Remocaldo, Mishelle F.

BSN 3-2

57 year old male with reports of Crushing Chest Pain

Mr. De los Santos, 57 years of age, presents to the Emergency Room at St. Frances Cabrini, with
chest pains. He reports that the pain started at around 9am while he was doing house chores. He
told the nurse that the pain was similar to a crushing pressure in his chest or fullness in his chest.
He rates the pain as 6/10. Upon assessment, Mr. De los Santos complains of shortness of breathe,
he is visibly pale and diaphoretic. Looking closely, there was no presence of Jugular Vein
Distention. ECG shows ST segment elevation.

Temp - 36.7
BP - 140/70
HR - 101
RR - 29
SpO2 - 99
Height - 167 cm
Weight - 81 kg

Demographic Profile
Sex - Male Age - 57 Birthday - February 25, 1966 Residence - Barangay 4, Sto.Tomas

Chief complaint
Crushing Chest Pain/ fullness of chest

Patient History
• History of Past Illnesses
• Smoker but stopped 5 years ago ; approximately smoked 2 sticks a day
• Drinks alcohol but stopped 3 years ago ; used to drink 3 bottles during weekends
• No previous surgeries or operations
•
• History of Present Illnesses
• Patient presents himself into the Emergency Department reporting for chest pains. Chest
Pains started around 9am in the morning while doing house chores.
• Family History
• Father died at the age of 70 due to Heart attack

Examinations
Vital Signs

Temp - 36.7
BP - 140/70
HR - 101
RR - 29
SpO2 - 99

ECG examination
- shows ST segment elevation

Nursing Care Plan

Assessment Nursing Planning Intervention Evaluation
Diagnosis
Objective: Acute Pain Relief of Acute Administer oxygen Verbalized
Temp - 36.7 related to low Pain theraphy combined relief of Pain.
BP - 140/70 oxygen rich with the
HR - 101 blood flowing medication
RR - 29 through the ordered by the
SpO2 – 99 heart as doctor (morphine
Pain – 6/10 evidenced by or aspirin)
verbal reports of
ECG chest pain Encourage bed rest
examination with head of the
- shows ST bed elevated
segment
elevation Monitor patient for
blood pressure,
respiration rate,
Subjective: reports of chest
Complains paints.
about crushing
pressure while
doing work and
shortness of
breath

Assessment Nursing Planning Intervention Evaluation

Diagnosis
Objective: Unstable Blood Patient will Administer Patient has
Temp - 36.7 Pressure show adequate medications based adequte cardiac
BP - 140/70 cardiac output from the doctor’s output as
HR - 101 as evidenced by order evidenced by
RR - 29 blood pressure, normal limits of
SpO2 – 99 heart rate, and Encourage bed rest bp, heart rate
Pain – 6/10 rhythm within with head of the and rhythm.
normal limits. bed elevated
ECG
examination Monitor patient for
blood pressure,
 - shows ST respiration rate,
segment reports of chest
elevation paints.

Subjective:
Complains
about crushing
pressure while
doing work and
shortness of
breath

Pathophysiology

Myocardial infarction is characterized as abrupt ischemic passing of myocardial tissue. In the

clinical setting, myocardial dead tissue is normally due to thrombotic impediment of a coronary
vessel brought about by burst of a weak plaque. Ischemia actuates significant metabolic and
ionic irritations in the impacted myocardium and causes fast melancholy of systolic capability.
Delayed myocardial ischemia initiates a "wavefront" of cardiomyocyte passing that reaches out
from the subendocardium to the subepicardium. Mitochondrial changes are noticeably associated
with apoptosis and rot of cardiomyocytes in the infarcted heart. The grown-up mammalian heart
has unimportant regenerative limit, in this manner the infarcted myocardium mends through
development of a scar. Infarct recuperating is reliant upon an incendiary fountain, set off by
alarmins delivered by kicking the bucket cells. Leeway of dead cells and lattice garbage by
invading phagocytes actuates mitigating pathways prompting concealment of cytokine and
chemokine flagging. Initiation of the renin-angiotensin-aldosterone framework and arrival of
changing development factor-β prompt transformation of fibroblasts into myofibroblasts,
advancing testimony of extracellular lattice proteins. Infarct mending is entwined with
mathematical rebuilding of the chamber, described by expansion, hypertrophy of feasible
fragments, and moderate brokenness.

Medications
• Morphine
• Beta Blockers
• Nitroglycerin
• Aspirin
• Anticoagulants
• ACE Inhibitors
• Statins

Laboratory Examinations
• CBC Test
• Creatine, Urea, Electrolytes, Glucose
• ECG
• Echocardiogram
• Angiogram
• Chest X-Ray