University of La Salette Inc.

Bachelor Street, Dubinan East,

Santiago City, Isabela, Philippines

ACUTE
MYOCARDIAL
INFARCTION WITH
ST ELEVATION

A Case Study
Presented to the College of Nursing, Public Health and Midwifery

Case presented by:

Cardenas, Ann Nicole
Cayago, Kristel Mae
Chiu, Hannah Kathrine
Cuaresma, Rose Ann Camille
De Chavez, Naiden Dianne
De Loreto, Janica Alaina
De Vera, Hanna Rhyjean
Doliente, Jinerva
Dumon, Larlene Genesis
Galestre, Shaynne
Gumabon, Jemaico

BSN-4A

Case presented to:

Richmond Caliboso
Clinical Instructor
I. Case Description

Acute Myocardial Infarction with ST Elevation

also known as a heart attack, a life-threatening condition which refers

to formation of localized necrotic areas within the myocardium of the heart
that are deprived of an adequate blood supply because of reduced coronary
artery blood flow. The common cause is a critical narrowing of a coronary
artery due to atherosclerosis of an artery due to embolus or thrombus.
Prolonged ischemia lasting more than 20 minutes produces irreversible
cellular damage and necrosis of the myocardium. If ischemia persist, it takes
approximately 4 to 6 hours for the entire thickness of the heart muscle to
become necrosed.

 Risk Factors
 Hypertension
 Smoking
 Diabetes Mellitus (DM)
 Genetic and Familial Tendency
 Direct trauma
 Obesity
 Use of cocaine

 Etiology
 Prolonged deprivation of oxygen supply to the myocardium
 Underlying coronary artery disease
 Coronary artery occlusion

 Three areas which develop in MI are as follows:

 Zone of injury which gives rise to elevated ST segment
 Zone of infarction which records pathologic Q wave in the ECG
 Zone of ischemia which produces inversion of T wave

 MI may be classified as follows:

 Transmural infarct, which extends from endocardium to
epicardium
 Subendocardial infarct, which affects the endocardial muscles
 Intramural infarct, which is seen in patchy areas of the
myocardium and is usually associated with long standing angina
pectoris

 Signs and Symptoms

 Chest Pain
 Shortness of Breath
 Cold and clammy skin
 Diaphoresis
 Tachycardia
 Levine Sign
 Pallor
  Anxiety (Feeling of Doom)
 Altered level of consciousness
 Tachypnea

NOTE: Patients with Diabetes Mellitus may not experience severe pain
due to because the neuropathy that accompanies diabetes can interfere
with the neuroreceptors, dulling the pain

 Diagnostic Test
 Electrocardiogram
 Laboratory test
 Cardiac Enzyme Biomarker (CK-MB, Troponin I)
 Lipid Profile (LDL, HDL and Cholesterol)
 Hemoglucose Test
 HgbA1C
 Complete Blood Count
 Echocardiogram
 Chest X-ray

 Complications
 Heart failure
 Heart valve problems
 Cardiac arrest and sudden death
 Pericardial effusion and cardiac tamponade
 Acute pulmonary edema
 Myocardial rupture

 Treatment options
 Initial management
 Supplemental oxygen
 Aspirin
 Nitrates (Nitroglycerin)
 Morphine
 Beta-blocker
 Percutaneous Coronary Intervention (PCI)
 Thrombolytics
 Streptokinase
 Altepase (Activase)
 Anistreplase (Eminase)
 Cardiac Rehabilitation
 Heart surgery
 Heart transplant
 Surgically implanted devices
II. Anatomy and Physiology

Anatomy of Cardiovascular System

A. Major components of the Cardiovascular System
 Heart
 Blood vessels
 blood

Heart
FUNCTIONS OF THE HEART
 The heart's primary function is to pump blood throughout the body.
 It supplies oxygen and nutrients to the tissues and removes carbon dioxide and
waste from the blood.
 It also helps to maintain adequate blood pressure throughout the body.
 Heart pumps the blood throughout the body, hence playing an important role
in maintaining body temperature.

LOCATION OF THE HUMAN HEART 

Location: Thorax, between the lungs in Inferior mediastinum. Located in the 5th
intercostal space
Orientation: Pointed apex directed toward left hip & base points towards right
shoulder

Coverings of the heart

 1. Pericardium – double-walled sac; thin protective layer
A. Fibrous Pericardium – loose and superficial
B. Serous Membrane – deep to the fibrous pericardium
o Parietal pericardium – outside layer that lines the inner
surface of the fibrous pericardium
o Visceral pericardium – next to the heart; epicardium

WALLS OF THE HEART 

The heart is surrounded by a double layered membrane which also surrounds blood
vessels of which is known as the pericardium. It also protects the heart and acts as a
protecting case. The heart consists of three layers which are given as 

 Epicardium (outer layer) 

 Myocardium (middle layer) 
 Endocardium (inner layer)

It is made up mainly of the myocardium, which consists largely of cardiac muscle.

EPICARDIUM 

The outermost layer of the heart is called epicardium. It is the visceral layer of the
serous pericardium. It is formed by epithelial cells. It also contributes to the coronary
blood vessels and myocardium and plays a protective role for the heart. 

MYOCARDIUM  
The muscular wall or layer of the heart or the heart muscle is also known as the
myocardium. Histologically it consists of cells known as the cardiac myocytes or
cardiomyocytes. It is an important layer which is also responsible for the involuntary
movements of the heart in contractility while pumping the blood. 

ENDOCARDIUM 
The innermost layer of the heart is known as the endocardium. It consists of thin
endothelial and smooth tissues that make up the linings of the heart chambers and
valves. It also acts as a barrier between the heart muscles and blood vessels. 
 CHAMBERS OF
THE HEART

The right atrium

It receives the blood from the veins and then transfers it to the right ventricle. 

The right ventricle

The right ventricle receives the blood from the right atrium and then pumps it towards
the lungs where the blood is mixed with oxygen and carbon dioxide is removed
from the blood. 

The left atrium

When the blood is mixed with the oxygen in the lungs it is transported to the right
atrium through pulmonary veins which are the only exceptional veins that carry
oxygenated blood. 

The left ventricle

The left ventricle is the strongest chamber of the heart which is responsible for
pumping the blood towards the rest of the body. The strong contractions of the left
ventricle are responsible for creating the blood pressure.

VALVES OF THE HEART 

The valves of the heart play an important role in the proper functioning of the heart.
They prevent the backflow of the blood. There are four main valves present in heart
which are given as 

Tricuspid valve

It is located between the right atrium and the right ventricle. It consists of three thin
flaps and allows the blood to move from the right atrium to the right ventricle. 

Pulmonary valve

Pulmonary valve is located between the right ventricle and the pulmonary artery and
is important for moving deoxygenated blood from the right ventricle to the lungs. 

Mitral valve
Mitral valve is also known as the bicuspid or atrioventricular valve, it is located
between the left atrium and the left ventricle and is necessary for the blood movement
in the right direction. 

Aortic valve
Aortic valve is the most important valve that separates the body from the heart and is
responsible for the movement of the blood towards the body in the right direction.
The aortic valve opens when the left ventricle contracts to pump the blood towards the
body and then closes between heartbeats to prevent backflow of blood towards the left
ventricle. 

BLOOD VESSELS OF THE HEART 

Your heart pumps blood through three types of blood vessels:

 Arteries carry oxygen-rich blood from your heart to your body’s tissues. The
exception is your pulmonary arteries, which go to your lungs.
 Veins carry oxygen-poor blood back to your heart.
  Capillaries are small blood vessels where your body exchanges oxygen-rich
and oxygen-poor blood.

The blood vessels that enter and exit from the heart for circulation of the blood
between the body and the heart are  

Aorta 
Aorta is the main artery of the cardiovascular system that carries the blood away from
the heart towards the rest of our body. 

Superior vena cava

It is the major vein of the upper body that carries deoxygenated blood from the head,
neck, thorax region and from the upper limb (arms and forearms and hands). 

Inferior vena cava

Inferior vena cava is formed by the combination of two common iliac veins, and it
collects the deoxygenated blood from the abdomen region and lower limb or
extremity(legs&feet)

Your heart receives nutrients through a network of coronary arteries. These arteries
run along your heart’s surface. They serve the heart itself.

 Left coronary artery: Divides into two branches (the circumflex artery and
the left anterior descending artery).
 Circumflex artery: Supplies blood to the left atrium and the side and back of
the left ventricle.
 Left anterior descending artery (LAD): Supplies blood to the front and
bottom of the left ventricle and the front of the septum.
 Right coronary artery (RCA): Supplies blood to the right atrium, right
ventricle, bottom portion of the left ventricle and back of the septum.
CONDUCTING SYSTEM OF THE HEART
Heart conducting system is also known as the cardiac conduction which consists of
the cells, nodes, and signals that control the heartbeats. The components of the
conducting system of the heart are given as 

 Sinoatrial (SA) node: Sends the signals that make your heart beat.
 Atrioventricular (AV) node: Carries electrical signals from your heart’s
upper chambers to its lower ones.

Your heart also has a network of electrical bundles and fibers. This network includes:

 Left bundle branch: Sends electric impulses to your left ventricle.

 Right bundle branch: Sends electric impulses to your right ventricle.
 Bundle of His: Sends impulses from your AV node to the Purkinje fibers.
 Purkinje fibers: Make your heart ventricles contract and pump out blood.
Physiology of Cardiovascular System
A. Blood Circulation

Superior vena cava Tricuspid Pulmonary

Right Pulmonary
Right artery
atrium ventricle

Inferior vena cava valve valve

Left
Left
Ventricle
atrium lungs

Rest of the
Aorta body

III. Nursing History

A. Demographic Data

Name: Mr. Z
Age: 53 years old
Address: Dubinan East, Santiago City, Isabela
Sex: Male
Religion: Roman Catholic
Birthdate: June 17, 1969
Civil status: Married
Height: 175cm
Weight: 73kg.
BMI: 23.7
Date of admission: October 6, 2022
Time of admission: 8:25 pm
Chief complaint: Severe chest pain 10/10
Admitting diagnosis: Acute Myocardial Infarction, STEMI
Admitting physician: Dr. K
Initial vital signs:
 T: 36.3ºc
 RR: 18 cpm
 PR: 92 bpm
 BP:110/80 mmHg
 O2: 93%

B. Past Health History

The patient has no allergy to foods and drugs, a former smoker and a
non-alcoholic person. He developed and was diagnosed with diabetes mellitus
type II. His wife stated that since the pandemic the patient and his family are
afraid to be hospitalized due to anxiety of the spreading virus.

C. History of Present Illness

3 hours PTA, the patient experienced sudden severe chest pain, cold
skin, tachycardia and diaphoresis according to his wife. He was advised to
have a check-up, but refused saying that this is just a heart burn like the last
time. The wife called their Doctor, was advised to had an electrocardiogram
and was admitted to Callang General Hospital Inc,.

D. Familial History
The patient has hypertension, and stated that his parents had the same
condition. They also have a genetic disorder which is Ankylosing Spondylitis.

E. Gordon’s 11 Functional Health Pattern

Gordon’s 11 functional health patterns

1. Health perception/ health management
a. Before
i. Patient always complied with the medications prescribed
by his primary health care providers.
b. During
i. Patient complies with the medications prescribed and
given to him. He also follows or complies with his doctors
prescribed diagnostic procedures.
2. Nutrition - metabolic
a. Before
i. Patient loved to eat. He liked sweets, savory, and foods
from fast food chains.
b. During
i. Patient consumes low fat – low salt diet. Patient
consumes low sugar diet. Patient also consumes foods
with no extreme temperatures.
3. Elimination
a. Before
i. Patient urinated 3 to 4 times and defecated 2 to 3 times
daily.
b. During
 i. Patient urinates 2 to 4 times but fails to defecate 2
straight days.
4. Activity – exercise
a. Before
i. Patient did not perform any form of exercises. Patient
usually traveled a lot and most of the time due to business
and family matters.
b. During
i. Patient turns himself from one side to another from time
to time.
5. Cognitive – perceptual
a. Before
i. Patient did not want to visit hospital for check-up and
preferred doing it through phone calls because he was
afraid of becoming infected to COVID-19.
b. During .
i. Patient gives consent for his hospital admission and rents
a private room aside from being alone inside the ICU.
6. Sleep – rest
a. Before
i. Patient did not usually take naps during daytime. Patient
usually slept late (1:00 am) and woke up early (6:00 am).
b. During
i. Patient takes daytime naps often and sleeps early (8:00 or
9:00pm).
7. Self-perception/ self-concept
a. Before
i. Patient was verbal to his wife in terms of how he felt most
especially when something’s wrong. However, he
preferred enduring it at home without check-up at
hospitals.
b. During
i. Patient is verbal about his feelings. He notifies
immediately the nurse and his attending physician about
his feelings such us chest pain.
8. Role-relationship
a. Before
i. Patient loved to hang-out with his friends and his family.
He has a good relationship with his family and so with
other people such as friends, costumers, and etc.
b. During
i. Patient is visited by his wife and other members of the
family from time to time. For the people who cannot pay
him a visit personally, He stays in touch with them via
messages and phone calls.
9. Sexuality – reproductive
a. Patient is male. Patient is not sexually active due to his and his
partner’s busy and tiring schedules.
10. Coping – stress tolerance
a. Before
 i. Patient was verbal to his needs and often acted needy like
a baby that demands more attention of his wife and other
members of the family.
b. During
i. Patient is verbal about his needs of assistance to his wife,
nurse, and primary care provider. However, patient does
not act like a needy child.
11. Value – belief
a. Before
i. Patient attended mass or paid a visit to church whenever
he can and whenever the number of people present is not
too much.
b. During
i. Patient is unable to attend or pay a visit to the church.
Patient silently prays every morning right after waking up
in the morning.

IV. Head-to-Toe Assessment

General Survey
October 8, 2022
2:00pm
The patient is lying on bed, wearing white shirt He is alert and
conscious, 5’7” in height, 73kg, with vital signs of: T: 36.1°C, RR- 19
breaths per min, PR- 70 bpm, and BP- 110/70mmHg O2sat: 96%
AREAS METHODS FINDINGS INTERPRETATIO
N
1.HEAD Hair, scalp, Inspection  Shiny black  Normal
face hair
Palpation  No bumps  Normal

Eyes and Inspection  Eyes are  Normal

Vision symmetrical

 Pupils  Normal
constrict
when
diverted to
light and
dilates when
 he gazes afar  Normal

 Conjunctiva is
clear and free
from lesions
Ears and Inspection  Ears are at  Normal
hearing the same size
and shape

 Normal
 Ears are
clean.
 Normal
 Patient can
hear normally
when spoken
softly

Nose Inspection  No swelling of  Normal

the mucus
membrane

Mouth and Inspection  Tongue is  Normal

esopharynx
pink and is
free of
swelling and
lesions
 Normal
 Lips are
smooth and
moist without
lesions or
swelling.
2. NECK Muscles Inspection  Patient is able  Normal
to freely move
his neck.
 Lymph nodes Palpation  Not palpable  Normal

3. UPPER Skin and Inspection

 Skin brown in  Normal
EXTREMITIE nails
S color
 Nails are  Normal
short and
clean
 Normal
 Good skin
Palpation turgor  Normal
 1-2 seconds
capillary refill
Muscle Inspection  Patient is able  Normal
to freely move
strength and
his arms
tone

Joint ROM Inspection  Able to move  Normal

arms through
active ROM

 Normal
 Able to
extend arms
in front or
push them
out to the
side.

Brachial and Palpation  Palpable  Normal

brachial and
Radial pulse
radial pulse
Sensation Inspection  The patient  Normal

Was able to
react on pain
and can
differentiate
hot and cold
4. CHEST Skin Inspection  (-) lesions  Normal
AND BACK Palpation  No bumps
 No reports of
pain during
the inhalation
and
exhalation.
Lungs Auscultation  Absence of  Normal
adventitious
sounds upon
auscultation

Heart Auscultation  (-) murmur  Normal

 There were  Normal
no visible
pulsations on
the aortic and
pulmonic
areas
Spinal Inspection  (-)  Normal
deformities
column Palpation
5. ABDOMEN Skin Inspection  Abdomen is  Normal
Palpation flat, not
distended.
 No palpable
mass

Bowel sound Auscultation  Decreased  Constipation

due to
bowel sound
medication
(Morphine)
and reduce
mobility
Palpation  A palpable
 due to the
abdominal length of time
 mass in the of the stool
stays in the
left lower
colon that
abdominal results in
bloating
quadrant
6. LOWER Skin and toe Inspection  Nails are  Normal
EXTREMITIE nails Palpation short and
S clean
 Normal
 2 sec capillary
refill
 Normal
 Pinkish nail
beds
Gait and Inspection  Can walk and  Normal
balance sit on his own

Joint ROM Inspection  Can move his  Normal

legs

Popliteal, Palpation  Normal  Normal

popliteal,
posterior
posterior
tubial, tubial,
dorsalis pedis
Dorsalis
pulses
pedis pulses

V. Laboratory Diagnostic
October 6, 2022
Test Ref. Value Unit Result
HGT @ 10:00 pm 76 – 160 mg/dL 331
HGT @ 10:45 pm 76 – 160 mg/dL 363
HGT @ 10:58 pm 76 – 160 mg/dL 320
HGT @ 5:00 am 76 – 160 mg/dL
Examination Result Ref. Value
Hematocrit (Male) 44.8 40.0 – 54%
Hemoglobin (Male) 15.6 13.0 – 18.0 g/dL
WBC count 16.40 (H) 5.0 – 10.0x10^9/L
(Differential count)
Neutrophil 91.5 (H) 50.0 – 65.0%
Lymphocyte 5.9 (L) 25.0 – 35.0%
Eosinophils 0.4 (L) 3.0 – 5.0%
Basophils 0.5 0.1 – 1.0%
Monocyte 1.7 (L) 3.0 – 5.0%
Platelet count 274 150 – 400.0x10^9/L
RBC Count 4.70 4.5 – 5.0x10^2/L
MCV 95.3 80.0 – 110.0 fL
MCH 33.3 26.0 – 38.0 pg

MCHC 35.0 31.0 – 37.0 pg

Determination Result Normal Value

HGT 331 @ 10:00 pm 74.0 – 160.0 mg/dL
Creatinine 90.30 53.0 – 115.0 Umol/L
SGOT(AST) 40.50 (H) 0.0 – 40.0 U/L
SGPT(ALT) 56.37 (H) 0.0 – 41.0 U/L
Hb1Ac 7.9 (H) 4.0 – 6.5 %
Na 142.0 135.0 – 145.0 mmol/L
K 4.45 3.5 – 5.5 mmol/L

October 6, 2022
Immunoserology
Qualitative Exam Result Normal Range
Rheumatoid Factor 0.3 0 – 0.3 ng/dL
CK-MB 18.85 0 – 5 ng/dL

October 7, 2022
Determination Result Normal values
Glucose FBS 5.94 (H) 3.9 – 5.8 mmol/L

Lipid Profile
Cholesterol 6.44 (H) 0.0 – 5.2 mmol/L
1.11 0.0 – 1.7 mmol/L
HDL – Cholesterol 1.78 (H) 1.3 – 1.6 mmol/L
LDL – Cholesterol 4.16 (H) 0.0 – 3.4 mmol/L
VLDL 0.50
HDL/Chole-Ratio 3.6: 1

October 10, 2022

Examination Result Ref. Value
Hematocrit (Male) 42.1 40.0 – 54%
Hemoglobin (Male) 14.9 13.0 – 18.0 g/dL
WBC count 7.39 5.0 – 10.0x10^9/L

Platelet count 229 150 – 400.0x10^9/L

RBC Count 4.37 4.5 – 5.0x10^2/L

October 10, 2022

Determination Result Normal Value
Creatinine 71.07 53.0 – 115.0 Umol/L
SGPT(ALT) 68.57 (H) 0.0 – 41.0 U/L
K 3.76 3.5 – 5.5 mmol/L
PSA 16 (H) <4ng/mL

October 10,2022
Test Ref. Value Unit Result
HGT @ 5:00 am 76 – 160 mg/dL 132

October 11,2022
Test Ref. Value Unit Result
HGT @ 5:00 am 76 – 160 mg/dL 188

October 6, 2022
Radiology Report – CXR

Radiology Findings:
1. There are no parenchymal infiltrates in both lungs fields.
Rationale: Both lungs are filled with air as manifested by the
darkening of both lungs as patient inhale. This presents no obstruction
in any parts of the lungs or lung parenchyma.

2. The heart is enlarged.

Rationale: The silhouette of the heart seen in the x-ray is greater than
the silhouette of our fist. The size of fist is the same size of the heart.
Therefore, a heart size the exceeded to the silhouette of the fist
manifest an enlargement.

3. Aorta in unremarkable.
Rationale: The aorta manifest no abnormal or pathologic change.

4. Chest wall, hemidiaphragms, costophrenic sulci and

visualized bones are intact.
Rationale: No abnormal findings for the chest wall and other
respiratory accessories such us diaphragm.

Impression: Cardiomegaly
Rationale:“Cardio-“ is heart. “-megaly” is enlargement. The size of fist is the
size of normal heart. Therefore, the size of the heart of the patient seen from
the x-ray is way larger than the size of the silhouette of a fist manifesting an
enlargement of the heart – Cardiomegaly.

October 6, 2022 @ 8:25pm

ECG Report

ECG REPORT without Streptokinase

Explanations:

 V1, V2, VV3, V4, V5, V6

o Presents the placement of the lead.
 V1 – 4th intercostal space, just to the right of the sternal
border.
 V2 – 4th intercostal space, just to the left of the sternal
boarder.
 V3 – midway between leads v2 and v4
 V4 – midclavicular line, above the 5th interspace. Just
below the breast.
 V5 – anterior axillary line at the same level of v4.
 V6 – midaxillary line at the same level as leads v4 and v5.
Almost located below the underarm of the patient

 I, II, III, aVR, aVL, aVF, V1, V2, VV3, V4, V5, V6
o Indicates the reading of the involve heart wall.

 V1-V2
o anterior descending (LAD) artery of the heart.

 V2-V4
o Presents the heart’s anterior wall. The location involved here is the
diagonal branch of the LAD artery of the heart.
 IAV1, V5, V6
 o Presents the heart’s lateral wall. The location involved here is the
circumflex branch of the left coronary artery (LCA) of the heart.
 II, III, AVR
o Presents the heart’s inferior wall. The location involved here is the
posterior descending branch of the right coronary artery (RCA) of
the heart.
 V1-V4
o Presents the heart’s posterior wall. The location involved here is the
circumflex branch of the LCA of the heart. Thus, the location also
involved the posterior descending branch of the RCA of the heart.

IMPORTANT POINTS!!
1. 2 different wall of the walls can read in one 1 ECG lead. For example V2
provide reading of both septal and anterior wall of the heart.
2. I, II, III, aVR, aVL, aVF, V1, V2, VV3, V4, V5, V6 presents different
readings in the ECG simply to locate the worst reading.
3. The worst reading of the ECG (I, II, III, aVR, aVL, aVF, V1, V2, VV3,
V4, V5, V6) indicates the location of the infarction or the damage of the
heart.
4. Elevated ST-segment

October 6, 2022 @ 8:40 pm

ECG Report
Explanation:
1. The ECG reading shows that change after 1 hr of streptokinase
administration.
2. ST-segment elevation is decreased.

October 7, 2022 @ 10:00 am

ECG Report

NORMAL ECG
EXPLANATION – According to research, 6-20% of patients who have AMI
have chance of having normal ECG after treatment. Normal ECG was
adopted simply to indicate a good or recovered heart after treatment of the
patient since no abnormal findings were taken nor discovered after the
treatment. Therefore the heart of the patient with AMI was successfully
stabilized with the treatment given to the patient.
VI. COURSE IN THE WARD
DATE/TIME DOCTOR’S ORDER
10-06-2022 - Please admit to ICU
8:25 PM - Secure consent for admission
Dr. K - Monitor VS q10°
Initial Vital - Monitor I&O q shift
Signs:
- CBR w/o BRP
 T: 36.3ºc
- IVF: PNSS 500cc x 24°
 RR: 18
- Labs: CBC, Na, K, Crea, Trop I
cpm
CKMB, CXR
 PR: 92
12LECG
bpm
AST, ALT, Lipid profile, FBS
 BP:110/80
HGBA1C
mmHg
- Medications:
 O2: 93%
1. Atorvastatin 80 mg/tab OD (give initial dose now)
2. Omeprazole 40mg IV now then OD am
3. Aspirin 80 mg, 1 tab to be chewed now HS then OD lunch
4. Clopidogrel 75 mg/tab, 3 tablets swallowed now, then 1 tab
lunch
5. Under O2 2-3L/min via nasal cannula
6. 3 hrs prior to admission sudden onset of severe pain 10/10
(-) fever, (+) SOB
- Refer to Dra. Gipit for co-management
- Start CBG monitoring TID prior to meals and ODHS
(Refer if <200 mg/dL hold terablock temporarily)

8:45 PM
- Streptokinase 1.5 M units + 90 cc D5W to run for 1° via soluset
Dr. Gipit
- Give hydrocortisone 100 mg IV 30 mins prior to giving streptokinase

- ECG q 30 mins during infusion before, middle and after ECG result

- Hook to cardiac monitor

- For ECG (V3R – V6R now)

9:10 PM
- (+) chest - Morphine 2 mg now
pain - Paracetamol 1 amp IV now
- 90/60
then
110/80
after
treatment

9:26 PM
- WOF arrhythmia
Dr. G
- Check/monitor BP q 5 mins
- Stand by metoclopramide ampule
- Start streptokinase drip
- NTG patch (Not Available) hold

10:00 PM
Dr. K - HGT 331 mg/dL

- Repeat HGT p 1°

11:00 PM
- HGT 321 mg/dL
- Give insulin 8 units IV now
- Repeat CBG p 1°an hr

10-07-2022
- For right-sided chest lead DONE
1:25 AM
- Hold terablock
Dr. G
- Morphine 2 mg IV q6° PRN for chest pain
- Colchicine 500 mg/tab OD
- Lenoxaparine 0.6 cc subq BID
- Avoid nitrates
- Trimetabudine 35 mg/tab 1 tab BID
- For repeat ECG 10 am tom
 - For 2D echo once stable

- HGT >200 mg/dL

- Start insulin 70/30, 20 units in am & 10 units in pm
8:37 AM
Dr. K
- Coralan 5 mg/tab OD
- Revise insulin to 15 units in am, 8 units in pm
- IVF: PNSS 500 for 24°
- HGT 224 mg/dL
- Give 6u of Humolin-R SQ
10-08-2022
1:30 am
Dr. G - Repeat ECG

- Complete enoxaparin for 5 days

- Start jardiance 10 mg/tab OD

- O2 PRN

- For UTZ of whole abdomen once stable

- IVF to PNSS 1L for 16°

10-08-2022
2:00 pm
- (-) chest - Shift omeprazole to pantoprazole 40 mg/tab OD AM
pain free - Revise insulin to 12 units in am, 6 units in pm
day 2 - Start bisacodyl tab now then ODHS
- (-) fever - Apply cold compress to previous IV site
- (-) DOB - IVF to consume then heplock (if ok with other AP)
- (-) BM x 2 - Refer
days - Additional: to hold methotrexate & solusamet temporarily

10-08-2022
9:40 pm
- Continue IVF
 Dr. G

10-09-22
- For transfer to regular room of choice
1:15 am
- For CBC, K, Crea, SGPT on October 10, 2022
Dr. G
(-) chest pain

10-09-22
4:00 pm - Day 3 chest pain free

(-) chest pain - IVF to continue then heplock

(+) UO - Condition explained to the wife and daughter

(+) BM - Refer

10-09-22
7:10 pm - For ECG tomorrow
(-) chest pain - Limit visitors please
(-) fever - Continue Medications
(+) BM

10-10-22
- Continue Medications
7:45 am
Dr. G

10-10-22 - For PSA

7:40 pm - Start Tamsulosin 40mg 1tab HS OD
Dr. K
(-) chest pain
(-) fever
(+) BM
 10-11-22
7:40 pm - Shift insulin to Trajenta Duo 2.5/500 OD ac in AM

Dr. K - Start Glimepiride 1mg tab HS OD ac in PM

(-) chest pain - Refer

(-) DOB - Please CBC monitoring after Bisacodyl

(+) BM

10-11-22 - May go home tomorrow

10:45 pm - Take home medications:
Dr. G 1. Perindopril 5mg tab; 1/2tab OD (1/2-0-0)
2. Colchicine 500mg tab OD x 2 weeks
3. Coralan 5mg tab; 1tab OD
4. Atorvastatin 80mg tab OD HS
5. ASA 80mg tab; 1tab OD
6. Clopidogrel 75mg tab OD
7. Trimetazidine 35mg tab OD
- Follow-up on October 19, 2022 at Adventist Hospital
- Please Photocopy all laboratories
- Please give # 09178303623

10-12-22 - Advised

8:50 am
- Final Diagnosis; Acute ST Elevation MI, type II DM
Dr. K

10-12-22
11:00 am - Home medications
Dr. K 1. Glimepiride 1mg 1tab OD
2. Trajenta duo 2.5mg/500mg tab OD
3. Tamsulosin 400 mg 1tab OD
VII. Pathophysiology
VIII. Nursing Care Plan
ASSESSMENT DIAGNOSIS PLANNING INTERVENTION EVALUATION
Subjective: Ineffective After 1 hour Independent: After nursing
“Parang cardiac tissue of nursing interventions, the
naninikip yung perfusion interventions, 1. Monitor VS: patient is:
dibdib ko”, as related to patient may skin
verbalized by the reduced include relief temperature Relieved of pain:
patient coronary of symptoms and peripheral  Absence of
thrombus and of ischemia, pulses Levine sign
Objective: atherosclerotic absence of 2. Supplemental  Not irritable
plaque as respiratory Oxygen 2L/min
(+) Chest Pain evidenced by difficulties, by means of Shows no signs of
(+) Levine Sign chest pain, adequate nasal cannula respiratory
(+) SOB shortness of tissue 3. Keep patient on difficulties:
(+) Cold and breath, cold perfusion, bed; bed rest to  RR: 18cpm
clammy skin and clammy and reduce cardiac  Absence of
(+) Restless skin, prevention or workload SOB
restlessness early
Maintain
V/S: and unstable recognition of Dependent:
adequate tissue
 T: 36.3ºc vital signs any 4. Administer
perfusion
complications Streptokinase
 RR:23cpm  Within
1.5U + 90cc
normal range
 PR:110bp D5W to run for 1
of O2
hr via soluset.
m saturation:
5. Hooked to
O2 96%
 BP:130/90 cardiac monitor.
6. Monitor ECG
mmHg every 30
 O2: 93% minutes before,
during and after
Streptokinase
infusion.
7. Administer
Aspirin 80mg, 4
tabs – to be
chewed.
 ASSESSMENT DIAGNOSIS PLANNING IMPLEMENTATI EVALUAT
ON ON
SUBJECTIVE: Acute pain After 30-1 hour 1. Administer AspirinAfter 30-1
“Sobrang sakit ng related to of appropriate 80 mg, 1 tab to be hour of
dibdib ko, para kong shifting of nursing chewed now as appropriate
dinadaganan” as aerobic interventions ordered nursing
verbalized by the respiration to the client will intervention
unaerobic describe 2.Administer , the goal wa
Pain Scale: 10/10 respiration as satisfactory Clopidogrel 75 met, patient
(+) Crushing Pain evidenced by pain control at a mg/tab, 3 tablets described
crushing pain level of less swallowed now as satisfactory
OBJECTIVE: with scale of than 6/10 on a ordered pain control
10/10, facial rating scale of 0 at a level of
(+) Facial grimace 3.After 45 minutes,
grimace, to 10, relief of 6/10 on a
(+) Levine sign administer Morphine rating scale
Levine sign, signs and
(+) Diaphoresis 2 mg and
diaphoresis, symptoms and of 0 to 10,
(+) Irritable Paracetamol 1 amp
irritability and improve vital relieved of
unstable vital signs IV as ordered signs and
V/S:
 T: 36.3ºc signs symptoms
4.Administer
and
 RR:23cpm supplemental oxygen
improved
by means of nasal
 PR:110bpm vital signs
cannula
 BP:130/90
5.Assess the patients
mmHg vital signs and
characteristic of pain
 O2: 93%
at least 15 minutes
after the
administration of
medication

6.Assist patient to
rest with back
elevated

7.Instruct patient to
do relaxation
techniques: deep and
slow breathing and
distraction
behaviors.

ASSESSMENT DIAGNOSIS PLANNING INTERVENTION EVALUATION

Subjective: Ineffective After 30mins Independent: After nursing
“Hindi ako breathing of nursing interventions, the
makahinga ng pattern r/t interventions, 1. Monitor vital patient
maayos” as chest pain as the patient signs; note established a
verbalized by the evidenced by will establish rate and normal
patient shortness of a normal depth of respiratory
breath, pursed respiratory respiration's pattern as
Objective: lip breathing, pattern as 2. Supplementa evidenced by:
use of evidence by l Oxygen
(+) SOB accessory absence of 2L/min by Absence of signs
(+) Pursed lip muscle and signs and means of and symptoms of
breathing unstable vital symptoms of nasal pain and
(+) Use of signs hypoxia and cannula hypoxia:
accessory muscle stable vital 3. Assist  Shortness of
signs patient to breath
V/S: rest with  Pursed-lip
 T: 36.3ºc back breathing
 RR:23cp elevated;  Use of
reposition of accessory
m patient every muscle
 PR:110bp 2 hours
4. Instruct
m patient to do Stable vital signs:
relaxation  T: 36.5ºc
 BP:130/9
techniques:  RR:20cpm
0 mmHg deep and
slow  PR:98bpm
 O2: 93%
breathing.  BP:120/80
Dependent: mmHg
5. Supplementa  O2: 95%
l Oxygen 2-
3L/ min by
means of
nasal
cannula
6. Administer
Morphine 2
mg and
Paracetamol
1 amp IV as
ordered for
chest pain

ASSESSMENT DIAGNOSIS PLANNING INTERVENTION EVALUATIO

 Risk for bleeding After 1 hour of 1. Monitor After
Objective: r/t thrombolytic nursing patients’ vital appropriate
Patient is under therapy of the interventions, the signs nursing
the medication prototype drug, patient will be interventions,
of the following: streptokinase free of possible 2. Instruct patient goal was met,
and aspirin signs of bleeding, to use soft the patient is
Streptokinase engage in bristled free from
1.5 M units appropriate toothbrush possible signs
behaviors and bleeding and
Aspirin 80 mg
lifestyle changes 3. Instruct the was able to
to prevent the patient to avoid understand wa
occurrence of forceful to prevent
bleeding episodes. blowing, bleeding
coughing, possibilities
sneezing, and
straining to
have a bowel
movement

4. Avoid
intramuscular
injection

5. Instruct patient
to monitor
signs of
bleeding in
gums, nose and
color/consisten
cy of the stool

6. Encourage the
patient to
increase
dietary fiber
intake
IX. Drug Study
DRUG DOSA CLASSI ACTION INDICATIO CONTRAINDI NURSING
GE FICATIO N CATION CONSIDER
N ATION
Generic 2mg/ Selective Selective  Use to  Hypersensiti  Taper
name: 500mg beta- activity at the manage vity to drug drug
Therabloc 1 tab blocking β1 receptor hypertens  Patient with gradually
agents produces ion sinus over 2 wk
Brand Route: cardioselecti  Use to bradycardia with
Name: vity due to manage  Patient with monitori
Freque the higher myocardi cardiogenic ng.
ncy: population of al shock  Avoid
OD this receptor infraction driving or
in cardiac  Managem dangerou
tissue ent of s
angina activities
pectoris if
associated dizziness
with or
coronary weakness
atheroscle occurs
rosis.
Generic 6tabs antineopl Methotrexate   Methotre  Monitor
Name: Route: astics calms your xate is  Bad infection result of
Methotrex (cancer immune used to  Dehydration CBC and
ate Freque medicines system, to treat  Condition liver
ncy: ). help stop it leukemia resulting function
Brand Every attacking and from a test
Name: Monda your body's certain defective  Assess
Otrexup y cells. This types of immune patient
helps reduce cancer of system for
the the  Low blood bleeding
inflammation breast, counts due to and
that causes skin, head bone marrow infection
swollen and and neck, failure  Increase
stiff joints in lung, or  Anemia fluid
rheumatoid uterus.  Decreased intake
arthritis, blood after
thickened  Methotre platelets taking
skin in xate is  Low levels of methotre
psoriasis or also used white blood xate.
damage to to treat cells
your bowel in severe  Low levels of
Crohn's psoriasis a type of
disease. and white blood
rheumato cell called
 id neutrophils
arthritis  Alcoholism
in adults  Escape of
fluid into the
lungs

Biguanide Metformin  Solosamet  Hypersensiti • Do not use

Generic
s decreases (Glimepir vity to any with renal
Name: Gli
blood glucose ide) is a component dysfunction,
mepiride +
levels by sulfonylur of Solosamet metabolic
Metformin
decreasing ea SR, acidosis
HCl
hepatic indicated sulfonylurea • May cause
glucose as an s, diarrhea,
Brand
production adjunct to sulfonamide nausea,
Name:
(also called diet and s or vomiting,
Solosamet
gluconeogen exercise biguanides. lactic acidosis
SR
esis), to  IDDM (type • Monitor
decreasing improve 1 DM) patient
the intestinal glycemic  Diabetic closely for
absorption of control in ketoacidosis ketoacidosis
glucose, and adults  Acute or and lactic
increasing with type chronic acidosis,
insulin 2 diabetes metabolic discontinue
sensitivity by mellitu acidosis. medication
increasing  Lactic immediately
peripheral acidosis if acidotic
glucose  Hypoxemia, • May cause
uptake and  Dehydration metallic taste
utilization. • Instruct
GI patient that
disturbances medication
does not cure
diabetes
Generic 80mg/ HMG- Catalyzes the  Treatmen  Hypersensiti  Advice
name: tab CoA conversion of t of vity to the
Atorvastati reductase HMG-CoA to several atorvastatin patient
n Freque inhibitors mevalonate, types of  Active liver not to
ncy: an early rate- dyslipide disease or crushed,
Brand OD limiting step mias unexplained chewed
Name: in cholesterol  Used as a transaminas or cut
biosynthesis preventiv e elevation prior to
e agent intake
for  Drug can
myocardi be taken
al without
infarction meals
 Used as a  Advice pt.
preventiv to avoid
 e agent drinking
for non- grapefruit
fatal MI juice and
alcohol
while
taking
atorvastat
in

Generic 40mg Proton- It stops  Treatmen  contraindica   take 30-

name: pump gastric acid t of ted in 60
Omeprazol Route:I inhibitors secretion by symptom patients minutes
e V selective atic taking prior to
inhibition of gastroeso dosage eating
Brand Freque the phageal forms  capsules
Name: ncy: ATPase enzy reflux containing should be
OD me system. disease rilpivirine swallowe
In turn, it (GERD)  Hypersensiti d whole
suppresses  Use to vity to this   instruct
gastric basal treat drug patient to
and heartburn report
stimulates and black
acid gastric tarry
secretion acid stool
hypersecr
etion
 promote
healing of
tissue
damage
and ulcers
caused by
gastric
acid and
H. pylori
infection

Generic 80mg Analgesic It works by  Use to  Hypersensiti  Instruct

name: 4tab and blocking a relieve vity to drug patients
Aspirin antipyreti certain pain, on
Route: c natural fever and symptom
Brand Oral substance in inflamma s of
Name: your body to tion toxicity
Freque reduce pain  Reducing such as a
ncy: and swelling. the risk of ringing in
HS OD cardiovas the ears
cular (tinnitus)
death or
 hearing
loss, and
unusual
bleeding
or
bruising
 Do not
take
aspirin
with
alcohol
due to an
increased
risk of
bleeding.
 Administ
er aspirin
with food
or milk to
reduce
the risk of
GI
irritation

Generic 75mg/3 Antiplatel clopidogrel  Used with  Hypersensiti  Monitor

name: tab et drug active form is aspirin to vity to for signs
Clopidogre a platelet treat clopidogrel of
l 1tab inhibitor that worsenin  Don’t give on bleeding
lunch irreversibly g chest patient with   Monitor
Brand binds to ADP pain bleeding CBC and
Name: Freque receptors on  Used to condition platelet
ncy: platelets. keep  Avoid count
OD This binding blood Alcoholic
prevents vessels beverages
ADP binding open and
to receptors, prevent
activation of blood
the clots after
glycoprotein certain
complex, and procedure
platelet s (such as
aggregation cardiac
stent).
 It blocks
platelets
from
sticking
together
 and
prevents
them
from
forming
harmful
clots.
Generic 1.5 Thrombol converts  Use in the  contraindica  contraind
name: Units + ytic plasminogen managem ted in icated
Streptokin 90cc Agents to plasmin ent of patients with with
ase D5W which acute active active
degrades myocardi internal bleeding,
Brand fibrin clots al bleeding hypersen
Name: infarction  patients with sitivity,
(AMI) severe bronchos
 For lysis uncontrolled pasm,
of hypertension intracrani
intracoro , intracranial al
nary neoplasms, hemorrha
thrombi surgery ge,
 improvem within two hypotensi
ent of months, and on
ventricula recent stroke  monitor
r function closely
 reduction for
of bleeding
mortality
associated
with AMI
Generic 100mg Corticoste Hydrocortiso  it  Hypersensiti  Avoid in
name: roids ne injection decreases vity to active
hydrocorti Route: works by periphera hydrocortiso untreated
sone IV reducing l vascular ne infections
inflammation resistance  Untreated  May
Brand Freque (irritation , serious cause
Name: ncy: and swelling)  It infections CNS
30mins in the body increases (except alteration
cardiac tuberculous s
output meningitis   Decrease
and or septic wound
coronary shock) healing
blood  May
flow elevate
blood
sugars

Generic 2mg Narcotic Morphine  Used for  Known  Tell

name: Analgesic binding to the hypersensiti patient to
Morphine s opioid managem vity to lie down
receptors ent of morphine during IV
Brand blocks chronic,  Respiratory administr
Name: transmission moderate depression ation.
of to severe in the   Dilute
nociceptive pain absence of and
signals, resuscitative administe
signals pain- equipment r slowly
modulating  Acute or IV
neurons in severe  Do not
the spinal bronchial take
cord asthma or leftover
hypercarbia medicatio
 Paralytic n for
ileus other
disorders.
 Take this
drug
exactly as
prescribe
d. Avoid
alcohol,
antihista
mines,
sedatives,
tranquiliz
ers, and
over-the-
counter
drugs.
 Report
severe
nausea,
vomiting,
constipati
on,
shortness
of breath
or
difficulty
breathing
, rash.
Generic 1 amp analgesic Acetaminoph  Used for  Hypersensiti  Do not
name: and en increases the vity to self-
Paracetam antipyreti the pain treatment paracetamol medicate
ol Route: c drugs threshold by of mild to adults for
IV inhibiting moderate pain
Brand two isoforms pain and  Patients
Name: of reduction should be
cyclooxygena of fever cautioned
se, COX-1 not to
and COX-2, take any
which are other
involved in products
prostaglandi containin
n (PG) g
synthesis. paraceta
mol
 Do not
drink
excessive
quantities
of alcohol
while
taking
paraceta
mol.
Generic Ampule Prokinetic Metoclopram Metoclopram  Gastrointesti  Do not
Name: agents ide causes ide is used to nal bleeding use with
Metoclopr Route: antiemetic treat the  Obstruction GI
amide Oral effects by symptoms of  Perforation obstructi
inhibiting slow stomach  Pheochromo on
Brand Freque dopamine D2 emptying cytoma  May
Name: ncy: and (gastroparesi  Seizures cause
Reglan serotonin 5- s) in patients  Depression extrapyra
HT3 with diabetes.  Parkinson midal
receptors in It works by disease reaction,
the increasing the  History of neurolypt
chemorecept movements tardive ic
or trigger or dyskinesia malignan
zone (CTZ) contractions t
located in the of the syndrome
area stomach and , tardive
postrema of intestines. It dyskinesi
the brain. relieves a,
symptoms arrhythm
such as ias, blood
nausea, pressure
vomiting, alteration
heartburn, a s,
feeling of hematolo
fullness after gic
meals, and alteration
loss of s, facial
appetite. movemen
ts,
 sedation
 Can
decrease
effects of
levodopa
 Assess
nausea/v
omiting
 Monitor
liver
function
tests
Insulin 8 units Insulins The primary Insulin is  Administ
activity of indicated to  Low blood er insulin
Route: insulin is the improve sugar through
IV regulation of glycemic  Low amount appropria
glucose control in of potassium te route.
Freque metabolism. adults and in the blood  Check the
ncy: Insulin paediatric  liver patency
promotes patient with problems of the IV
glucose and diabetes  Kidney  Monitor
amino acid mellitus disease glucose
uptake into level
muscle and
adipose  Monitor
tissues, and potassiu
other tissues m level
except brain  Monitor
and liver. It liver
also has an enzymes
anabolic role  Monitor
in kidney
stimulating function
glycogen, test
fatty acid,
and protein
synthesis.
Insulin
inhibits
gluconeogen
esis in the
liver
Generic 6u Insulins It is a short- For the  Administ
Name: Route: acting treatment of  Low blood er insulin
Humulin- SQ insulin. It patients with sugar through
 Low amount
R works by diabetes appropria
Freque helping mellitus who of potassium te route.
Brand ncy: blood sugar require in the blood  Daily
Name: (glucose) get insulin for  liver rotate of
Insulin into cells so the problems injection
NPH your body maintenance  Kidney site to
can use it for of glucose disease prevent
energy. homeostasis. lipodystr
ophy.
 Monitor
glucose
level

 Monitor
potassiu
m level
 Monitor
liver
enzymes
 Monitor
kidney
function
test
Generic 500mg Uricosuri works by  Colchicin  Hypersensiti  Be alert
Name: /tab c Agent decreasing e capsules vity to the for signs
Colchicine swelling and are active of kidney
Route: lessening the indicated substance damage,
Brand Oral build-up of for   Patients including
name: uric acid prophylax with severe bloody
Freque crystals is of gout renal urine
ncy: that cause flares impairment (hematuri
OD pain in then   Prophyla  Colchicine a) and
affected xis of gout should not decreased
joint(s).This attack be used in or absent
medication is during patients urine
also used to initiation undergoing output.
prevent of therapy haemodialys Report
attacks of with is since it these
pain in allopurin cannot be signs to
the abdomen, ol and removed by the
chest, or uricosuric dialysis or physician
joints drugs exchange immediat
transfusion. ely.

 Monitor
I&O ratio
and
pattern
(during
acute
gouty
 attack):
High
fluid
intake
promotes
excretion
and
reduces
danger of
crystal
formation
in
kidneys
and
ureters.
 Monitor
for early
signs of
colchicine
toxicity
including
weakness
,
abdomina
l
discomfor
t,
anorexia,
nausea,
vomiting,
and
diarrhea,
regardles
s of
administr
ation
route.
Report to
physician
. To avoid
more
serious
toxicity,
drug
should be
discontin
ued
promptly
 until
symptom
s subside.

Generic 0.6cc Low- Helps keep Enoxaparin is  Active major  Monitor

name: Route: molecular your blood indicated for bleeding for signs
Lenoxapar SQ -weight flowing the  History of of
in Freque heaparin smoothly by prevention of immune- bleeding
ncy: lowering the ischemic mediated •
Brand BID activity of complications heparin- Administ
name: clotting in unstable induced er in
Lovenox proteins in angina and in thrombocyto subcutan
the blood non-Q-wave penia (HIT) eous
myocardial within the tissue
infarction; it past 100 • DO
is indicated in days or in NOT eject
conjunction the presence air
with of circulating bubble
percutaneous antibodies [s prior to
intervention ee Warnings injection
and/or other and • DO
treatment for Precautions NOT
the (5.4)] aspirate
management  Known or
of acute ST hypersensiti massage
elevation vity to site.
myocardial enoxaparin
infarction. sodium (e.g.,  Avoid IM
pruritus, injection
urticaria,
anaphylactic  Monitor
/anaphylacto platelet
id count
reactions) [s closely if
ee Adverse less than
Reactions 100,000
(6.2)] report to
 Known the
hypersensiti physician
vity to and stop
heparin or ng
pork medicatio
products n.
 Known
hypersensiti
vity to benzyl
alcohol
(which is in
 only the
multiple-
dose
formulation
of Lovenox)

Generic 5mg/ Hyperpol Ivabradine is Ivabradine is  Hypersensiti  Monitor

name: tab arization- a pure heart indicated by vity bp and
Ivabradine activated rate lowering the FDA to cardiac
Route: cyclic agent, acting reduce the  Decompensa rate
nucleotid by selective risk of ted heart  Tell
Freque e-gated and specific hospitalizatio failure patients
Brand ncy:OD (HCN) inhibition of n for to report
name: channel the cardiac worsening  Blood significan
Coralan bl pacemaker If  heart failure pressure less t signs
current that in adult than 90/50 and
controls the patients with symptom
spontaneous stable,  Conduction s such as
diastolic symptomatic abnormalitie dizziness,
depolarisatio chronic heart s, e.g., sick fatigue,
n in the sinus failure with sinus or as well
node and left syndrome, as
regulates ventricular sinoatrial symptom
heart rate ejection block, or s of atrial
fraction third-degree fibrillatio
≤35%, who AV block, n such as
are in sinus unless a palpitatio
rhythm with pacemaker ns or
resting heart determines shortness
rate ≥70 the heart of breath.
beats per rate  Instruct
minute. patients
 Severe liver to take
impairment each dose
with food.
 Patients  Warn
taking patien
cytochrome ts to
P450 3A4 avoid
(CYP3A4) grapef
inhibitors ruit
 Monit
 Resting or
heart rate liver
less than 60 functi
before on
therapy test.
initiation
Generic 40mg/ proton- Accumulate Treatment  Hypersensiti  Assess for
Name: tab pump in the acidic and vity to possible
Pantopraz inhibitors space of the maintenance pantoprazole contraind
ole Route: parietal cell of erosive or other ications
Oral before being esophagitis, proton pump and
Brand converted in treatment of inhibitors cautions:
name: Freque the canaliculi  heartburn  Therapy history of
ncy: (small canal) associated increases the allergy to
OD of the gastric with GERD. risk a proton
parietal cell, of Salmonell pump
an acidic a, inhibitor
environment, Campylobact to reduce
to er, and other the risk of
active sulfon infections hypersen
amide deriva sitivity
tives reaction
 Inspect
and
palpate
the
abdomen
to
determin
e
potential
underlyin
g medical
condition
s; assess
for
changes
in bowel
eliminati
on and GI
upset to
identify
possible
adverse
effects.
Generic 1tab Stimulant Stimulating Indicated to  Hypersensiti • Monitor
Name: laxatives enteric relieve vity potassium
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X. Discharge Planning

A case of AMI, 53 yr. Old, male, married, Roman catholic was admitted on
October 6,2022 8:25 pm for complaints of severe chest pain with a pain scale
of 10/10; final diagnosis of (M.I.) ACS-STEMI.

Planning
After 30 minutes to 1 hour of health teaching the patient will be able to
enumerate and identify activities that allowed for his case as well as those that
are needed to be avoided. The patient’s SO will also be able to verbalize
understanding of the patient’s condition and care needed.

Interventions
DISCHARGE TEACHING:

1. Inform and educate patient regarding the disease

(ensure understanding of disease and changes in lifestyle and daily activities)

2. Enumerate signs and symptoms of angina; chest pain caused by

reduced blood flow to the heart.
(for patient to easily identify and differentiate from heartburn;stomach acid
travelling up towards the throat that the pt usually experiences.)
a. pressure like squeezing, burning or tightness in the chest area
b. -discomfort in the back, shoulder and stomach
c. -tiredness, shortness of breath and lightheadedness

3. Instruct patient to seek immediate medical help when the pt

experiences;
● Chest pain/ discomfort
● Shortness of breath
● Shoulder/ arm pain or weakness
( signs of impending or pre heart attack that may occur hours or weeks before
the attack)

4. Instruct the patient to avoid:

a. excessive physical activity
(vigorous physical exertion increases myocardial oxygen demand and
simultaneously shortens diastole and coronary perfusion time; induces
myocardial ischemia and malignant cardiac arrhythmias)
-climbing stairs, walking uphill
b. lifting and sexual activity
(strenuous exertion does increase immediate risk for heart attack and sudden
cardiac arrest)
for sexual activity it is best to consult the AP for further instruction
c. -extreme weather neither hot/cold
(increase occurrences of heart attack and strokes in susceptible patients
because of increased blood viscosity.)

5. Advice patient to take it easy for 4-6 wks

a. if patient is tasked with heavy chores try to get help if able
b. advice patient to have 30-60 mins afternoon rest and go to bed early
 c. If planning to start an exercise regime first consult AP and have an
exercise test for a catered/ recommended exercise program. The AP
may refer the patient to a cardiac rehab program for better heart care.
d. Encourage the pt to participate in a formal rehabilitation program and
ultimately to plan engage in 20 mins of exercise at the level of BRISK
WALKING at least 3x a week.

6. Instruct the patient to avoid STRESSORS. Take a break from work for
the meantime as well as emotional stimulants. ( increased sympathetic
stimulation and catecholamines increase oxygen demand by increasing
heart rate, blood pressure, and cardiac contractility; stimulation of the
sympathetic receptors can increase the coronary vascular tone,
reducing relative oxygen supply. Increased concentrations of
catecholamines (important in stress response) can trigger arrhythmias
and increase platelet aggregation)

7. Inform patient of Changes in DIET

a. Instruct pt to achieve an ideal weight and modify diet low in saturated
fat and cholesterol.
b. As patient was a former smoker there is a possibility of relapse which is
why the nurse STRICTLY emphasize NO SMOKING ( the nicotine, the
content of the tobacco causes constriction on the blood vessels that
results in cardiac attack and stroke while toxins inhaled to the lung
compromises lung activity to get O2 into the blood. Even 2nd and 3rd
hand smoking should be avoided)
c. Advice to continue being non alcoholic.
d. eat foods that are low in sodium, and added sugars

8.MEDICATIONS
Inform pt to follow the med regime and to take only with water since other
liquids may alter how the body absorbs certain medication
● Perindopril - ACE inhibitor ; lowers blood pressure and increase the
supply of blood and oxygen
● Colchicine -Anti inflammatory; reduce cardiovascular events after
recent MI.
● Coralan- Anti angina; slows the heart rate.inhibits the electrical current
made by heart's natural pacemaker
● Atorvastatin- Lipid modifying agent; lower cholesterol and triglyceride
levels in the blood.
● ASA aspirin; reduces clotting action of platelets-possibly preventing a
heart attack
● Clopidogrel-antiplatelet med; prevents platelet from sticking together
and forming clot
● Trimetazidine- helps metabolize fatty acids, which help the body use
oxygen- allows for more blood to flow to the heart and limits quick
changes in the bp.

9. Inform pt of follow up schedule on the 19th of October and encourage pt to

have regular cardiac check ups.