ERA UNIVERSITY

ERA COLLEGE OF NURSING

CASE STUDY

ON

ACUTE CORONARY SYNDROME

SUBMITTED TO SUBMITTED BY

MS.GODHULI GOSH MS. ARCHANA DEVI

ASSISTANT PROFESSOR M.Sc. NURSING 1ST YEAR
ERA COLLEGFE OF NURSI NG ERA COLLEGFE OF NURSING

SUBMITTED ON –
 IDENTIFICATION DATA
Name : Saida Begam
Age : 68 years
Gender : Female
PID No : 2133759
Diagnosis : ACS(Acute coronary syndrome)
Name of the physician : Dr. Fazal Karim / Dr. Irshad Wani
Date of admission : 02/03/2020
Date of surgery : Nothing significant
Date of discharge : Nothing significant
Education : Graduate
Marital status : Married
Religion : Muslim
Nationality : Indian
Address : Mejarganj, Sultanpur UTTER PRADESH

Name of Ward : CARDIAC CARE UNIT

HISTORY OF THE PATIENT

 CHIEF COMPLAINTS
My patient Mrs. Saida Begam was admitted to ERA’S hospital lucknow on 02.03.2020
with the complaints of –
 Chest pain – 3 days.
 Breathlessness - 3 days.

 PAST MEDICAL HISTORY

 Patient has history of hypertension.
 And diabetes mellitus

 PRESENT MEDICAL HISTORY

 Patient was apparently asymptomatic 5 days back when she develops pain in chest and
abdomen. The pain was sudden and was not relived on medication the patient also
complain of breathlessness has aggregated since 3 day anxiety. The pain became so
severe that he had to come for treatment at ERA LUCKNOW MEDICAL COLLEGE
AND HOSPITAL critical care unit department and she got admitted on the same date
critical care unit.

 PAST MEDICAL HISTORY

 History of hypertension, taking antihypertensive drugs from 6 years back.
 And diabetes mellitus from 3 year back
  PRESENT SURGICAL HISTORY
 No surgery has been planned for the recent complain of the patient.

 PAST SURGICAL HISTORY

 No past surgical history

FAMILY TREE

Male

Mohd. Siddiq (70 yrs) Saida Begam (68 yrs)

Female

Patient

Affreen (37 yrs) Heena (34 yrs) Siraj (29 yrs)

PERSONAL HISTORY

Dietary habits : Non – Vegetarian

Sleeping pattern : Normal
Life style : Sedentary life style
Reliance with the family members : Cordial relation with family member
Elimination process : Normal bowel and bladder pattern

SOCIOECONOMIC HISTORY

Monthly income : Rs. 15,000/monthly

Earning members of the family : Mr. Mohd Siddiq
Maintenance of hygiene : Moderately maintained
Housing : Pakka house
Electricity : Domestic electric supply is available
Water supply : From cooperation
Drainage system : Closed drainage system
Relationship with the neighbors : Maintained good relationship with neighbors
 PHYSICAL EXAMINATION
GENERAL EXAMINATION

 Consciousness : Conscious
 Orientation : Altered
 Nourishment : Well nourished
 Body built : Moderately built
 Activity : Dull
 Look : Dull
 Hygiene : Power
 Speech : Normal
 Height : 5.2 inch
 Weight : 68 kg

S No. VITAL SIGN PATIENT NORMAL REMAEK

VALUE VALUE
1. TEMPERATURE 98.6F 98.6F Normal
2. PULSE 106 b/mt 70-80 b/mt Tachycardia
3. RESPIRATION 20 bt/mt 16-24 bt/mt Normal
4. BLOOD PRESSURE 130/90 mmhg 120/80 mmhg Normal

INTEGUMENTARY SYSTEM

SKIN

 Colour : Fair
 Texture : Normal
 Skin turgor : Absent
 Hydration : Moderate
 Lesions / Masses : No lesions present

NAILS

 Nail beds : Whitish

 Nail plate : Normal

HAIR

 Colour : White and black

 Texture : Normal
  Grooming : Normal
 Distribution : Normal

HEAD

 Scalp : No lesions or dandruff present

 Hairs : Equally distributed

EYES

 Eye brows : Symmetrical

 Eye lashes : There are no inflammation present
 Eye lids : No edema, swelling or redness found
 Sclera : White in colour
 Conjunctiva : Moist and pink in colour
 Vision : Normal
 Discharge : No abnormal discharge present

EARS

 Pinna : Normally placed

 Hearing : Normal
 Discharge : No abnormal discharge present

NOSE

 Nasal septum : No deviation of septum present

 Nasal pathway : Clear
 Discharge : No abnormal discharge present
 Smell : Good

MOUTH AND PHARYNX

 Lips : No chelieosis present

 Gums : No inflammation or bleeding present
 Tougue : No coating present
 Teeth : White
 Mucous Membrane : Dry but no inflammation
 Integrity : Normal
 Tonsils : Not enlarged
 Voice : Dysphonia

NECK
  Alignment : Normal
 Movement : Normal
 Trachea : Normal
 Glands and lymph nodes : No enlargement present

CARDIO – RESPIRATION SYSTEM

 Thorax : Normal
 Thorax expansion : Normal
 Heart sound : S1 AND S2 sound heard
 Breath sound : Normal breath sound heard.
 Apical pulse : 106 b/min
 Cough : Absent
 Sputum : No sputum present

ABDOMEN

 Inspection : No scar present

 Palpation : No tenderness present
 Percussion : Dull sound present
 Auscultation : Normal peristaltic sound can be heard

MUSCULO – SKELETAL

 Postural curves : Normal

 Muscle tone : Normal
 Muscle strength : Normal

UPPER EXTERMITIES

 Symmetry : Normal
 Range of motion : No restriction of range of motion , normal flexion

LOWER EXTERMITIES

 Symmetry : Normal
 Range of motion : No restriction of range of motion , normal flexion
 Oedema / swelling : Absent
 Cyanosis : No cyanosis present
 Joints : No joint pain present
 Deformity : No any deformity present
 Gait : Normal

GENTIO- URINARY
  Lesions/ Scars : No scar and lesions present
 Discharge / Infection : No discharge present

RECTUM AND ANUS

 Bowel elimination pattern : Irregular

INVESTIGATION
Day 1

S. No. Tests Normal value Patient value

1. CBC
HB 7.2 g/dl 10 – 16. 5 g/dl
TLC 11.000 cells/ cumm 4000- 11000 cells/cumm
Neutrophils 80% 40-70%
Lymphocyte 15% 20- 45%
Eosinophils 03% 1-6%
Monocytes 02 % 2-8%
Platelet count 3.0 lakh 1.5-4.0 lakh
RBC 3.06 m/ mm3 3.8-6.0 m/ mm3
M.C.V 78.8 fl 80-100 fl
M.C.H 23.5 pg 25- 32 pg
M.C.H.C 29.9 g/dl 28- 36 g/dl

2. KFT
Urea 52 mg /dl 15- 36 mg/dl
Creatinine 1.8 mg /dl 0.5- 1.25 mmol/L
Na+ 136 mmol/L 135-145 mmol/L
K+ 4.1 mmol/L 3.5- 5.1 mmol/L

3. LFT
Serum Bilirubin ( Total ) 0.8 mg/ dl 0.2- 1.3 mg / dl
S.G.P.T 73 U/L < 50 U/L
S.G.O.T 46 U/L 17 – 59 U/L
Serum Alkaline Phosphatase 164 U/L 38- 126 U/L
4. CALCIUM 8.5 mg/dl 8. 4 – 10.2 mg /dl

 Chest X Ray done and ECG also done.

 Arterial blood gas done.
 Troponin I- 0.98

Day 2 -

S. No. Tests Normal value Patient value

1. KFT
 Urea 38 mg /dl 15- 36 mg/dl
Creatinine 1.7 mg/dl 0.5- 1.25 mg /dl
Na+ 141 mmol/L 135-145 mmol/L
K+ 4.6 mmol/L 3.5- 5.1 mmol/L

2. Calcium 8.7 mg / dl 8. 4 – 10.2 mg /dl

DAY 3-

S. No. Tests Normal value Patient value

1. Calcium 9.2 mg / dl 8. 4 – 10.2 mg /dl

DAY 4-

S. No. Tests Normal value Patient value

1- CBC
HB 8.8 g/dl 10 – 16. 5 g/dl
TLC 9, 900 cells/ cumm 4000- 11000
Neutrophils 80% cells/cumm
Lymphocyte 16% 40-70%
Eosinophils 01 % 20- 45%
Monocytes 03 % 1-6%
Platelet count 2.8 lakh 2-8%

2- KFT
Urea 52 mg /dl 15- 36 mg/dl
Creatinine 1.8 mg/dl 0.5- 1.25 mg /dl
Na+ 136 mmol/L 135-145 mmol/L
K+ 4.1 mmol/L 3.5- 5.1 mmol/L

3- Calcium 8.5 mg / dl 8. 4 – 10.2 mg /dl

DAY 5-

S. No. Tests Normal value Patient value

1. Calcium 9.2 mg / dl 8. 4 – 10.2 mg /dl
2- T3 1.56
T4 119
TSH 4.47

TREATMENT
S. Trade Phar Action Do Route Freq Indication Contraindic Adverse Nsg.
N name ma se uenc ation effect Responsibi
O name y lities
1- Tab Ramip Ramistar 2.5 0ral BD Hypertension Kidney Blurred Inform the
Ramist ril Tablet is an mg disease vision doctor if
ar Angiotensin Congestive Liver disease Sweating have a
converting Pregnant Dizziness history of
enzyme Heart failure Marfan Unusual allergy in
(ACE) syndrome tiredness this
inhibitor. Heart disease and medicine.
weakness Report any
Diabetes Back pain undesirable
Chest side effect
tightness to the
Increased doctor
heartbeat promptly.
Cough Check the
Diarrhea vital sign.
Vomiting
2. Tab. Cardiz Anti – 30 Oral TDS Hypertension Hypotension Body pain Check BP
Dilze em anginal mg AV block Cough and ECG
m agent, Anti – Angina Sick sinus Fever before
arrhythmics, syndrome Headache initiation of
Calcium Certain heart Hepatic Diarrhea therapy and
channel rhythm disease Constipatio monitor
blocker disorder Aortic n particularly
stenosis Skin rash during.
Irregual heart Gastroesopha Monitor for
beat geal reflux headache
disease
(GERD)
Pregnancy

3 Tab. Folic Vitamin B 1 Oral OD Anemia Folic acid Rash Nurses

Folvite acid complex tab should not be Itching should refer
ParegnancyL used in Trouble to
iver disease undiagnosed breathing manufactur
megaloblasti Dizziness er summary
High c anemia Numbness of roduct
cholestrol unless Abdominal characterist
vitamin B12 distension ic and to
Intestinal is appropirate
problems administered local
concurrently, guidelime.
Kidney otherwise
Dialysis neuropathy
may be
precipitated.
4. Tab. Trimet rimetazidine 1 Oral BD Anemia of Ferric maltol Hypersensit Check the
Flavedon razidin is an anti- tab chronic Hypersentivit ivity dose
MR e ischemic disease. y Headache of the drug
(anti-anginal) hemochroma Nausea and check yhe
which Breath tosis. vomiting route
improves holding Abdominal of the drug
myocardial pain
glucose ACE Fatigue check the
 utilization inhibitors vital signs
through
inhibition of Heart failure Tell patient
fatty acid that
metabolism. antacids
don’t affect
absorption.
Pantoprazole 1 Oral OD Gastroesophe Inadequate headache, Advise
5. Tab is to inhibit tab geal reflux vitamin B12 insomnia, patient that
pantoprazol the final step disease Low amount Chest pain. drug
e in gastric Stomach acid of rhinitis, can be
acid Helicobacter magnesium diarrhea, taken
production. pylori Systemic nausea, without
pantoprazole infection lupus back pain Regard to
covalently Gastro- erythematosu bronchitis, meals.
binds to the duodenal s rash.s Check the
H+/K+ ATP ulcer. Osteoporosis dose
pump to Condition of of the drug
inhibit week bone . check
gastric acid patient that
and basal antacids
acid don’t affect
secretion. pantoprazol
e
absorption. 

CASE STUDY

ANATOMY AND PHYSIOLOGY OF HEART

HEART
The heart is a roughly cone-shaped hollow muscular organ. It is about 10 cm long and is
about the size of the owner's fist. It weighs about 225 g in women and is heavier in men about
310 g.
POSITION
The heart lies in the thoracic cavity in the mediasternum between the lungs. It lies
obliquely, a little more to the left than the right, and presents a base above, and an apex below.
The apex is about 9 cm to the left of the midline at the level of the 5th intercostals space. The
base extends to the level of the 2nd rib.
STRUCTURE- The heart is composed of three layers of tissue.
 Pericardium
 Myocardium
 Endocardium
CARDIAC CIRCULATION
The two systems communicate with one another and are intimately associated. The heart pumps
blood into two anatomically separate systems of blood vessels.

 The pulmonary circulation

 The systemic circulation.
The pulmonary circulation
The right side of the heart pumps blood to the lungs (the pulmonary circulation) where gas
exchange occurs; i.e. CO2 leaves the blood and enters the lungs, and O2 leaves the lungs and
enters the blood.
The systemic circulation
The left side of the heart pumps blood into the systemic circulation, which supplies the
rest of the body. Here, tissue wastes are passed into the blood for excretion, and body cells
extract nutrients and O2.

Aorta

PHYSIOLOGY OF THE HEART The main function of heart is pumping blood it bring out
oxygenated blood from lung to all the body part.The oxygenated blood from body to lungs.

Heart blood flow

Superior (upper exterimities)and inferior vena cava ( lower exterimities)

 Right atrium (right aterio ventricular value)
TRICUSPID VALUE

Right ventricle (through atrioventricular value)

PULMONARY VALVE

Pulmonary artery or trunk(deoxygenated blood)

Right and left pulmonary artery

Lungs ( deoxygenated changes to oxygenated blood)

Pulmonary vein

Left atrium
BICUSPID VALVE
Left ventricle
AORTIC VALVE

 Coronary Systole and Diastole

At any given time the chambers of the heart may found in one of two states:
 Systole - During systole, cardiac muscle tissue is contracting to push blood out of the
chamber.

 Diastole - During diastole, the cardiac muscle cells relax to allow the chamber to fill
with blood. Blood pressure increases in the major arteries during ventricular systole and
decreases during ventricular diastole. This leads to the 2 numbers associated with blood
pressure—systolic blood pressure is the higher number and diastolic blood pressure is
the lower number. For example, a blood pressure of 120/80 describes the systolic
pressure (120) and the diastolic pressure (80).
  The Cardiac Cycle - The cardiac cycle includes all of the events that take place during
one heartbeat. There are 3 phases to the cardiac cycle: atrial systole, ventricular systole,
and relaxation.

 Atrial systole- During the atrial systole phase of the cardiac cycle, the atria contract and
push blood into the ventricles. To facilitate this filling, the AV valves stay open and the
semi lunar valves stay closed to keep arterial blood from re-entering the heart. The atria
are much smaller than the ventricles, so they only fill about 25% of the ventricles during
this phase. The ventricles remain in diastole during this phase.

 Ventricular systole: During ventricular systole, the ventricles contract to push blood into
the aorta and pulmonary trunk. The pressure of the ventricles forces the semi lunar valves
to open and the AV valves to close. This arrangement of valves allows for blood flow
from the ventricles into the arteries. The cardiac muscles of the atria depolarize and enter
the state of diastole during this phase.

 Relaxation phase: During the relaxation phase, all 4 chambers of the heart are in diastole
as blood pours into the heart from the veins. The ventricles fill to about 75% capacity
during this phase and will be completely filled only after the atria enter systole. The
cardiac muscle cells of the ventricles depolarize during this phase to prepare for the next
round of depolarization and contraction. During this phase, the AV valves open to allow
blood to flow freely into the ventricles while the semi lunar valves close to prevent the
regurgitation of blood from the great arteries into the ventricles.
DEFINITION
Impedance or blockage of one or more arteries that supply blood to the heart usually due
to atherosclerosis is known as CAD.
INCIDENCE
Coronary Artery diseases (CAD) have now become the leading cause of mortality in
India. A quarter of all mortality is attributable to CAD. Ischemic heart disease and stroke are the
predominant causes and are responsible for >80% of CAD deaths. The Global Burden of Disease
study estimate of age-standardized CVD death rate of 272 per 100 000 population in India is
higher than the global average of 235 per 100000 population.
CAUSES

Book Picture Patient Picture

 Coronary artery disease  Insufficient coronary blood flow
 Cardiac disease impending blood flow
 Insufficient coronary blood flow

RISK FACTORS
 Book Picture Patient Picture
 High blood pressure  Obesity
 High cholesterol levels  High blood pressure
 High triglyceride levels  High cholesterol levels
 Diabetes and high blood sugar levels  High triglyceride levels
 Obesity
 Smoking
 Age
 Family history
CLINICAL MANIFESTATION

Book Picture Patient Picture

 Pressure or tightness in the chest  Pressure or tightness in the chest
 Pain in the chest, back, jaw, and other  Sweating
areas of the upper body that lasts more  Nausea
than a few minutes or that goes away  Vomiting
and comes back  Anxiety
 Shortness of breath  Dizziness
 Sweating  A fast heart rate
 Nausea
 Vomiting
 Anxiety
 A cough
 Dizziness
 A fast heart rate

DIAGNOSTIC EVALUATION

BOOK PICTURE PATIENT PICTURE

 Electrocardiogram (ECG).  Electrocardiogram (ECG).
 Echocardiogram.   Echocardiogram. 
 Nuclear scan.   Angiography
 Angiography  Troponin I
 Troponin I

MANAGEMENT

 Medical Management:

Book Picture Patient Picture

 Blood thinners, such as aspirin, are  Tab. Aspirin is given to the patient.
 often used to break up blood clots and
improve blood flow through narrowed  Inj. Nitroglycerine are administered as
arteries. prescribed.
 Thrombolytic are often used to dissolve
 IV fluids on flow.
clots.
 Vital signs are continuously monitored.
 Anti platelet drugs, such as clopidogrel,  ECG monitoring has been done.
can be used to prevent new clots from  Analgesics are prescribed to the patient.
forming and existing clots from growing. Tab. Sorbitate has been given in case of
angina.
 Nitroglycerin can be used to widen
blood vessels.
 Beta-blockers lower your blood
pressure and relax your heart muscle. This
can help limit the severity of damage to
heart.
 ACE inhibitors can also be used to
lower blood pressure and decrease stress on
the heart.
 Pain relievers may be used to reduce
any discomfort may feel.

THEORY APPLICATION
“OREM’S theory” Self - care deficit will be appropriate to apply in this condition, as because
in Coronary
Artery Disease most of the patients are unable to take care of themselves.

COPONENTS PROBLEMS IDENTIFIED NURSING DIAGNOSIS

1. Air Patient will be having decreased Ineffective Breathing Pattern related
breathing pattern. to Decreased cardiac output as
evidenced by patient’s breath rate
less than 16 breaths per minute.

2. Nutrition The nutritional status of the Imbalance nutrition less than body
patient will decrease. requirement related to less intake of
food.

3. Water Patient fluid electrolyte balance Excess Fluid volume related to

is deteriorated. decreased organ perfusion (renal) as
evidenced by increased sodium/water
 retention in patient reports.

4. Elimination -------------- ----------------

5. Activity & Patient will be having chest Acute pain related to disease
rest pain. condition.

Patient will be having activity Activity intolerance related to

intolerance. disease condition as evidenced by
Patients sleeping pattern will be patient unable to perform daily
disturbed. activity.
Disturbed sleeping pattern related
to unfamiliar environment.

6. Social Patient will be having low self- Risk for situational low self-esteem
interaction esteem. related to unfamiliar environment.
7. Prevention of ----------- -----------
hazard
8. Promotion of Patient is unable to understand Ineffective therapeutic regimen
human the treatment modalities. related to complexity of treatment.
function Patient will be having anxiety. Anxiety related of hospitalization.

NURSING DIAGNOSIS
 Acute Pain related to coronary artery occlusion as evidenced by reports of chest pain with
radiation.

 Decreased cardiac output related to decreased cardiac contractility as evidenced by

changes in rate, rhythm, electrical conduction.

 Ineffective Breathing Pattern related to Decreased cardiac output as evidenced by

patient’s breath rate less than 16 breaths per minute.

 Activity intolerance related to disease condition as evidenced by patient unable to

perform daily activity.

 Disturbed sleeping pattern related to unfamiliar environment as evidenced by patient

verbalization.

 Imbalance nutrition status less than body requirement related to less intake of food as
evidence by weight loss.

 Excess Fluid volume related to decreased organ perfusion (renal) as evidenced by

increased sodium/water retention in patient reports.

 Ineffective therapeutic regimen related to complexity of treatment as evidenced by

verbalization by patient that he or she did not follow prescribed regimen.
  Anxiety related to hospitalization as evidenced by patient asking too many questions.

NURSING DIAGNOSIS (1- DAYS)

Assessment Diagnos Goal Planning Implementati Rationale Evaluati

is on on
Subjective Decreas Patient Auscultate BP. Auscultated To know the Expected
data: ed will Compare both BP. Compare proper outcome
Patient is cardiac maintain arms and both arms and functioning of is
complaints output hemodyn obtain lying, obtain lying, the vital organ. partially
about related amic sitting, and sitting, and met as
breathlessne to stability, standing standing patient
ss and decrease e.g., BP, pressures when pressures when has
unconscious d cardiac able. able. maintain
ness. cardiac output Check Checked To known the ed
contract within presence of presence of base line data of hemodyn
ility as normal murmurs or murmurs or the patient amic
evidenc range. friction rubs. friction rubs. stability,
ed by Auscultate Auscultated e.g., BP,
changes breath sounds. breath sounds. cardiac
Objective in rate, Measured To know the output
data: rhythm, Measure cardiac output fluid and within
On the electrica cardiac output and other electrolytes in normal
assessment l and other functional the patient body. range.
it was found conducti functional parameters as
that on. parameters as appropriate.
patient’s appropriate.
vital signs Administered To know the
is altered. Administer supplemental fluid and
supplemental oxygen, as electrolytes in
oxygen, as indicated. the patient body.
indicated.

Administereda To reduce pain.

Administer ntidysrhythmic
antidysrhythmi drugs as
c drugs as indicated.
indicated.

NURSING DIAGNOSIS ( DAYS - 2)

Assessmen Diagno Goal Planning Implementatio Rationale Evaluati

t sis n on
Subjective Ineffect Maintain Monitor Monitored To know the Expecte
data:- ive effective respiratory respiratory respiratory d
Patient is Breathi respirator rate, depth, and rate, depth, and rate. outcome
complainin ng y pattern; effort. effort. partially
g of Pattern be free of Auscultate Auscultated To know the achieved
difficulty in related dyspnea breath sounds, breath sounds, breathing as
breathing. to and noting noting pattern. patient’s
Decrea cyanosis, crackles, crackles, respirato
sed with wheezes, wheezes, ry
Objective cardiac ABGs and bronchi. bronchi. Provide pattern is
data:- output vital Keep head of Kept head of comfort improve
On the as capacity bed elevated. bed elevated. position. d.
assessment evidenc within Position on Position on
it was ed by acceptable sides. sides.
found that patient’ range. To maintained
patient is s Encourage Encouraged the breathing
having breath frequent frequent pattern.
breathlessn rate repositioning repositioning
ess. less and deep- and deep-
than 16 breathing breathing
breaths exercises and exercises and
per coughing coughing
minute. exercises. exercises. To maintain
Provide Provided the general
supplemental supplemental condition.
O2 as O2 as
indicated. indicated.

Assessmen Diagno Goal Planning Implementatio Rationale Evaluat

t sis n ion
Subjective Imbalan Client will Assess the Assessed the To know the Expecte
data: ced have an condition of condition of nutritional d
Patient is nutritio increased patient. patient. condition. outcom
having nal nutritional e
complaints status intake and Check the Checked the To know the partially
of less absence of weight of weight of general met as
weakness. than nausea patient. patient. condition. evidenc
body and ed by
require vomiting. Provide diet in Provided diet in To take the food patient
ment frequent frequent intervals gaps. has
related intervals. intervals. started
to less eating
intake Provide Provided To maintained food
of food nutritional diet nutritional diet the nutritional and able
Objective as like green like green leafy pattern. to
data: evidenc leafy vegetables, digest.
On the ed by vegetables,dal, dal,soup etc.
assessment weight soup etc.
it was loss
found that (4kg). Provide Provided To maintained
patient lost parenteral parenteral fluids, the intake and
4 kg fluids, as as ordered. output of the
weight. ordered. patient.
Refer to Referred to To select the
a dietitian if a dietitian if alternative food.
indicated. indicated.
NURSING DIAGNOSIS ( DAYS - 3)

Assessmen Diagno Goal Planning Implementatio Rationale Evalua

t sis n tion
Subjective Activity Patient Assess the level Assessed the To know the Expecte
Data:- Intolera will be of activity that level of activity general activity d
Patient is nce able to can be performed that can be of the patient. outcom
complainin related perform by patient. performed by e
g of to certain Assist in patient. partiall
inability to disease level of performance of Assisted in y met
perform conditio activity. daily activities. performance of as
daily n as daily activities. evidenc
activities. evidenc Provide alternate Provided To take the ed by
ed by periods of alternate periods interest to do patient
patient activity and rest. of activity and the work. is able
Objective unable rest. to
Data:- to perform
On the perform Provide hygienic Provided To maintain the certain
close activity. care to then hygienic care to health status. daily
observation patient. then patient. activitie
it was s.
observed Provide balance Provided To maintain the
that patient diet to the balanced diet to nutritional
is unable to patient. the patient. pattern.
perform Encourage Encouraged To encouraged
daily patient to patient to the to do daily
activity. perform range of perform range of activities.
motion exercises. motion
exercises.

Assessmen Diagno Goal Planning Implementation Rationale Evalua

t sis tion
Subjective Disturb Patient’s Assess the Assessed the To know the Expecte
data: ed sleeping condition of condition of sleeping d
Patient is sleeping pattern patient. patient. pattern. outcom
complaints pattern will be e is
of not able related improve Provide comfort Provided comfort To take proper partiall
to sleep. to d. devices to the devices to the rest. y met
unfamil patient. patient. as
iar evidenc
Objective environ Provide quiet Provided quiet To maintained ed by
data: ment as and calm and calm the calm patients
On the evidenc environment. environment. environment. sleepin
assessment ed by g
it was patient Provide well Provided well To take the pattern
found that verbaliz ventilated room ventilated room to proper is
patient is ation. to the patient. the patient. sleeping improv
unable to pattern. ed.
sleep and Provide one Provided one Provide sleep.
looks dull. glass milk glass milk before
before sleep. sleep.

NURSING DIAGNOSIS ( DAYS – 4 )

Assessmen Diagnosi Goal Planning Implementation Rationale Evaluati

t s on
Subjective Ineffectiv Patient Assess the Assessment was To know the Expected
data: e will related done. general and outcome
Patient is therapeut verbaliz circumstances physical is
complaints ic e of that may condition. partially
of inability regimen ability negatively met as
to related to to influence evidence
understand complexi follow resolution with d by
treatment. ty of the following the patient
treatment treatme program. verbalize
as nt s of
evidence Evaluate the The patient To performed understa
d by patient conviction desired nding of
verbalizat conviction in evaluated. behaviors. treatment
ion by his or her process.
Objective patient ability to
data: that he perform the
On the did not desired
assessment follow behavior.
it was prescribe
found that d Evaluate the Individual To know the
patient is regimen patients thought thoughts of health problems of
unable to of health problems the patient.
understand problems. evaluated.
the
treatment. Allow patients Patient allowed To involved
participation in participating in the patient in
planning the planning the own
treatment treatment treatment.
program. program.

Inform the Patient informed To know the

patient about about the better
the advantages advantages of condition.
of adhering to adhering to the
the treatment prescribed
regimen. regimen.
Assessment Diagno Goal Planning Implementation Rationale Evaluati
sis on
Subjective Risk of To Assess the Assessment was To know the Expected
data: situatio increase condition of done. base line outcome
Patient is nal low the self- patient. data. is
having less self- esteem partially
confidence esteem of Help patient to Helped the patient To adjust the met as
about him. related patient. identify to identify environment. evidence
to environmental environmental d by self-
disease factors which factors. esteem is
conditi increase risk for increased
on. low self- as patient
esteem. verbaliza
tion.
Objective Encourage Encouraged To express
data: patient to patient to the feeling.
On the Verbalize verbalize thoughts
assessment thoughts and and feelings.
it was found feelings.
that patient
has low Encourage client Encouraged client To maintain
confidence to create a sense to create a sense the
level. of competence of competence confidence
through short through short- level.
term goal setting term goal setting
and goal and goal
achievement. achievement.

NURSING DIAGNOSIS ( DAYS – 5 )

Assessment Diagno Goal Planning Implementation Rationale Evaluatio

sis n
Subjective Anxiety Patient Assess the level Assessed the level To know the Expected
Data:- related will of anxiety of the of anxiety of the anxiety level outcome
Patient is to verbalize patient. patient. of the patient. is partially
complaining hospital of met as
of fear of ization reduced Orient the Oriented the To know the evidenced
hospitalizati as level of patient to the patient to the hospital staff by anxiety
on. evidenc anxiety. hospital and hospital and staff. members. is reduced
ed by staff. by patient
patient verbalizati
Objective asking Provide Provided To maintain on.
Data:- too psychological psychological the
On the many support. support. confidence
assessment questio level.
it was found ns. Explain all the Explained all the To adjust the
that patient procedures with procedures with situation.
is having rationale. rationale.
anxiety.
Answer patient Answered To clarify the
question. patient’s question. doubt.

Provide Provided To decreased

antianxiety antianxiety drugs the level of
drugs as per as per physician anxiety.
physician order. order.

HEALTH EDUCATION
Home care
 Take medicines exactly as directed. Don’t skip doses. Talk with healthcare provider if
medicines aren't working for.
 Recovery after a heart attack takes time. Plan to rest for at least 4 to 8 weeks while
recover. Then return to normal activity when doctor says it’s OK.
 Ask doctor about joining a heart rehabilitation program. This can help strengthen heart
and lungs and give more energy and confidence.
 Tell doctor if are feeling depressed. Feelings of sadness are common after a heart attack.
But it is important to speak to someone or seek counseling if feeling overwhelmed by these
feelings.
 Ask family members to learn CPR. This is an important skill that can save lives when it's
needed.
 Learn to take own blood pressure and pulse. Keep a record of results. Ask doctor when
should seek emergency medical attention.

Lifestyle changes

This will help the heart disease from getting worse. These changes will most likely be a
combination of diet and exercise.

Diet

Patient may need to see a registered dietitian for help with these diet changes. These changes
may include:

 Cutting back on much fat and cholesterol.

 Cutting back on much salt (sodium) especially if patient has high blood pressure.
 Eating more fresh vegetables and fruits.
 Eating lean proteins such as fish, poultry, beans, and peas, and eating less red meat and
processed meats.
 Using low-fat dairy products.
 Using vegetable and nut oils in limited amounts.
 Limiting how many sweets and processed foods such as chips, cookies, and baked goods.
 Limiting often eat out. And when do eat out, making better food choices.
 Not eating fried or greasy foods, or foods high in saturated fat.

Exercise

Depending on case, patient may recommended that get moderate to vigorous physical activity for
at least 40 minutes each day, and for at least 3 to 4 days each week. A few examples of moderate
to vigorous activity include:

 Walking at a brisk pace, about 3 to 4 miles per hour

 Jogging or running
 Swimming or water aerobics
 Hiking
 Dancing
 Martial arts
 Tennis
 Riding a bicycle or stationary bike

Other changes

 Lose weight.
 Stop smoking.
 Learn to manage stress.

Follow-up

Make a follow-up appointment as directed.

BIBLIOGRAPHY
 Hinkle L. Janice , Cheever H. Kerry . Brunner & Suddarth’s Textbook of Medical
Surgical Nursing. 10th edition. page no 1094 – 1103.
 Chintamani and Mani Mrinalini. Medical surgical nursing Assessment and management
of clinical problems. Third south Asia edition.2018: ELSEVIER India private limited;
new delhi. Pg-674-678.

 shodhganga.inflibnet.ac.in/bitstream/10603/.../12_summary%20and%20conclusion.p.

 https://www.ncbi.nlm.nih.gov/books/NBK235823/

 vivaessay.net/custom-written-medical-essay-example-on-myocardial-infarction.php


 https://www.mayoclinic.org/diseases-conditions/heart-attack/...causes/syc-20373106

 https://www.health.harvard.edu/a_to_z/heart-attack-myocardial-infarction-a-to-z