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Acute coronary syndrome (ACS) refers to the spectrum of clinical presentations ranging from ST-segment elevation

myocardial infarction (STEMI) to non–ST-segment elevation myocardial infarction (NSTEMI) to unstable angina. These types
are named according to the appearance of the electrocardiogram (ECG/EKG). There can be some variation as to which forms of
MI are classified under acute coronary syndrome. ACS should be distinguished from stable angina, which develops during
exertion and resolves at rest. In contrast with stable angina, unstable angina occurs suddenly, often at rest or with minimal
exertion, or at lesser degrees of exertion than the individual's previous angina. Killip classification is a system used in individuals
with an acute myocardial infarction (heart attack), in order to risk stratify them. Individuals with a low Killip class are less likely
to die within the first 30 days after their myocardial infarction than individuals with a high Killip class. Though ACS is usually
associated with coronary thrombosis, it can also be associated with cocaine use. Cardiac chest pain can also be precipitated
by anemia, bradycardia, or tachycardia. In terms of pathology, acute coronary syndrome is almost always associated with rupture
of an atherosclerotic plaque and partial or complete thrombosis of the infarct-related artery.

If the ECG does not show typical changes, the term "non-ST segment elevation ACS" is applied. The patient may still

have suffered a "non-ST elevation MI" (NSTEMI). The accepted management of unstable angina and acute coronary syndrome is

therefore empirical treatment with aspirin, heparin (usually a low-molecular weight heparin such as enoxaparin) andclopidogrel,

with intravenous glyceryl trinitrate and opioids if the pain persists.

A blood test is generally performed for cardiac troponins twelve hours after onset of the pain. If this is

positive, coronary angiography is typically performed on an urgent basis, as this is highly predictive of a heart attack in the near-

future. If the troponin is negative, a treadmill exercise test or a thallium scintigram may be requested.

Cocaine associated ACS should be managed in a manner similar to other patients with acute coronary syndrome

except beta blockers should not be used and benzodiazepines should be administered early.[16]

One of the difficult parts in doing a case study is choosing what case is to present. We had agreed that we will choose
patient with ACS. Though we were not able to handle the patient personally during our duty we had the chance to
established rapport with the patient and his relatives by joining our classmate in doing his NPI, in that way we had
established the “trust” we need from them which makes easy for us to relate with them suitably and ask certain questions
that we need in order to conduct and study this case. Another thing is we find the patient and his relatives very kind with
our previous visit which make our interaction smooth. Most importantly, the term Acute Coronary Syndrome (ACS) is not
accustomed to us that much. With that thought alone, we want to further enhance our knowledge about the disease such as to
ensure appropriate evaluation of the etiology, reassess and address the course the illness takes in its progression. Also, to
have an experience in handling and providing humanitarian health services to a patient who has it and provide any
intervention or treatment indicated based on the specific etiology and the course it follows in that specific patient. With that
scenario, it is not only the knowledge that was enhanced but also our skills as a future registered health care practitioners.


physiologically and psychologically. OBJECTIVES 1. Educated the significant others of the patient on the prevention of complications and fostered optimal level of functioning physically. 2.000). Identified nursing problems and formulate a comprehensive plan of care for the patient with Acute coronary disease utilizing the nursing process.americanheart. After the completion of the case study. 2. the nurse-researcher shall have: General Objective: Acquired deeper knowledge and understanding of the development of acute coronary syndrome in relation to the risk factors presented by the patient. Discussed the disease process. discuss management and treatment and provide better nursing care and preventive measures through the utilization of the nursing process. which resulted from the disease process of Acute coronary disease.pdf a. During the course of the study. A conservative estimate for the number of discharges with ACS from hospitals in 2006 is 733.000 are female. an estimated 401. Given recommendations to all in general and to the health care providers on proper education and health teachings on the prevention of Acute coronary disease and its complications. This estimate is derived by adding the first-listed inpatient hospital discharges for MI (647.000 are male and 332. http://www. 6. 4.000.000) to those for Unstable Angina (86. treatment and management of the disease. the patient and the significant others shall have: General objectives: . and 5. Specific objectives: 1. 3. Identified clinical manifestations presented by the patient. related diagnostic findings on the development of Acute coronary 3241%20HeartStrokeUpdate_2010. Of these. Determined the non-modifiable and modifiable risk factors presented by the patient that have contributed to the development of acute coronary syndrome.

He was admitted for reasons of: Chest pain and DOB. He is . Specific objectives: 1. mail man and electrician in Maharaja Hotel located in Friendship. and 5. PERSONAL DATA Demographic data Mr. its risk factors and possible complications. They are all affiliated in the Roman Catholic Church. Killips is the youngest child of the three siblings of Mommy A and Daddy B. Mr. and good prognosis of the disease condition. Demonstrated independence on self-care and home management upon discharge and during follow-up home visits. NURSING ASSESSMENT a. They earn at least 10.000 a month because they have 5 rooms which are being rented. Received best possible care. Demonstrated compliance on treatment and management. at the same year he went to tarlac and worked as a driver until 1965. and went to Cuba for 3 years working as maintenance in a company. From1965-1996 he worked as a maintenance doing plumbing. He was admitted in Angeles University Foundation Medical Center last 2008 because of chest pain. is now 73 years of age and was born on the 26 th day of December 1936. Together with his family. He works as a farmer in Mindoro from the year 1952 until 1960. Built a trusting relationship with the nurse researcher as well as with the other health care providers. Gained knowledge on the disease condition. comfort. Killips. 3. a Filipin0. 2. Acquired knowledge on the risk factors that have contributed to the development of Acute coronary disease and gained positive understanding and compliance on the treatment. Socio-economic and Cultural factor He is currently living with his wife and his son. having a feeling of security. they presently reside in 2076 Texas st. Villasol Angeles City. 4. management and care rendered by the health care team.

000.00 in addition to the cost of their daily living. They also practice taking OTC medicines like paracetamols to relieve pain and fever. and remittance from his children that range from P2. They are being supplied by electricity and water by their district suppliers. he consults to the herbolarios before going to the hospital. Killips home is made of concrete.000-P3. Their house has a gate which serves as their protection against harm. . They are all Filipino citizen and Roman Catholic. Environmental factors Mr. Their garbage is disposed in a sack and usually collected by the garbage collectors.00 pesos per month.500. also receiving a pension of P3. In times of illness.

Skin > Good skin turgor > Dry skin???????????????????????????????????????????????????????? > No presence of edema > Normal skin color > No scars noted > With bruise noted on right hand?????????????????????????????????? 5. PERTINENT FAMILY HISTORY (SEE THE DIAGRAM) c. A year after his come back in our country he was again hospitalized in Angeles University Foundation Medical Center because we experienced chest pain. he was then given a drug indicated for his hypertension. Head > With normal cephalic configuration > No tenderness.b. Vital Signs T= 37. In the year 2009 he was confined in Amando P.1° C PR= 86 bpm RR= 21 cpm BP= 150/90 mmHg 2. e. HISTORY OF PAST ILLNESS d. HISTORY OF PRESENT ILLNESS During his years working in Cuba as one of the Maintenance personnel of a company. Eyes . Garcia Hospital because of dysuria. December 9. drug given to him was anti hypertensive. swelling and lesion noted > No edema present 3. Presently the patient was admitted in Angeles University Foundation Medical Center because of DOB and chest pain. dizziness and nape pain. he was again hospitalized in AUFMC because of chest pain. we was hospitalized in Miami Hospital due to chest pain. 2010 1. In year 2008. PHYSICAL EXAMINATION A. dizziness and headache. Hair and Scalp > Hair grayish in color > With no presence of dandruffs > Thin stranded hair 4.

not tender > Air moves freely through the nares > Nasal septum intact > No nasal discharges 8. Abdomen > soft. flabby and non tender abdomen > No pain when pressure is given 13. Outer Lips > No presence of sores > Pink colored lips > Symmetrical contour b. pain or unusual mass upon palpation 12. Tongue > No lesions. Nose > Symmetric. uniform in color. > Eyebrows and eye lashes are evenly distributed > Eyelashes are long and curved outward > No presence of edema over lacrimal gland > Pink conjunctiva 6. Lips a. no lesions. upper extremities > wrinkled skin . Inner Lip > Absence of lesions 9. pinna coils after it is folded > With good hearing condition 7. Ears and hearing > Symmetrical in size and shape > Not tender. Mouth a. Chest and lungs > Unequal size of chest > (-) rales on both lung fields > No tenderness. moves freely 10. Extremities a. Teeth and Gums > Normal buccal mucosa > teeth????????????????????????????????????????????????? > (+) gag reflex b. Neck and neck muscles > Trachea is midline position > No usual mass upon palpation > Muscles are equal in size and head centered > No lesions noted 11.

4. 2. pupils will constrict. head. In lightly dimmed environment. visual fields 3. the pupils of the eyes will dilate but upon the introduction of light. Trochlear The eye must follow the The client was able to Type: Motor movement of a ballpen in follow the ballpen with her Fxn: Downward inward different directions with eyes without moving her eye movement coordination. 5. Trigeminal The client elicited blinking The client elicited blinking Type: Sensory and Motor reflex upon touching the reflex upon touching the Fxn: Jaw movements. . General Apperance: Patient feels weak and restless. cornea with the use of cornea. > uniform in color > Equal in size > no lesions noted > with bruise on right hand b.>uniform in color > with enlarged knee on both side > no lesion noted 14. raising of eyelid penlight. smell it. a given distance. lower extremities > wrinkled skin . Oculomotor Eyes must follow the The client’s eyes were Type: Motor direction of the able to follow the Fxn: Pupil constriction and movement of the movement of the penlight.????????????????????????????????????????? Neurological Assessment Cranial Nerve Normal Findings Actual Findings 1. Optic Client must see the Client could able to see Type: Sensory ballpen or penlight clearly the ball pen or penlight at Fxn: Sense of vision and at a given distance. chewing and mastication cotton. Urogenital > with FC attached?????????????????????????????????????????? 15. Olfactory Client must be able to Client was able to identify Type: Sensory identify the scent of the scent of alcohol when Fxn: Sense of smell alcohol when asked to ask to smell it. Nail > Pinkish nail beds > With good capillary refill test 15.

CO2. hear the snap of the Type: Sensory finger. show raise eyebrows. speak clearly. show Fxn: Movement of teeth and puff out cheeks. sense of taste on the anterior two-thirds of the tongue 8. the more complex this system must be. Vagus Must be able to speak The client was able to Type: Motor clearly. Fxn: Sense of hearing 9. thus need a system that will do this. Fxn: Swallowing and speaking 11. like insects and spiders. Acoustic Client must be able to The client was able to (Vestibulocochlear) hear a snap of the finger. tongue. ANATOMY AND PHYSIOLOGY Circulatory System All animals must exchange materials with their environment. etc. movements and swallowing Sense of taste on the posterior one-third of the tongue 10. O2. tongue III.6. Arthropods. including nutrients and wastes. Accessory The client must able to The client was not able to Type: Motor elevate her shoulders elevate her shoulders Fxn: Movement of against resistance against resistance. Abducens Client must be able to The client was able to Type: Motor follow the index finger of follow the index finger of Fxn: Lateral movements the examiner. swallow foods that were Fxn: Pharyngeal chewed.. the examiner of the eyes 7. Hypoglossal The client must able to The client was able to Type: Motor move her tongue side to move her tongue side to Fxn: Movement of tongue side and protrude her side and protrude her and strength of the tongue. Facial Client must be able to The client was able to Type: Motor and Sensory raise eyebrows. shoulder muscles 12. The more complex the organism. teeth and puffed out her muscles of the face and cheeks. Glossopharyngeal Must be able to swallow The client was able to Type: Motor and Sensory foods that were chewed. .

and chemicals are exchanged by diffusion. From the lungs. not oxygen content. The superior (a) and inferior (b) vena cava are the main veins that receive blood from the body. The two major exceptions. 6. The blood goes into the right ventricle (note that it has a thinner wall. Vertebrates. The pulmonary artery or pulmonary trunk is the main artery taking deoxygenated blood to the lungs. The path of blood flow in a human. Our system is also called our cardiovascular system. 2. but then flows through the body cavity. like humans. The atria are on the top in the heart. In a person’s heart. preventing blood from reentering the atrium. Blood goes to the right and left lungs. As the arteries become more finely divided. The right semilunar valve marks the beginning of the artery. 8. The ventricles are on the bottom of the heart. it is supposed to close to prevent blood from flowing back into the ventricle. is as follows: 1.have an open circulatory system. in which the blood is pumped forward by the heart. We have double circulation: we have a separate pulmonary circuit to the lungs and a systemic circuit to the body. The superior vena cava drains the head and arms. Veins carry blood toward the heart and arteries carry it away from the heart. which is forced shut when the ventricles contract. Again. Note that the distinction between arteries and veins is by direction of blood flow. then. have a closed circulatory system in which the blood stays in the circulatory system as it circulates. The right atrium receives blood from the body via the vena cavae. . not all arteries carry oxygenated blood. the smallest are called venules which join and enlarge to form veins. and the inferior vena cava drains the lower body. and is composed of our heart plus our arteries and veins. it only pumps to lungs). 7. Because of this. they are called arterioles. directly bathing the internal organs. the pulmonary vein carries oxygenated blood back into the heart. 4. The finest divisions of our vascular system are called capillaries. The blood then passes through the right atrioventricular valve. 5. the atria (plural of atrium) receive blood from the veins and the ventricles send blood to the arteries. As the vessels get larger again. in which arteries are carrying deoxygenated blood are the pulmonary artery which carries deoxygenated blood from the heart to the lungs (to pick up oxygen there) and the umbilical arteries which carry deoxygenated blood away from the baby’s body to the placenta (to pick up oxygen there). 3. This illustration is orientated as thought you were looking at this heart in another person standing in front of you. where capillaries are in close contact with the thin-walled alveoli so the blood can release CO2 and pick up O2.

Note the thickened wall. the ventricular walls vibrate a little casuing the first sound of the heart beat. and so. The ventricles contract and force blood into the arteries. causing them to contract. The left atrium receives oxygenated blood from the lungs. When the semilunar valves snap shut. The impulse then spreads to the ventricles. are putting on the blood. The diastolic BP is the lower of the two numbers. the smallest of the veins. The atria contract and force blood into the ventricles. or similar problem. the “dup. 16. The aorta divides into arteries to distribute blood to the body. When the atria start beating normally again. these clots may be sent throughout the person’s system. the blood flows back through the coronary vein. If the atria don’t contract.” 3. join to form the larger veins. A blockage of the coronary artery or one of its branches is very serious because this can cause portions of the heart to die if they don’t get nutrients and oxygen. 15. Small arteries are called arterioles. This is a coronary heart attack. The heart cycle involves three phases: 1. it could cause a stroke. The blood enters the left ventricle. themselves. in turn. 2. this causes the second sound of the heart beat. thus are called heart murmurs. thus more likely to cause the arteries to burst. 18. which carry the blood back to the superior and inferior vena cava. The rate of contraction is the heart rate. The atrioventricular and semilunar valves prevent backflow as the heart contracts. 14. If one of these clots lodges in an arteriole somewhere. The aorta is the main artery to the body. One of the first arteries to branch off is the coronary artery. when the heart is relaxed. A baby’s heart starts beating when it is about four weeks old (the mother’s period is two weeks late. when the heart is actively contracting and putting pressure on the blood. As blood is pushed into the ventricles. The blood passes through the left semilunar valve at the beginning of the aorta. this is called atrial fibrillation and pooled blood in the atria can begin to clot. which supplies blood to the heart muscle itself so it can pump. 9. These. 10. and she’s just beginning to suspect she might be pregnant). Clogged arteries are less elastic. which lies on top of the artery. The blood passes through the left atrioventricular valve. The coronary artery goes around the heart like a crown. The sinoatrial node controls the heart beat. 17. This is called systole and the systolic blood pressure (BP) is the higher of the two numbers. the left ventricle must pump blood throughout the whole body. 13. when the A-V valves close. heart attack. These join again to form venules. This natural pacemaker is located in the upper wall of the right atrium. The smallest vessels are the capillaries. From the capillaries in the heart muscle. and is composed of muscle tissue that sends electrical impulses to the rest of both atria to contract. 12. is a measure of how much pressure the arteries. This is called diastole. 11. so the blood is under more pressure. A newborn’s heart rate is around 135 to 140 beats per . the “lubb” sound. The heart relaxes and blood flows into the atria and ventricles. Defects in any of these that allow some blood to leak backwards cause distinctive sounds through a stethoscope.

” Here’s a tip: you. and when the sound becomes faint. As the pressure in the cuff is lowered. elastic artery walls exert pressure on the blood. splitting into the radial and ulnar arteries near the elbow. To find your pulse. when you go to the doctor’s office. The cuff of the sphygmomanometer is wrapped around the arm just above the elbow and pumped up to block off blood flow (the pressure exerted by the cuff is higher than the systolic pressure). while watching the pressure indicator on the sphygomomanometer. not they. which runs down the upper arm. Typically. it is possible to determine someone’s blood pressure. You need to know the actual numbers to be able to evaluate if things have changed or are good or bad. are in charge of your health. Pulse is usually measured using the radial artery (the one along the radius). blood can flow freely. one of the first things that is done to you is that someone (a nurse?) takes your blood pressure. the blood pressure doesn’t go to zero because the thick. With gentle pressure. The only way you can educate yourself to how your body works is to keep re-asking the question until you get a real answer. so the sound disappears (not enough pressure is exerted by cuff to restrict blood flow). Blood pressure is maximum during systole. (clipart edited from Corel Presentations 8) A neonate’s BP is around 80/45 mm Hg meaning that the systolic pressure is equivalent to air pressure that will support a column of mercury 80 millimeters high in a barometer. In a living person. thus the accepted average is said to be 120/80 mm . by listening for the first sound. The pressure in the cuff is gradually decreased. and the diastolic is equivalent to the air pressure that will support a column of mercury 45 millimeters high. I initially get the answer “It’s OK. For adults in their 20s. By age 15 to 30. and a sound is heard as the pulses of blood surge under the cuff. the heart can force blood under the cuff. and when it equals the person’s systolic pressure. when the heart is pushing. Place several fingers of your left hand along and just to the outside (thumb side) of the tendon that runs along your wrist. A sphygmomanometer is the instrument used to determine BP. you should be able to feel your pulse. when it equals the diastolic pressure. The artery used to determine BP is the brachial artery. when the heart is relaxed. and minimum during diastole. then speeds up slightly as the person ages. Be persistent and eventually they’ll tell you what your BP is. rest your right arm in the palm of your left hand. I have frequently had the experience that when I ask what the results were. 120/80 mm Hg is considered average for a male and 115/75 mm Hg for a female. Curl the fingers of your left hand up around the thumb side of your right wrist. Thus.minute (bpm). the rate decreases to about 65-75 bpm. The pulse is a wave of contraction of the artery walls (which roughly corresponds to the heart rate) as blood is forced into the arteries.

especially profuse. A hemorrhage is bleeding. it is necessary for strong capillary walls (one of the first signs of a vitamin C deficiency is easy bruising). With age. When your core temperature is too high. a bruise. Hypertension is when the BP is too high. so that and the bioflavonoid rutin (found in buckwheat) have proven useful for strengthening blood vessels and preventing/treating hemorrhoids and other varicose veins. Edema is an accumulation of fluid (plasma) within tissues and/or the lymph system. to a number of other possible causes. Arteries and veins lying near each other in your extremities. many diuretics also remove potassium (and other beneficial minerals?) from the person’s system. If one of these becomes lodged in an artery in the lungs. Sometimes. . These can result from surgery or from conditions like atrial fibrillation. Much like a heat pump for your house or your refrigerator coils. it is also a life-threatening pulmonary embolism. especially a large one. again. a cerebral (or cerebellar) embolism or stroke or cerebrovascular accident (CVA).Hg. if the injury is extensive. to lack of exercise. diuretics are prescribed to try to remove water from the person’s blood. to improperly functioning kidneys. and sugar in one’s diet and the amount of exercise the person gets. leading to a hard lump (which may need to be surgically removed). If thrombi or emboli lodge in an artery supplying blood to the heart. Hemorrhoids are dilated or varicose veins in the anal area. Increasing the amount of fiber in one’s diet can help prevent hemorrhoids and possibly aid in healing mild cases. this could cause a heart attack! A thrombus is a blood clot (platelets and fibrin) which forms within a vessel and blocks the blood flow. There are two ways this could happen: either the systolic pressure is greater than 145 to 160 mm Hg and/or the diastolic is greater than 90 to 100. but flowing in opposite directions can absorb heat from each other as needed. thus lowering the blood volume and hopefully thereby. A hematoma is a local swelling or tumor filled with blood. If in doubt. and can be severe if internal. see a doctor. cholesterol (and other lipids). the arteries carry heat to the extremities to be dissipated. Typically. so the BP rises. its heat is transferred to the venous blood and sent back into the body to keep it warm. Frequently. However. the arteries become less elastic (due in part to undesirable lipid deposits in their walls). Major contributing factors include the amounts of salt. to female hormonal changes. and if in the brain. the BP. any excess heat still in the blood is transferred to the arterial blood and sent to the extremities. An embolus is a moving thrombus which may “get stuck” somewhere. this can cause a coronary embolism or heart attack or myocardial infarction. As the blood returns via the veins. as the blood flows out in the arteries to nourish the extremities. it can calcify as it heals. these are caused not enough fiber in diet causing the feces to be very hard so the person has to strain to pass them. There are many possible causes of edema from injury. to too much salt. When your core temperature is too low. Because vitamin C is necessary for collagen synthesis. and if serum potassium levels are not carefully monitored and go to low. your cardiovascular system is also involved in countercurrent heating/cooling of your body.

the good guys). and using tiny cuffs made of Velcro® and aquarium tubing. obesity. As the person warms up and circulation is restored. Diagnosis is confirmed by testing the blood pressure in not only the brachial artery. male sex. when the person (more common in women than men) gets cold. Female hormones offer protection against accumulation of arterial plaque. One special form of this is atherosclerosis which is a build-up of lipids on the inside of blood vessels. lipids will start to accumulate.In Raynaud’s Phenomenon. both when the person is comfortably warm and when the person’s hands have been soaking in ice water. The Merck Manual suggests that there may be a relationship between migraine headaches and Raynaud’s. the bad guys) and lowered HDL (high-density lipoproteins. each finger. after menopause. so usually. but also the radial and ulnar arteries. then will be flushed and red. elevated serum lipids. wearing a scarf or hat can actually help to keep the person’s whole body warm and lessen the chances of a Raynaud’s episode in the fingers/toes! Hardening of the arteries is also called arteriosclerosis. before returning to normal. and family history. diabetes. . elevated LDL (low-density lipoproteins. However. premenopausal women do not have as many problems with this as men do. a generic term for a number of diseases in which the artery walls become thickened and lose elasticity. People with Raynaud’s need to make sure to wear warm mittens and heavy socks in winter weather. I once hear a statistic that the average 55-year-old woman has a build-up equivalent to the average 18-year-old man. smoking.” and that portion of the finger/toe turns completely white. initially these areas of the fingers/toes will be cyanotic (blue). and since much heat is lost from our heads. Major risk factors for atherosclerosis include hypertension. spasms in the tiny arteriole muscles cause the circulation in portions of the fingers or toes to completely “turn off.