MYOCARDIAL INFARCTION

INTRODUCTION
Coronary Artery Bypass Surgery redirects blood around a section of a blocked or partially blocked artery in your heart. The procedure involves taking a healthy blood vessel from
your leg, arm or chest and connecting it below and above the blocked arteries in your heart. With a new pathway, blood flow to the heart muscle improves. bypass surgery doesn't cure the heart
disease that causes Coronaryed the blockages, such as atherosclerosis or coronary artery disease. However, it can ease symptoms, such as chest pain and shortness of breath.
Myocardial Infarction is defined as a diseased condition which is caused by reduced blood flow in a coronary artery due to atherosclerosis & occlusion of an artery by an embolus or
thrombus. MI or heart attack is the irreversible damage of myocardial tissue caused by prolonged ischemia & hypoxia. In some cases, doctors perform emergency bypass surgery at the time of
a heart attack. If possible, however, they might have bypass surgery after the heart had time about three to seven days to recover from the heart attack.
According to Epidemiology of Myocardial Infarction (J.C. Jarayah, K.Davatyan, S.S. Subrmanian and J.Priya, November 2018) In 2014, based on the self-reported national survey of
the UK, the prevalence of Myocardial Infarction was reported as 640,000 in men and 275,000 in women; this represents about 915,000 people that have suffered a Myocardial Infarction in the
UK. In 2013, the prevalence of Myocardial Infarction in men was about three times higher than for women in the UK. the prevalence of age-specific Myocardial Infarction extends from 0.06%
of men less than 45 years of age to 2.46% of those greater than 75 years old.

SIGNIFICANCE OF THE STUDY

The importance of this study it will provide information about Post-Operative of Coronary Artery Bypass Surgery due to Myocardial Infarction to the students of 3rd year BSN B
Group 4. This study will also help the students to learn and understand the management of Post-operative of Coronary Artery Bypass Surgery due to Myocardial Infarction. Moreover, this
study will enhance and evaluate the student’s academic and clinical skills.

SCOPE
The scope of the study is to focus on Mr. J.C.S a 49 years old male that was diagnose with Myocardial Infarction and undergone into Coronary Artery Bypass Surgery. The focus of
this study is to explain the Post-operative management of a person undergone into Coronary Artery Bypass Surgery due to Myocardial infarction. The researcher’s include the pathophysiology
of Myocardial Infarction, the client’s present and past illness, medication taken, nursing assessment, nursing care plans, drug study, health teachings and prognosis.

LIMITATION
The researcher was unable to conduct an actual assessment of the client, so this study was a hypothetical study. Furthermore, this study was only limited to Post-Operative condition
and management of a client who was undergone into Coronary Artery Bypass Surgery due to Myocardial Infarction in a ward room setting.
 ANATOMY AND PHYSIOLOGY

OVERVIEW OF MYOCARDIAL INFARCTION

 A heart attack occurs when the flow of blood to the heart is blocked. The blockage is most often a buildup of fat, cholesterol and other substances, which form a plaque in the arteries that
feed the heart (coronary arteries).

 Sometimes, a plaque can rupture and form a clot that blocks blood flow. The interrupted blood flow can damage or destroy part of the heart muscle.

 A heart attack, also called a myocardial infarction, can be fatal, but treatment has improved dramatically over the years. It's crucial to call 911 or emergency medical help if you think you
might be having a heart attack.

COMMON HEART ATTACK SIGNS AND SYMPTOMS

 Pressure, tightness, pain, or a squeezing or aching sensation in your chest or arms that may spread to your neck, jaw or back
 Nausea, indigestion, heartburn or abdominal pain
 Shortness of breath
 Cold sweat
 Fatigue
 Lightheadedness or sudden dizziness

MODIFIABLE PREDISPOSING RISK FACTORS

 Smoking
 Hypertension
 Physical Activity
 Obesity
 Diabetes Mellitus
 Psycho-social Stress

NON-MODIFIABLE PREDISPOSING RISK FACTORS

 Increasing Age
 Gender
 Heredity/Family History
 Genetic Factor

PATHOPHYSIOLOGY
Myocardial infarction is a consequence of prolonged and severe imbalance between myocardial oxygen supply and demand. In the vast majority of cases, myocardial infarction results
from coronary atherosclerosis with a superimposed luminal thrombus. Slowly developing high-grade coronary stenoses often progress to complete occlusion without causing acute myocardial
infarction because formation of a collateral vascular network protects the cardiomyocytes from ischemic death. Myocardial infarction usually results from sudden occlusion of the coronary
artery when a ‘high-risk’, thrombosis-prone plaque becomes eroded or ruptures.
 DATA BASE AND HISTORY
Name of the Client: JC Sabanal
Gender: Male
Age: 49 years old
Religion: Roman Catholic
Civil Status: Married
Income: Confidential
Nationality: Filipino
Date Admission: July 5, 2017 Time: 9:25 am Informant: JC Sabanal
Temperature: 37℃
Pulse Rate: 50 bpm
Respiration Rate: 10 cpm
Blood Pressure: 110/80 mmHg
Height: 162 cm
Weight: 60 kg

Chief Complaint and History of Present Illness

 A 49-year old male client complains central chest pain, shoulder pain, shortness of breath and vomiting the day he was admitted. Mr. JC was apparently well one day back, then he
gradually developed chest pain radiating in his shoulder. He had an episode of vomiting but there is no any blood composition. He also developed the history of shortness of breath. He smokes
12 sticks per day for 20 years. He is also an alcoholic. He has no food and drug allergy. And his sleeping pattern was disturbed due to hospitalization.

Types of Previous Illness Date Types of Previous Illness Date

Diabetes Mellitus Type II October 16, 2015 - -

Has received blood in the past: __Yes ✓No ; If yes, list dates - Reaction - Yes - No

Medication Name Dose/ Frequency Time of Last Dose Medication Name Dose/ Frequency Time of Last Dose

4.5 mg/tds 1:00 pm - - -

Tazopip

Lupenox 40 mg/bd 12:00 am - - -

Clonazepam 0.25 mg/hs 7:00 am - - -

150 mg/bd 6:00 pm - - -

Ecosprin


Respiration
[-]Asymmetric [ X ]Tachypnea [-] Barrel Chest
[-]Apnea [-] Rales [-] Cough
[-]Bradypnea [-] Shallow [-] Rhonchi
[-]Sputum [-] Diminished [X] Dyspnea
[-]Orthopnea [-] Labored [-] Wheezing
[-]Pain [-]Cyanotic [-]No problem
 Admitting diagnosis: Myocardial Infarction
 Attending Physician: Dr. Mark Loell Pabustan

Nursing System Review Chart

Name: JC Sabanal
Date: July 5, 2017
Vital Signs:
Pulse Rate: 50 bpm
Blood Pressure: 110/80 mmHg
Temperature: 37℃
Height: 162 cm
Weight: 60 kg

EENT:
[-] impaired vision [-] blind
[-] pain reddened [-] drainage
[-] burning [-] edema [-] lesion teeth
[-] assess eyes, ears, and nose
[-] throat for abnormality [X] no problem

GASTRO INTESTINAL TRACT:

[-] obese [-] distention [-] mass

[-] dysphagia [-] rigidly [-] pain
[-] assess abdomen, bowel habits, swallowing
[-] bowel sounds, comfort [X] no problem

GENITOURINARY and GYNE:

SUBJECTIVES OBJECTIVES

COMMUNICATION:

HEARING LOSS GLASSESS LANGUANGES

 VISUAL CHANGES CONTACT LENS HEARING AID

X DENIED R L

COMMENTS: “ Okay ra akong PUPIL SIZE: Normal SPEECH DIFFICULTIES:

hearing and vision after sa surgery” verbalized by the cl REACTION: Pupil Equally Round and Reactive to Light Accommod
ient. ation.

OXYGENATION:

X DYSPNEA RESP. X REGULAR IRREGULAR

X SMOKING HISTORY DESCRIBE: No shortness of breathe.

COUGH

SPUTUM

DENIED COMMENTS: “ before sa R: Symmetric Breathing

akong surgery maka 12 L: Symmetric Breathing

per sticks ko per day” as

verbalized by the client.

SUBJECTIVES OBJECTIVES

CIRCULATION:

X CHEST PAIN HEART RHYTHM X REGULAR IRREGULAR

LEG PAIN ANKLE EDEMA: There’s no presence of ankle

NUMBNESS OF EXTREMITIES edema.

DENIED CAROTID RADIAL DOSALIS PEDIS FEMORAL

R:

COMMENTS: “Central Chest Pain L:

radiating to my shoulder after sa COMMENTS: Edema is present in right dorsal

akong surgery” verbalized by the palm.

client. *IF APPLICABLE:

NUTRITION:

DIET DENTURES X NONE

N V

X RECENT CHANGES IN WEIGHT AN APPETITE FULL PARTIAL WITH PATIENT

DIFFICULTY IN SWALLOWING UPPER X

DENIED

COMMENTS: “Wala kayo koy

LOWER X
gana mukaon after sa akong

surgery” as verbalized by the

client.
 SUBJECTIVES OBJECTIVES

SKIN INTEGRITY:

DRY COLD X PALE

DRY COMMENTS: FLUSHED WARM

ITCHING “Wala ra nag dry ug MOIST CYANOTIC

OTHER katol katol ako skin”

X DENIED as verbalized by the *rashed, ulcers, decubitus (described size, locations, drainage)

client.

ACTIVITY SAFETY:
COMMENTS: No abnormal Findings
CONVULSION COMMENTS:
 DIZZINESS “Wla ko nalipong

LIMITED MOTION OF after sa akong X LOC and orientation

JOINTS surgery. Pero dili GAIT: WALKER CARE OTHER

LIMITATION IN ABILITY TO: ko maka ligo ug X STEADY UNSTEADY

X AMBULATE maka suot sa Sensory and motor losses in the face or extremities

X BATHE SELF sanina” as verbalized No sensory motor loses.

OTHER by the client.

DENIED ROM limitations : Client does not have ROM

limitations.

SUBJECTIVES OBJECTIVES
COMFORT / SLEEP / AWAKE

X PAIN (location, frequency, remedies) X FACIAL GRIMACES

NOCTURIA GUARDING

X SLEEP DIFFICULTIES OTHER SIGNS OF PAIN

DENIED

COMMENTS: “ Ga lisod jud kog COMMENTS: His face and mouth are twisted

tulog basta sa hospital. due to exaggeration.

 And gaka feel jud kog SIDE RAIL RELEASED FORM SIGNED (60+years) N/A

slightly pain sa akong

chest padulong sa side

chest before, after sa

akong bypass surgery” as

as verbalized by the client.

COPING: OBSERVED NON-VERBAL BEAHAVIOR:

OCCUPATION: House wife Patient is cooperative.

MEMBERS OF HOUSEHOLD: Lucille Sabanal

PERSON (PHONE NUMBER)

The patient refused ti give his phone number.

MOST SUPPORTIVE PERSON: Wife

SPECIAL PATIENT INFORMATION

None DAILY WEIGHT None PT/OT

None BP SHIFT None IRRADIATION

None NEURO VS None URINE TEST

None CVP/SG READING None 24 HOURS URINE COLLECTION

DIAGNOSTIC/ LABOR DATE DATE ORDERE L.V. FLUIDS/ BL DATE

DATE ORDERED
ATORY DONE D OODS DISC.

IV Analgesia 5-10
July 05, 2021 FULL BLOOD COUNT July 05, 2021
mg morphine

July 05, 2021 CHEST XRAY

July 05, 2021 ECG

DIAGNOSTIC PROCEDURES
 Total Leukocyte Count (TLC)
 Differential Leukocyte Count (DLC)
 Plateles Count
 Total Bilirubin
 ALP Test
 SUMMARY OF FINDINGS
Remarks:
 There is a normal bleeding in the incision site. A clinical finding of a successful Coronary artery bypass grafting (CABG).
NURSING CARE PLAN FOR PHYSIOLOGIC
Subjective cue:
“Central Chest Pain radiating to my shoulder after sa akong surgery” verbalized by the client.
“Wla ko nalipong after sa akong surgery. Pero dili ko maka ligo ug maka suot sa sanina” as verbalized by the client.
Objective cue:
 Facial grimace
 Irritable
Diagnosis
Acute pain related to tissue ischemia as evidenced by facial grimace.
Activity intolerance related to presence of ischemic myocardial tissues
Objectives:
After 1 hour of nursing interventions, the patient will be able to:
Verbalize relief/control of chest pain within appropriate time frame for administered medications.
Demonstrate measurable/progressive increase in tolerance for activity

INTERVENTION AND RATIONALE

INDEPENDENT
1. Instruct patient to do relaxation techniques: deep and slow breathing, distraction behaviors, visualization, guided imagery. Assist as needed (Helpful in decreasing perception
and response to pain. Provides a sense of having some control over the situation, increase in positive attitude.)
2. Instruct patient to report pain immediately. Provide quiet environment, calm activities, and comfort measures. (Decreases external stimuli, which may aggravate anxiety and
cardiac strain, limit coping abilities and adjustment to current situation.)
3. Explain pattern of graded increase of activity level: getting up to commode or sitting in chair, progressive ambulation, and resting after meals. (Progressive activity provides a
controlled demand on the heart, increasing strength and preventing overexertion)
4. Encourage rest initially. Thereafter, limit activity on basis of pain and/or adverse cardiac response. Provide nonstress diversional activities. (Reduces myocardial workload and
oxygen consumption, reducing risk of complications)
DEPENDENT
1. Administer analgesic (Morphine 5-10 mg), as indicated.(To maintain a “tolerable” level of pain.)
2. Refer to cardiac rehabilitation program.(Provides continued support and/or additional supervision and participation in recovery and wellness process.)

EVALUATION
After 1 hour of nursing interventions, the patient was able to:
 Express and demonstrate relief and comfort. Demonstrate increase in tolerance with normal and stable vital signs.
DRUG STUDY
HEALTH TEACHING AND PROGNOSIS