug. and to determine effectiveness of drug dosage.

To promote the development of productive interpersonal relationships 16. THEORETICAL FRAMEWORK FAYE GLENN ABDELLAH Abdellah’s typology was divided into three areas: (1) the physical. To use community resources as an aid in resolving problems arising from illness . emotional. sociological. To identify and accept positive and negative expressions. feelings. To facilitate progress toward achievement of personal spiritual goals 17. To facilitate the maintenance of a supply of oxygen to all body cells 6. To facilitate the maintenance of nutrition of all body cells 7. To promote safety through prevention of accidents. To recognize the physiologic responses of the body to disease conditions 10. exercise. and emotional needs of the patient. Typology of 21 Nursing Problems are as follows: 1. To facilitate the maintenance of elimination 8. To facilitate awareness of self as an individual with varying physical. and reactions 13. To identify and accept the interrelatedness of emotions and organic illness 14. and (3) the common elements of patient care. To facilitate the maintenance of sensory function 12. To maintain good body mechanics and prevent and correct deformities 5. rest. To promote good hygiene and physical comfort 2. To create and maintain a therapeutic environment 18. (2) the types of interpersonal relationships between the nurse and the patient.VII. To promote optimal activity. or other trauma and through the prevention of the spread of infection 4. and sleep 3. injury. To facilitate the maintenance of fluid and electrolyte balance 9. To facilitate the maintenance of regulatory mechanisms and functions 11. and developmental needs 19. Adbellah and her colleagues thought the typology would provide a method to evaluate a student’s experiences and also a method to evaluate a nurse’s competency based on outcome measures. To accept the optimum possible goals in light of physical and emotional limitations 20. To facilitate the maintenance of effective verbal and nonverbal communication 15.

To understand the role of social problems as influencing factors in the cause of illness .21.





>Emphasize the importance of the participation of family members in the therapeutic regimen for easy acceptance of the patient of his condition. DIET AND NUTRITION >Encourage a diet low in sodium (avoid canned and preserved food. dyspnea & infections. >Instruct relatives to remove stressful stimulus such as loud noise. >Encourage patient to seek immediate health care facilities. >Stress proper hand washing techniques by all relatives/caregivers. TREATMENT >Advise patient to incorporate therapeutic regimens into activities of daily living such as including specific exercises or light house work before going to work. DISCHARGE PLANNING MEDICATION >Instruct patient and relatives the importance of drug compliance and possible complications that may arise if drug regimens are not followed. >Advice patient to have a pill organizer marked by the time and day he should take his medication to avoid missed doses or over doses. keep skin moist and maintain oral hygiene to prevent infection. intense light and frequent visitors to the patient. >Teach relatives and patient the importance of the given medications.VIII.) . HEALTH TEACHINGS >Teach patient to have adequate rest to prevent fatigue. OUT PATIENT >Inform the patient about the follow-up checkups with the physician and emphasize the importance of this to his health. >Encourage patient to have a regular contact with his physicians. >Inform relatives to help patient in taking his medicine regularly. >Advise patient a diet low in fat and cholesterol (avoid pork. even when not scheduled like chest pain. >Instruct relatives to report immediately to the physician if any abnormal events happened to the patient. simvastatine and other cardiovascular drugs) ENVIRONMENT >Instruct relatives at home to provide a quiet. curtains and dusting to remove allergens. >Encourage hypoallergenic bath soap. >Instruct the patient to take drug before meals ( trimetazidine. calm and restful environment. >Instruct relatives to record any progress to the patient’s status. fish sauce and etc because it contains high sodium). >Instruct patient and relatives to maintain cleanliness of the surroundings by regular changing of bed linens. chorizo and etc. >Advise patient to visit a place with fresh air and free from pollution environment.

B. spinach and chard to help regulate heart activity. NURSING IMPLICATION A. IX. Nursing research • Health because of research outcomes is the key to knowing not only what quality of care can be achieved but also how it can be achieved. Nursing Practice • Through this case study. broccoli. . dilates arteries. • The outcome of this case study is enhanced knowledge. and inhibits blood platelets from collecting. >Promote food like cayenne pepper because it can lowers cholesterol. which will then lead to improved assessment. student nurses were able to understand the disease process. SPIRITUAL >Seek assistance and Blessings from God. • This case study can be a reference for new researches and may be useful for other cases in the future. reduced delay in treatment time. and more effective teaching strategies. C. increases blood flow to the coronary circulation. and proper management of the disease. >Provide opportunity for patient to express spiritual beliefs. Nursing Education • As we all know.>Encourage patient to eat plenty of magnesium rich foods such as tofu. When the care that patients receive is linked with the outcomes they experience. wheat germ. Cardiovascular diseases account for 12 million deaths annually worldwide. potatoes. risks. So the study will assist and help readers in gaining a basic knowledge of what Acute Myocardial Infarction is all about. Myocardial Infarction continues to be a significant problem in industrialized countries and is becoming an increasingly significant problem in developing countries. its evident symptoms. practiced thorough assessment and provided necessary interventions for a patient diagnosed with acute myocardial infarction. • The outcomes of this study can become a key in developing better ways to monitor and improve the quality of the nursing care that is provided. >Encourage relatives to accompany the patient in church mass and or seminars.

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