Republic of the Philippines

TARLAC STATE UNIVERSITY

COLLEGE OF SCIENCE
DEPARTMENT OF NURSING
Lucinda Campus, Brgy. Ungot, Tarlac City
Philippines 2300
________________________________________________________________

A Clinical Case Study Presented to the Faculty of the

Department of Nursing

In Partial Fulfillment

Of the Requirement of the Subject NCM 112

RLE

MYOCARDIAL INFARCTION

S.Y. 2019 – 2020

Angel, Daphne Joi

Apolonio, Leona Marie

Cabrera, Princess Ezramae

Carreon, Jemaica

Gragasin, Alexandra Nicole

Gregorio, Ruben

Inso, Krishcel

Ofrecio, Patricia Pearl

Pineda, Roanne Patrice

Ramos, Kaye Justine

BSN - 3A (Clinical Group A3)

Submitted to:

Ms. Rowena G. Escoto

Ms. Ma. Czarina B. Maninang

Clinical Instructors

February 2021
Introduction

Myocardial Infarction is commonly known as the heart attack. This is a life threatening

condition in which it affects the area of myocardium and it is permanently destroyed. This

occurs when the flow of the blood to the heart is blocked by plaques or the fatty deposits in

the coronary arteries.

Classical symptoms of acute myocardial infarction include shortness of breath, sudden

chest pain that usually radiates to the left side of the neck or left arm, generalized sweating,

palpitations, weakness, and anxiety.

According to Mechanic (2020), an MI results in irreversible damage to the heart muscle due to

a lack of oxygen. An MI may lead to impairment in diastolic and systolic function and make

the patient prone to arrhythmias. In addition, an MI can lead to a number of serious

complications. The key is to reperfuse heart and restore blood flow. The earlier the treatment,

the better the prognosis.

Mehri and colleagues (2018) stated that the early diagnosis of Acute Myocardial Infarction is

crucial for deciding the course of treatment and saving lives, because the higher risk of fatality

occurs within the initial hours of onset acute myocardial infarction.

Myocardial Infarction is known to be one of the leading causes of death in the whole world.

According to World Health Organization (WHO), the number of deaths from heart disease

increased by more than 2 million since 2000, to nearly 9 million in 2019. Heart disease now

represents 16% of total deaths from all causes. More than half of the 2 million additional

deaths were in the WHO Western Pacific Region. Conversely, the European region has seen a

relative decline in heart disease, with deaths falling by 15%. In the Philippine setting, the

leading cause of death are the diseases of the heart including the myocardial infarction.

Moreover, myocardial infarction is responsible for over 15% of mortality each year, among

the vast majority of people suffering from NSTEMI (Non ST Elevation Myocardial Infarction)

than STEMI. Men age 45 or older and women age 55 or older are more likely to have heart

than are younger men and women.

This case was chosen to help us to broaden the knowledge regarding care and management for

Acute Myocardial Infarction. With this, we were able to distinguish what appropriate nursing

interventions and care plans, its manifestations, management and the anatomy and physiology

behind this case. This study may enhance our skills, management and critical thinking in

delivering optimum quality care.

General Objectives

This case study aims to broaden and develop our skills, knowledge,

understanding, critical thinking and management about acute myocardial infarction by

assessing the patient to gather data and information to formulate nursing diagnoses and

nursing care plans which will serve as a guide in decision making for management and

application of nursing process to achieve optimum health needs.4

Nurse-Client Centered Objectives

Specific Objectives

1. To strengthen nurse and patient relationship to effectively deliver therapeutic care in

order to assess the patient’s condition using the 13 areas of assessment.

2. To formulate nursing diagnosis related to the chief complaint of the patient in

formulating proper nursing interventions to the patient.

3. To implement interventions by collaborating to other healthcare personnel who are

involved to patient’s care and treatment.

4. To develop nursing care plan by setting priorities by establishing goals and selecting

interventions for management of pain and discomfort.

5. To assess, evaluate and modify all nursing care plan for continuity of care towards

wellness and recovery.

6. To give health education regarding the health of the patient for awareness and

prevention of possible risks that may interfere the attainment of wellness and

recovery
Nursing Process

A. ASSESSMENT

a. Personal Data

Patient X, is a 55-year-old widowed men. He lives in Abcd City. Patient X

was born on August 8, 1966. He is a roman catholic. He was admitted on Feb. 1,

2021 with a chief complaint of chest pain that radiates across his left arm. The

final diagnosis of Patient X is acute anterior wall myocardial infarction.

b. Environmental Status

Patient X lives in a small trailer in Abcd City alone. He and his kids, who

are now adults, lives in the same area but with a different trailer. He lives in a

rural area and is mostly surrounded by grass, trees with a lake on the back of his

trailer. His trailer is located 10 minutes away from the hospital. He buys mineral

water as a source for safe water intake. He also disposes his garbage properly and

is collected in his household weekly.

c. Lifestyle

Patient X usually began his day at 6 A.M and retired at 10:30 P.M. His

work hours varied according to the weather and job requirements, but he often

work until dusk. If not working late, he usually became involved in some physical

sport. He also smokes approximately 1 pack of cigarette each day. He also drinks

coffee atleast 2 times a day. He is self-sufficient, with no particular food dislikes,

Patient X prepares his own meal, usually of beef, potatoes and vegetables. He

usually showers in the evening.

1. Past Medical History

According to Patient X, he recalled only two previous episodes of illness.

The first was an “upset stomach” in 2018 which was diagnosed as ulcer. A bland

diet and probathine was prescribed. Patient X said that he resigned himself to
 following the diet. He admitted to deviating from it occasionally, but basically his

diet habits changed to avoid abdominal distress. This change in dietary habit

would seem to include strong self-discipline.

The second illness was in year 2020, when he was hospitalized for two

days following an allergic reaction to tetanus toxoid, which he had received after

a laceration and fracture of his left hand. Patient X described the hospitalization as

“confining”, saying he wanted “to be on my own again.” This reaction indicates

an independent nature.

2. History of Present Hospitalization

January 8, while reclining on the sofa in his trailer, he began having

substernal, dull, aching chest pain. Thinking at first that his stomach was the

cause of the distress, he took an antacid. He had read about the signs of a heart

attack and it occurred to him that this might be the cause of his pain, but he was

inclined to deny it.

When the antacids failed to give him relief, he and his son walked around

the trailer court several hours in an attempt to relieve the pain. Five hours after the

onset of chest pain, Patient X became more concerned as the intensity of pain

increased and pain began radiating across his chest and down his left arm. He then

asked his son to take him to the hospital, where he was admitted to the intensive

care unit with a diagnosis of an acute anterior wall myocardial infarction.

 3. Family History of Health and Illness

FAMILY GENOGRAM

Grandfather Grandmother
Grandfather Grandmother,
, 77 , 79
, 72 66

Living,
Male
Living,
Female Father, Mother, Uncle,
Deceas
83 82 84
M.I

Hypertensi
ve
Diab

Brother 1, Sister, Sister, Patient X, Patient,

60 58 56 55 50
13 AREAS OF ASSESSMENT
I. Social Status

The social history of the patient shows that he has a good relationship with his family
members and did his responsibilities to raise his twin daughters and son despite his wife's
sudden death. Until his children have families of their own and they live separately,
Patient X still communicate with them and always move together. On the other hand,
Patient X also lived productively by using his leisure time to read a good deal, learning
different things from his travels, and lastly participating in different outdoor physical
activities. During the initial assessment, the patient was frequently visited by many
friends and family members who gives him positive support, affection, diversion, and
motivation to help him through his adjustment to living with heart disease.

Norms: Social status includes family relationships that state the patient's support system
in that time of stress and in time of need. It meets a fundamental need for social ties,
making life stressful, and social support buffers the negative effects of stress, thus
indicating indirectly contributing to good health outcomes (Kozier, 2014)

Economic wellbeing incorporates family connections that express the patient's

emotionally supportive network in times of pressure and critical moment. It meets a basic
requirement for social ties, making life upsetting and social help cushions the negative
impacts of pressure, subsequently demonstrating by implication adding to great wellbeing
results. (Friedman and Smith 1998)

Analysis: The patient reveals a good state of social status because of having a positive
support system by his family and friends and having a good engagement in socializing,
communicating, and expressing his self with them.

II. Mental Status

Level of Consciousness

During the initial assessment, the patient was confused about what does the nurse explain
to him regarding his condition and he does not even look directly at the nurse.

Norms: The clients must be alert and awake with eyes open and looking at the examiner
and able to respond appropriately. (Weber, 2013)

Analysis: The patient is not aware, alert, and pays attention to his environment.

Appearance and Movement

During the initial assessment of the patient, facial grimace, fatigue, diaphoresis, pallor,
and shortness of breath were noted to the patient. Moreover, the patient was not able to
meet basic needs such as bathing and feeding himself because of activity restrictions
imposed by medical orders and due to body weakness, fatigability, and pain felt by him
that radiates from the abdomen to the back rated at a pain scale of 9/10. On the other
hand, on the 2nd and 3rd week of being hospitalized the patient was quietly improved
regarding his appearance and some physical activity.

Norms: The client must be relaxed with shoulders back and both felt stable smooth,
coordinated movement. (Estes, 2014)

Analysis: The patient shows an alteration of his appearance and physical movement due
to the signs and symptoms felt by him from his health condition and activity restriction
ordered by the primary provider.

Orientation

During the initial assessment, the patient was confused and doubtful about what he is
going to answer on the question being asked to him, but somehow, he still aware and able
to determine the time, place, and recent events that were being asked of him.

Norms: A person is normally aware of self, others, place, time, and address (Weber,
2013)

Analysis: The patient was a little bit confused about his surroundings and doubtful to
answer questions due to the pain felt by him but somehow his sensorium was quietly
clear as determined by orientation to time, place, and recent life events that happened in
his life.

Speech

During the initial assessment, the patient cannot speak loud and clear because he is still
quietly in pain. Meanwhile, on the 2nd day of hospitalization, the patient can now speak
loud and clear but not frequently, he only spoke when he was just being asked by the
nurse, his family, and friends, but usually, he just stays silent and taking a rest on his bed
throughout the day.

Norms: Speech should be at a clear and moderate pace. It should be exerted effortlessly.
(Estes, 2014)

Analysis: The patient was able to communicate verbally with some people but not
frequently. He cannot speak normally when he is in pain.

Intellectual Function

During the initial assessment, the patient cannot think normally and respond
appropriately to the things being asked and explained to him because of the anxiety, and
mild depression felt by him due to his condition and being hospitalized. On the 2nd week
 of hospitalization, when the patient was questioned how cholesterol affected the heart and
the role of diet to prevent future heart attacks, and when past health habits were discussed
in the history the patient can now respond appropriately and reflects a positive attitude
toward following preventive health practices. On the 3rd week on which the patient is
discharged from the hospital, he expressed concern about the physical activity he was
allowed. Lastly, during the post-hospitalization course, the patient asks his concerns to
the nurse regarding diet regimen, the role of gradual weight loss in reducing the heart's
workload, a gradual increase in exercise, and a gradual return to a full day's work.

Norms: A person should respond normally and appropriately to topics discussed. Express
full and free-flowing thought during the interview and listen and responds with full
thought (Estes, 2014)

Analysis: The patient's intellectual function was quietly altered due to the impact of the
health condition that brought anxiety and mild depression to him.

III. Emotional Status

During the initial assessment, the patient reveals a sense of impending doom, expressions
of concern about current and future events that will possibly happen to him that brought
anxiety, mild depression, uncertainty, grieving, and fear that he will be going to die due
to his health condition. He was also worried to his family especially his children that if he
dies sooner or later her children's life will be miserable. On the 2nd week of
hospitalization, the patient was still worried and fearful about his condition, but he is
trying to use positive coping- adaptation mechanisms. Lastly, on the 3rd week of
hospitalization or discharge from the hospital, the patient expressed anxiety but not
because of his illness it is about leaving the intensive care unit, though he realized
discharge from the unit was an indication of improved physical status. On the other hand,
he now exhibited strong mental health factors that would be utilized to attain maximum-
long-term rehabilitation and return to work and expresses that he was impatient to return
to his former lifestyle.

Norms: Normally, the patient should have the ability to manage stress and to express
emotion appropriately. It also involves the ability to recognize, accept and express
feelings and to accept one's limitations. (Fundamentals of Nursing: Concepts, Process,
and Practice, 10th Edition, 2018)

Analysis: The patient experienced some relative emotions on what he is being

experienced because of his condition but afterward he still can use positive coping-
adaptation mechanisms and exhibited strong mental health.

IV. Sensory perception

 During the initial assessment, the patient was not able to participate the assessment due to
fatigability and body weakness and he just wants to take a rest and not showing interest to
perform it, but afterward, on the 3rd day of being hospitalized, he already participated in
the examination of his five senses wherein he was able to read a paragraph in a
newspaper, able to taste sugar, able to hear the wristwatch, smell a perfume, and feel the
cold water on a careful and gentle manner. On the other hand, during the period of his
hospitalization, the patient does not reveal or complain of any problem with his five
senses.

Norms: Each of the five senses become less efficient in older adulthood. Changes result
in loss of visual acuity, less power of adaption to darkness and dim light, decreased in
accommodation to near and far objects. The loss of hearing ability related to aging affects
people over age 65. The gradual loss of hearing is more common among men than
women, perhaps because men are more frequently in noisy work environments. Older
people have a poorer sense of taste and smell and are less stimulated by food than the
young. Loss of skin receptors takes place gradually, producing an increased threshold for
sensations of pain, touch, and temperature. (Fundamentals of Nursing: Concepts, Process,
and Practice, 10th Edition, 2018)

Analysis: The patient sensory status was uncomplicated.

V. Motor Stability

During the initial assessment, the patient was not able to meet basic needs such as bathing
and feeding himself because of activity restrictions imposed by medical orders and due to
body weakness, fatigability, and pain felt by him that radiates from the abdomen to the
back rated at a pain scale of 9/10. On the other hand, on the 2nd and 3rd week of being
hospitalized the patient was quietly improved regarding his appearance and some
physical activity.

Norms: The normal range is that patient has a good posture, easy to walk, transfer from
bed to chair and walk fast not just slowly. In a standing position, the torso and head are
upright. The head is midline and perpendicular to the horizontal line of the shoulder and
the pelvis. The shoulders and hips are levels, the symmetry of the scapulae and iliac
crests. The arms are free from the shoulders. The feet are aligned, and the toes point
forward. Walking initiated in one smooth rhythmic fashion. (Health Assessment and
Physical examination by Estes).

Analysis: The patient's motor stability status was affected by the signs and symptoms that
resulted from his health condition but somehow, he shows an improvement in physical
activity since he was admitted to the hospital and until the post-hospitalization course.
VI. Temperature

TEMPERATUR
DATE ASSESSED TIME ANALYSIS
E

February 02, 2021 3:20 P.M. 36. 5C NORMAL

Norms: Normal axillary temperature is within 36.4 to 37.4 degrees Celsius. (Health
assessment and physical examination 3rd edition by Mary Ellen Zator Estes)

Analysis: The patient’s temperature is in the normal range.

VII. Respiratory Status

February 2, 2021 28 CPM ABNORMAL

Norms: A normal respiratory rate ranges from 12-20 cycle per minute. Average is 18
cycles per minute. Breathing patterns must be regular and even in rhythm. (Kozier &
Erb’s, 2018)

Analysis: The patient’s respiratory rate is above the normal range due to decreasing
pump function of the left ventricle, causing left ventricular failure.

VIII. Circulatory Status

Pulse Rate

February 2, 2021 120 bpm ABNORMAL

Blood Pressure

February 2, 2021 140/90 mmHg ABNORMAL

Norms: A typical blood pressure for a healthy adult is 120/80 mmHg (pulse pressure of
40). The normal adult pulse rate is 80 (60–100) beats per minute. The pulse must have a
regular beat and not bounding nor weak. Blood pressure is not measured on the client's
limb if is injured or diseased, has an intravenous infusion or blood transfusion. (Kozier &
Erb's, 2018)

Analysis: Patient X has an increased pulse rate and blood pressure due to cardiac demand
and arterial vasoconstriction.

IX. Nutritional Status

The patient stated that he eats more than three times a day and his snacks are usually
French fries and burgers. He has no particular food dislikes, and his appetite was good.
 The patient said that he loves to drink coffee every day and eat in fast food chains. He
prepared his meals, usually beef and pork. He drinks about 5 – 6 glasses of water a day.

Norms: Adequate food intake consists of a balance of nutrients such as water,

carbohydrates, proteins, fats, vitamins, and minerals. The normal eating pattern of a
person is a minimum of three times per day depending upon the metabolic demand and
needs of the patient (Kozier & Erb's, 2018)

Analysis: Patient X's eating and drinking habit became a factor that contributed to his
condition.

X. Elimination Status

For the elimination status, patient X is constipated. He states that he has a sausage-shaped
stool, brown in color, and defecates once a day. The color of his urine is dark yellow and
urinates 5 – 6 times a day.

Norms: Normal urinary output of a person is 2 liters per day and should typically
defecate from once a day to every 3 to 5 days. Feces are normally brown in color and soft
but formed. (Kozier & Erb's, 2018)

Analysis: Strain at stool causes the blood pressure to increase which can trigger the
patient’s condition.

XI. Reproductive Status

Patient X stated that he is no longer sexually active.

XII. State of Skin and Appendages

The patient is pallor and has bluish discoloration of the skin with a capillary refill of 4
seconds. The skin is cool to touch. He has thick, wavy, black, and predominantly gray
hair.

Norms: Skin, hair, and nail changes are evident in an aging person. The skin becomes
drier and loses its elasticity, there will be a hair loss and change of color. (Kozier & Erb's,
2018)

Analysis: Patient X's skin and appendages are not normal due to points of
vasoconstriction.

XIII. Sleep and Rest Pattern

The client stated that he usually began his day at 9:00 in the morning and sleep at around
12:00 am. During hospitalization, the patient has some disturbance in sleep as evidenced
by insomnia. He stated that the dream he had was a way of relieving the anxieties created
by the heart attack and subsequent hospitalization.
Norms: Sleep is a basic human need, and it is a universal biologic process common to all
people. Humans spend about one-third of their lives asleep. A person needs 7 to 9 hours
of sleep per night. (Kozier & Erb's, 2018)

Analysis: The client's sleep is altered due to anxiety and pain.

LABORATORY AND DIAGNOSTIC PROCEDURES

BLOOD CHEMISTRY RESULT

-To assess many conditions and learn how the body organ are working. It is a test to
measure chemicals including enzymes, electrolytes, fats (also lipids), hormones, sugars,
proteins, vitamins and minerals.
Normal Patient Result Nursing Responsility
Range
RBS/ HGT ( 2.5- 7.2 ++
mmol/L)
FBS (3.9- 6.1 ++
mmol/L)
BUN (2.9- ++
8.2
mmol/L)
CREATININE (53.0- 106.0 ++
mmol/L)
LIPID
PROFILE
-To measure
amount of
cholesterols and
triglycerides in
your blood
CHOLESTEROL ( 3.88- Elevated Educate the patient to eat a
6.470 low-salt diet and emphasizes
mmol/L) fruits, vegetables and whole
grains.
TRIGLYCERID ( 0.11- 2.15 Elevated Instruct patient to engage into
E mmol/L) more physical activity for at
least 30 minutes of exercise
for about 5 times a week.
HDL ( 30.0- 75.0 Lowered Encourage patient to do
mg/dL) exercise to help pump up
HDL.
LDL (66.0-178.0 Elevated Educate patient to reduce
mg/dL) saturated fats found in red
 meat and full-fat dairy
products and raise the patient
total cholesterol
ANATOMY AND PHYSIOLOGY

CARDIOVASCULAR AND CIRCULATORY SYSTEM

Introduction

The circulatory system is composed of the heart which pumps blood all over the body, blood

vessels which transport blood and the blood. Blood contains oxygen and other nutrients which

the body needs to survive. Blood delivers oxygen and nutrients to every cell and removes

carbo dioxide and waste products made by those cells. Blood is carried from the heart to the

rest of the body through complex network of arteries, arterioles and capillaries. The vital role

of the cardiovascular system in maintaining homeostasis depends on the continuous and

controlled movement of blood through the thousands of miles of capillaries that permeate

every tissue and reach every cell in the body.

The one- way system which carries blood to all parts of the body. This process of blood flow

within the body is called circulation.

 Arteries- carry oxygen-rich blood away from the heart.

 Vein- carry oxygen-poor blood back to the heart.

PULMONARY AND SYSTEMIC CIRCULATION

1. Pulmonary Circulation

- Moves blood between the heart and the lungs. It transports deoxygenated blood to the

lungs to absorb oxygen and release carbon dioxide. The oxygenated blood then flows

back to the heart.

2. Systemic Circulation-

- Moves blood between the heart and the rest of the body. It sends oxygenated blood

out to the cells and returns deoxygenated blood to the heart.

Source: Texas Heart Institute: Anatomy of the Heart and Cardiovascular System
Anatomic and Physiologic Overview

The Heart

The heart pumps blood throughout the body in blood vessels. Blood flow requires both

the pumping action of the heart and changes in blood pressure. It Snugly enclosed within the

inferior mediastinum, the medial section of the thoracic cavity, the heart is flanked on the side

by the lungs. Its pointed apex is directed towards the left hip and of the fifth intercostal space.

Its broad posterosuperior aspect, or base, from which the great vessels of the body emerge,

points toward the right shoulder and lies beneath the second rib. ON

LAYERS OF THE HEART:

1. EPICARDIUM (inner layer of the pericardium)

The heart is enclosed by the sac called the pericardium that made up of two layers: an

outer fibrous layer and the inner serous membrane pair.

2. MYOCARDIUM

Consist of thick bundles of cardiac muscle twisted and whorled into ring-like

arrangements. Myocardial cells are linked together by intercalated discs, which contain

both desmosomes and gap junction.

3. ENDOCARDIUM

It is a thin, glistening sheet of endothelium that lines the heart chambers. It is continuous

with the linings of the blood vessels leaving and entering the heart.

CHAMBERS AND ASSOCIATED GREAT VESSELS

The heart has four hollow cavities, or chambers—two atria and two ventricles. Each of these

chambers is lined with endocardium, which helps blood flow smoothly through the heart.

- The superior atria are primarily receiving chambers- they are not important in the

pumping activity of the heart, instead they assist with the filling the ventricles.

- The interior atria are the discharging chambers- thick-walled ventricles that actual

pumps the heart. When they contract, the blood is propelled out of the heart and into

circulation.
Although heart is a single organ, the heart functions as a double pump, with arteries carrying

blood away from and veins carrying blood towards the heart. The right side works as the

pulmonary circuit pump which receives oxygen- poor blood from the veins of the body

through the large superior vena cava and pumps it our through the pulmonary trunk. The

pulmonary trunk splits into the right and left pulmonary arteries, which carries blood into the

lungs, where oxygen is picked up and carbon dioxide is unloaded. Oxygen-rich blood drains

from the lungs and is returned to the left side of the heart through the four pulmonary veins.

HEART VALVE’S

The heart is equipped with four valves, which allows blood to flow in only one direction

through the heart chambers- from the atria through the ventricles and out the great arteries

leaving the heart.

1. ATRIOVENTRICULAR (AV) VALVES

- Bicuspid/ Mitral and Tricuspid valve

2. SEMILUNAR VALVE

- Pulmonary and aortic semilunar valve

A. Operation of the AV valves

1. Blood returning to the atria puts pressure against AV valves; the AV valves are

forced open.

2. As the ventricles fill, AV valves cusps hang limply into ventricles.

3. Atria contract, forcing additional blood into ventricles.

4. Ventricle’s contract, forcing blood against AV cusps.

5. AV valves close.

6. Chinese tendineae tighten, preventing valve cusps from everting into atria.

B. Operation of the semilunar valves

1. As ventricles contracted and intraventricular pressure rises, blood is pushed up against

semilunar valves, forcing them open.

 2. As ventricles relax and intraventricular press falls, blood flows back from arteries,

filling the cusps of semilunar valves and forcing them to close.

HEART RATE CONTROL

THE CONDUCTING SYSTEM OF THE HEART

1. SA node- the pacemaker

2. AV node- slowest conduction

3. Bundle of His – branches into the Right and the Left bundle branch

4. Purkinje fibers- fastest conduction

CARDIAC CIRCULATION

The functional blood supply that oxygenates and nourishes the myocardium is provided by the

right and left coronary arteries. The coronary arteries branch from the base of the aorta and

encircle the heart in the coronary sulcus (atrioventricular groove) at the junction of the atria

and ventricular. The coronary arteries and their major branches (the anterior interventricular

artery and circumflex artery on the left, and the posterior interventricular artery and marginal

artery on the right) are compressed (flow is inhibited, not stopped completely) when the

ventricles are contracting and fill when the heart is relaxed.

CARDIAC CYCLE

1. Atrial diastole (ventricular filling)- pressure in the heart is low, the AV valves are open,

and blood is flowing passively through the atria into the ventricles. The semilunar valve

are closed.

2. Atrial systole- the ventricles remain in diastole as the atria contract, forcing blood into

the ventricles to complete ventricular filling.

3. Isovolumetric contraction- atrial systole ends, and ventricular systole begins. The initial

rise in intraventricular pressure closes the AV valves, preventing backflow of blood into

the atria. For a moment, the ventricles are completely closed chambers.
 4. Ventricular systole (ejection phase)- the ventricles continue to contract, causing the

intraventricular pressure to surpass the pressure in the major arteries leaving the heart.

This causes the semilunar valves to open and blood to be ejected from the ventricles.

During this phase, the atria are again relaxed and filling with blood.

5. Isovolumetric relaxation- as ventricular diastole begins, the pressure in the ventricles

falls below that in the major arteries, and the semilunar valves close to prevent backflow

into the ventricles. For another moment, the ventricles are completely closed chambers

and intraventricular pressure continues to decrease. Meanwhile, the atria have been in

diastole, filling with blood. When atrial pressure increases above intraventricular

pressure, the AV valves open and the cycle repeats.

CARDIAC OUTPUT

It is the amount of blood pumped out by each side of the heart in 1 full minute. It is the

product of the heart rate (HR) and the stroke volume (SV). Stroke volume is the volume of

blood pumped out by a ventricle with each heartbeat. In general, stroke volume increases as

the force of ventricular contraction increases. The normal adult blood volume is about 6,000

ml, so nearly the entire blood supply passes through the body once each minute.

Source: Marieb and Keller (2018). Essentials of Human Anatomy and Physiology, 12 th ed. pg.

382-392
PATHOPHYSIOLOGY

Non– Modifiable Risk Modifiable Risk

 (+) Father side family history of AMI  8 years since diagnosed with hypertension
 Male  Smokes 1 pack of cigarette a day for 5 years
 55 yrs old  Excessive intake of fatty foods like french-fries and
hamburger which caused elevated levels of

Chest pain
that radiates
 Che
st
pai

Elev
ated
ST

Pul Blood
se pressu
Rat re of
B. PLANNING

NURSING CARE PLAN NO. 1

ASSESSMENT DIAGNOSIS PLANNING/ IMPLEMENTATION RATIONALE EVALUATION

GOALS
Date: Feb 2, 2021 Acute pain related After 5-15 Independent: GOAL PARTIALLY
Time: 1:00pm to myocardial minutes of nursing  Administer  Increases amount of MET:
ischemia as intervention the supplemental oxygen via oxygen available for After 10 minutes of
Subjective:
manifested by patient will be nasal cannula or face myocardial uptake which nursing intervention
“Napakasakit ng
pain scale of 9/10 able to report that mask, as indicated may relieve pain related the pain was relieved
dibdib ko parang
the pain was to ischemia from a pain scale of
dinudurog” as
relieved from a  Monitor vital signs  respirations and pulse rate 9/10 to 5/10
verbalized by the
pain scale of 9/10 may be increased as a
patient
to 1-4/10 result of pain and
associate anxiety
Objective:
-Sharp stabbing pain  Monitor and document  To obtain baseline data
radiating from characteristics of chest which could be used to
abdomen to the back
pain, including location, plan for further care
rated at a pain scale of
9 out of 10 started 2 duration, quality,
hours prior to intensity, presence of
admission and is
radiation, precipitating
constantly present
while patient is in and alleviating factors,
supine position and associated
-Shortness of breath symptoms
-Palpitations
 Maintain bed rest
-ST elevation
-Peripheral cyanosis during pain
-Grimace  Position the patient in  to reduce oxygen
-Confusion
semi-fowlers position consumption and demand
-Fatigue
-Diaphoresis  Maintain quiet and well  To provide comfort
-Pallor ventilated room
-O2 Sat: 90%  to reduce competing
-Vital Signs as
 Instruct patient to do stimuli and reduces
follows:
Temperature: 36.5°C relaxation techniques: anxiety
RR: 28rpm deep and slow  to decrease perception
PR: 120bpm
breathing, distraction and response to pain
BP: 120/80mmHg
behaviors
 Check vital signs before
and after administration
 To monitor for the
of narcotic drugs
possible side effects of
narcotic drugs which is
Dependent:
hypotension and
 Administer pain
respiratory depression.
medications such as
morphine sulfate as
 narcotics may be used in
 ordered acute-phase and recurrent
chest pain unrelieved by
 Administer medications nitroglycerin to reduce
such as beta-blockers severe pain
and calcium channel  These medications help
blockers as ordered. reduce heart rate and
lowers myocardial
demand and increase
coronary blood flow
which can decrease pain
due to ischemia.

NURSING CARE PLAN NO. 2

PLANNING/
ASSESSMENT DIAGNOSIS IMPLEMENTATION RATIONALE EVALUATION
GOALS
Date: Feb 3, 2021 Impaired gas After 30 minutes Independent: After 30 minutes of
Time: 9:30 am exchange related of giving  Administer  To improve ventilation giving appropriate
to altered oxygen appropriate humidified air or and increase oxygen nursing
oxygen saturation level.
Subjective: supply secondary nursing interventions, the
“Mabilis ako to myocardial interventions, the patient will be able
ischemia as patient will be to manifest
mapagod,kahit wala  To provide a baseline data
manifested by able to manifest  Assess lung sounds, decrease of
naman ako depth and effort that can be used for
dyspnea and 90% decreased of respiratory rate
further plan of care.
masyadong ginagawa” oxygen saturation respiratory rate from 28 rpm to 12-
as verbalized by the level. from 28 rpm to 20 rpm.
12-20 rpm.  Assess and monitor
patient.  To identify if hypoxia is
pulse using pulse
oximeter. present.

Objective:
-Dyspnea  To improve oxygen
 Elevate the head of
-O2 Sat: 90% the bed, help the delivery.
-RR: 28rpm patient to change
-Sharp stabbing pain positions to breath
comfortably.
radiating from
abdomen to the back  Assess and monitor
rated at a pain scale of respiratory status  To identify further need
9 out of 10 started 2 including; rate, of care.
hours prior to pattern, and breath
admission and is sounds
constantly present
while patient is in
 Demonstrate and  To provide relaxation
supine position
help patient perform
 -Peripheral cyanosis pursed lip breathing.
-Pallor
 Advise the patient to
-Grimace rest and limit  To provide comfort.
-Diaphoresis activities.

 Provide a quiet
environment,  To reduce oyxygen
preventing external consumption/ demand.
stimuli such as
noise.

 Instruct patient in
performing  To provide comfort and
breathing and help breath effectively.
relaxation
techniques.

Dependent:
 Administer
intravenous fluids  To help patient breath
and medications as comfortably and prevent
prescribed. further complications.

NURSING CARE PLAN NO. 3

ASSESSMENT DIAGNOSIS PLANNING/ IMPLEMENTATION RATIONALE EVALUATION

 GOALS
Date: Feb 2, 2021 Activity After 3-4 hours of Independent: After 3-4 hours of giving
Time: 2:00 pm intolerance related giving appropriate  Monitor vital signs.  To provide a baseline appropriate nursing
to generalized nursing data for the interventions, the patient
Subjective: weakness as interventions, the management of has used identified
patient’s condition.
“Hindi ako evidenced by patient will use techniques to increase
makapagtrabaho, inability to identified activity tolerance.
hinang-hina perform basic techniques to  Assess patient’s  This will serve as a
activities. increase activity ability to respond to guideline for the
pakiramdam ko” as
activities. management of care.
verbalized by the tolerance.
patient
 Evaluate patient’s  To promote comfort
ability and and relaxation.
Objective:
willingness to
-Chest pain with a increase activity.
9/10 pain scale
-Dyspnea  To establish plan of
 Assist patient to care.
- Palpitations
identify choices for
-Body Weakness activity.
-Easily fatiguability
during standing  Promote comfort and
 Instruct patient and
-Grimace family members in relaxation.
using different
relaxation methods
such as deep
breathing exercises.
 To provide comfort.
 Decrease
environmental
stimuli such as
 noise.

 Allow the patient to

 To promote comfort.
change positions
such as sitting and
standing.

 Demonstrate
activities that
enables and helps  To increase patient’s
the patient to be tolerance with
independent with the activities.
family members.

Dependent:
 Administer pain
medication as
prescribed such as  To relieve pain and
analgesic. provide comfort or
relaxation.

NURSING CARE PLAN NO. 4

PLANNING/
ASSESSMENT DIAGNOSIS IMPLEMENTATION RATIONALE EVALUATION
GOALS
Date: Feb 2, 2021 Anxiety related to Short term goal: Independent: GOAL MET
Time: 2:00pm perceived threat of After 2 hours of  Identify and  Expression of feelings Short term goal:
death secondary to appropriate acknowledge patient’s promotes coping with the After 2 hours of
Subjective: myocardial nursing perception of threat and pain and emotional appropriate nursing
infarction as situation. Encourage trauma
“Mamamatay na ba interventions, the interventions, the
expressions of, and do
ako? Ayoko pang manifested by patient will not deny feelings of, patient responded to
mamatay” and “Sino sense of respond to anger, grief, sadness, relaxation techniques as
nalang ang mag aalaga impending doom, relaxation fear. evidenced by the ability
sa mga anak ko kapag uncertainty, and techniques with a  Maintain confident  Patients can be affected to express feelings of
nawala ako” as expressions and decreased anxiety manner without false by the anxiety/uneasiness sadness, and the ability
verbalized by the concern about level reassurance. displayed by health team to respond to the nurse’s
patient current and future members. Honest questions
events Long term goal: explanations can alleviate
Objective: After 1 week of anxiety. GOAL MET
-Sense of impending appropriate  Observe for verbal and  Intervention can help Long term goal:
doom nursing nonverbal signs of patient regain control of After 1 week of
-Expressions of interventions, the anxiety (restlessness, own behavior. appropriate nursing
concern about current patient will be changes in vital signs), interventions, the
and future events able to look and stay with patient. patient is now able to
-Uncertainty towards and plan Intervene if patient discuss about her plans
RR: 28rpm for the future displays destructive for the next day and is
PR: 120bpm behavior. looking forward to the
BP: 140/90mmHg  Accept but do not  Denial can be beneficial success of her operation
reinforce use of denial. in decreasing anxiety but
Avoid confrontations. can postpone dealing with
the reality of the current
situation and
confrontation can
promote anger and
 increase use of denial
 Orient patient to routine  Predictability and
procedures and information can decrease
expected activities. anxiety for patient.
 Answer all questions  Accurate information
factually. Provide about the situation
consistent information. reduces fear, strengthens
nurse-patient
relationship, and assists
patient to deal
realistically with
situation.
 Provide rest periods  Conserves energy and
and/or uninterrupted enhances coping abilities.
sleep time, quiet
surroundings, with
patient controlling type,
amount of external
stimuli.
 Encourage  Increased independence
independence, self-care, from staff promotes self-
and decision making confidence and reduces
within accepted feelings of abandonment.
treatment plan.

 Encourage discussion  Helps patient identify

about postdischarge realistic goals, thereby
expectations. reducing risk of
discouragement.
 Dependent:

 Administer anti anxiety

and hypnotics as  Promotes relaxation and
indicated rest and reduces feelings
of anxiety.
 SOAPIE NO. 1
Date: February 2, 2021
Time: 1:00pm
Patients name: Mr. Carpenter (Patient X)
Age: 55 y/o
Gender: Male
Subjective:
 “Napakasakit ng dibdib ko parang dinudurog” as verbalized by the patient
Objective:
 Sharp stabbing pain radiating from abdomen to the back rated at a pain scale of 9 out of
10 started 2 hours prior to admission and is constantly present while patient is in supine
position
 Shortness of breath
 Palpitations
 ST elevation
 Pallor
 Grimace
 Peripheral cyanosis
 Confusion
 Diaphoresis
 O2 Sat: 95%
 Vital Signs:
Temperature: 36.5°C
RR: 28rpm
PR: 120bpm
BP: 140/90mmHg

Assessment:
Acute pain related to myocardial ischemia as manifested by pain scale of 9/10
Planning:
After 30minutes-1hour of appropriate nursing intervention the patient will be able to report
that the pain was relieved from a pain scale of 9/10 to 1-4/10
Interventions:
Independent:
 Administered supplemental oxygen via nasal cannula
 Monitored and documented characteristics of chest pain, including location, duration, quality,
intensity, presence of radiation, precipitating and alleviating factors, and associated
symptoms.
 Monitored vital signs
 Maintained bed rest during pain
 Positioned the patient in a modified trendelenburgs position
 Maintained quiet and relaxing environment.
 Instructed the patient to do relaxation techniques: deep and slow breathing, distraction
behaviors
 Checked the vital signs before and after narcotic medication.

Dependent:
 Administered morphine sulfate as ordered
 Administered beta-blockers and calcium channel blockers as ordered.
Evaluation:

GOAL PARTIALLY MET:

After 1 hour of appropriate nursing intervention the pain was relieved from a pain scale of 10/10
to 5/10
SOAPIE NO. 2

Date: Feb 3, 2021

Time: 9:30 am
Patient’s name: Mr. Carpenter (Patient X)
Age: 55 y/o
Gender: Male
Subjective:
 “Mabilis ako mapagod,kahit wala naman ako masyadong ginagawa” as verbalized by the
patient.

Objective:
 Dyspnea
 O2 Sat: 90%
 RR: 28rpm
 Sharp stabbing pain radiating from abdomen to the back rated at a pain scale of 9 out of
10 started 2 hours prior to admission and is constantly present while patient is in supine
position.
 Peripheral cyanosis
 Pallor
 Diaphoresis

Assessment:
 Impaired gas exchange related to altered oxygen supply secondary to myocardial
ischemia as manifested by dyspnea and 90% oxygen saturation level.

Planning:
 After 30 minutes of giving appropriate nursing interventions, the patient will be able to
manifest decreased of respiratory rate from 28 rpm to 12-20 rpm.

Intervention:
 Administer humidified air or oxygen
 Assess lung sounds, depth and effort
 Assess and monitor pulse using pulse oximeter.
 Elevate the head of the bed, help the patient to change positions to breath comfortably.
 Assess and monitor respiratory status including; rate, pattern, and breath sounds
 Demonstrate and help patient perform pursed lip breathing.
 Advise the patient to rest and limit activities.
 Provide a quiet environment, preventing external stimuli such as noise.
 Instruct patient in performing breathing and relaxation techniques.
 Administer intravenous fluids and medications as prescribed.
Evaluation:
 After 30 minutes of giving appropriate nursing interventions, the patient will be able to
manifest decrease of respiratory rate from 28 rpm to 12-20 rpm.
SOAPIE NO. 3

Date: Feb 2, 2021

Time: 2:00 pm
Patient’s name: Mr. Carpenter (Patient X)
Age: 55 y/o
Gender: Male
Subjective:
 “Hindi ako makapagtrabaho, hinang-hina pakiramdam ko” as verbalized by the patient

Objective:
 Chest pain with a 9/10 pain scale
 Dyspnea
 Palpitations
 Body Weakness
 Easily fatiguability during standing
 Grimace

Assessment:
 Activity intolerance related to generalized weakness as evidenced by inability to perform
basic activities.

Planning:
 After 3-4 hours of giving appropriate nursing interventions, the patient will use identified
techniques to increase activity tolerance.

Intervention:
 Monitor vital signs.
 Assess patient’s ability to respond to activities.
 Evaluate patient’s ability and willingness to increase activity.
 Assist patient to identify choices for activity.
 Instruct patient and family members in using different relaxation methods such as deep
breathing exercises.
 Decrease environmental stimuli such as noise.
 Allow the patient to change positions such as sitting and standing.
 Demonstrate activities that enables and helps the patient to be independent with the
family members.
 Administer pain medication as prescribed such as analgesic.
Evaluation:
After 3-4 hours of giving appropriate nursing interventions, the patient has used identified
techniques to increase activity tolerance.
SOAPIE NO. 4
Date: February 2, 2021
Time: 2:00pm
Patients name: Mr. Carpenter (Patient X)
Age: 55 y/o
Gender: Male
Subjective Data:
 “Mamamatay na ba ako? Ayoko pang mamatay” and “Sino nalang ang mag aalaga sa
mga anak ko kapag nawala ako” as verbalized by the patient.
Objective Data:
 Sense of impending doom
 Restlessness
 Expressions of concern about current and future events
 Uncertainty
 Grieving
 Fear
 Vital Signs as follows:
Temperature: 36.5°C
RR: 28rpm
PR: 120bpm
BP: 140/90mmHg

Assessment:
Anxiety related to perceived threat of death secondary to myocardial infarction as manifested
by sense of impending doom

Planning:
Short term goal:
After 2 hours of appropriate nursing interventions, the patient will respond to relaxation
techniques with a decreased anxiety level

Long term goal:

After 1 week of appropriate nursing interventions, the patient will be able to look towards and
plan for the future
 Intervention:
Independent:
 Identified and acknowledged patient’s perception of threat and situation. Encourage
expressions of, and do not deny feelings of, anger, grief, sadness, fear.
 Maintained confident manner without false reassurance.
 Observed for verbal and nonverbal signs of anxiety (restlessness, changes in vital signs), and
stayed with patient. Intervened whenever patient displays destructive behavior
 Accepted but did not reinforced use of denial. Avoided confrontations.
 Oriented patient to routine procedures and expected activities.
 Answered all questions factually and provided consistent information
 Provided rest periods and/or uninterrupted sleep time, quiet surroundings, with patient
controlling type, amount of external stimuli..
 Encouraged independence, self-care, and decision making within accepted treatment plan.
 Encouraged discussion about postdischarge expectations.

Dependent:
 Administered anti anxiety and hypnotics as indicated.

Evaluation:

GOAL MET
Short term goal:
After 2 hours of appropriate nursing interventions, the patient responded to relaxation
techniques as evidenced by the ability to express feelings of sadness, and the ability to respond
to the nurse’s questions

GOAL MET
Long term goal:
After 1 week of appropriate nursing interventions, the patient is now able to discuss about her
plans for the next day and is looking forward to the success of her operation
 B. IMPLEMENTATION
1. DRUG STUDY
DRUG STUDY NO.1
DRUG NAME DOSAGE, ACTION INDICATION CONTRAINDICA POSSIBLE NURSING
ROUTE, TION SIDE EFFECT RESPONSIBILITIES
FREQUENC
Y
Generic Name: 15mg, IV, General Action: Indications:  Contraindicate CNS: Sedation, Before
Morphine Sulfate Stat Binds with opioid Treatment of the d in patient somnolence, - Check the doctor’s
receptors in CNS, following: hypersensitive clouded order
altering both perception  Severe pain to the drug or sensorium, - Blood pressure
Trade Name: of and emotional  Moderate to any of its euphoria, should be at normal
Astramorph PF response to pain severe components seizures, limit.
through unknown requiring and in those dizziness, - Assess for allergies
mechanism. continuous with conditions nightmares. to morphine
Classification: around-the- that preclude - Assess patient pain
Therapeutic effects: clock opioid IV CV: before therapy and
Pharmacologic: Relieves pain  Pain following administration hypotension, regularly thereafter
Opioid agonist major surgery of opiods flushing, to monitor drug
Pharmacokinetics ( acute bradycardia, effectiveness.
Therapeutic: Absorption: variable bronchial shock, cardiac During
analgesic when given P.O ; asthma or arrest. - Administer the right
unknown for other upper airway drug in the right
routes. obstruction) GI: nausea, route and dosage at
Pregnancy risk Distribution: Wide  Use cautiously vomiting, the right time.
Category: C in debilitated constipation, - Check the patency of
Metabolism and patients and in ileus the IV site and IV
Excretion: Primarily in patients with line
liver. And secretion in head injury, GU: urine After
urine and bile. increased retention - Take this drug
intracranial around the clock
Half-life: 2 to 3 hours pressure, Hematologic:
- Check the IV site
seizure, thrombocytope carefully for signs of
chronic nia thrombosis or drug
pulmonary reaction
disease, Respiratory: - Monitor patient for
prostatic Respiratory respiratory
hyperplasia, depression, depression after
severe hepatic respiratory administration
or renal arrest - Report pain or
disease, acute discomfort at sites,
abdominal Other: physical unusual bleeding or
conditions, dependence. bruising, mouth
hypothyroidis sores, rash, hives,
m, addisons fever and itching.
disease or - Assess patient’s and
urethral family’s knowledge
stricture of drug therapy
DRUG STUDY NO. 2
DRUG NAME DOSAGE, ACTION INDICATION CONTRAINDICA POSSIBLE NURSING
ROUTE, TION SIDE EFFECT RESPONSIBILITIES
FREQUENC
Y
Generic Name: 100mg PO at Therapeutic effects: Indications:  Contraindicate EENT: throat Before
Docusate sodium HS Soften stools Treatment to soften d in patients irritation. - Check the doctor’s
stool. hypersensitive GI: bitter taste, order
Trade Name: Chemical effect: to drug or any diarrhea, - Obtain history of
Colace Reduces surface tension of its laxative patients bowel
of interfacing liquid components dependence patterns before the
contents of bowel. This and in those with long-term therapy and re assess
Classification: detergent activity with intestinal or excessive regularly.
promotes incorporation obstruction, use, mild - Determine if patient
Pharmacologic: of additional liquid into undiagnosed abdominal has adequate fluid
Surfactant stool, thus forming abdominal cramping. intake, exercise , and
softer mass. pain, signs f diet
Therapeutic: appendicitis, - Be alert for adverse
Emolliet laxative fecal impaction reaction and drug
or acute interaction.
Pregnancy risk surgical During
Category: C abdomen. - Administer the right
drug in the right
route and dosage at
the right time.
- If abdominal
cramping occurs,
stop drug and notify
the prescriber.
After
- Be alert for adverse
reactions and drug
 interactions
- Assess patient’s and
family’s knowledge
of drug therapy.
DRUG STUDY NO. 3

DRUG NAME DOSAGE, ACTION INDICATION CONTRAINDICA POSSIBLE NURSING

ROUTE, TION SIDE EFFECT RESPONSIBILITIES
FREQUENC
Y
Generic Name: 5mg P.O Reduces blood pressure Treatment of mild Hypersensitivity to NORVASC  Assess patient
amlodipine once daily prevents angina, and to moderate amlodipine may cause the BP or angina
besylate lowers serum hypertension and following side before the
cholesterol level. angina effects. Most therapy
Trade Name: side effects are  Be alert for
Norvasc mild or adverse reaction
moderate:  Assess patient
Classification: family’s
Cardiovascular  swelling knowledge of
agent; of your drug therapy.
Calcium Channel legs or
Blocker ankles

Pregnancy  tiredness,
Category: C extreme
sleepiness

 stomach
pain,
nausea

 dizziness

 flushing
(hot or
warm
 feeling in
your face)

 arrhythmi
a
(irregular
heartbeat)

 heart
palpitation
s (very
fast
heartbeat)

 muscle
rigidity,
tremor
and/or
abnormal
muscle
movement
 2. MEDICAL MANAGEMENT

Medical Date Performed/

Client’s Reaction to
Management/Treatmen Changed/ General Description Indication/Purpose
Treatment
t Discontinued
 Morphine sulphate Date Performed: A drug used to treat The attending Chest pain was
 September 8, moderate to severe physician ordered relieved from 9/10 to
2021 pain. It binds to opioid morphine sulphate for 5/10 1 hour after the
receptors in the central pain management. administration of
nervous system and drug.
some other tissues.
Morphine sulfate is
made from opium. It
is a type of opiate and
a type of analgesic
agent.
 Medical Date Performed/
Client’s Reaction to
Management/Treatmen Changed/ General Description Indication/Purpose
Treatment
t Discontinued
 Docusate sodium Date Performed: Promotes The physician ordered A soft formed bowel
(Colace)  September 8, incorporation of water a laxative so that the movement was
 100 mg at hour of 2021 into stool, resulting patient will not exert observed in the
sleep into softer fecal mass effort in having BM. commode.

Medical Date Performed/

Client’s Reaction
Management/Treatmen Changed/ General Description Indication/Purpose
to Treatment
t Discontinued
 amlodipine Date Performed:  Reduces blood pressure  Treatment of  No adverse
February 2021 prevents angina, and lowers mild to effect was
serum cholesterol level. moderate observed.
hypertension
and angina
 Medical Date Performed/
Client’s Reaction
Management/Treatmen Changed/ General Description Indication/Purpose
to Treatment
t Discontinued
 12 lead Date Performed:  An electrocardiogram (ECG) is  It was ordered  Client is
Electrocardiography February 2021 a medical test that detects to trace the relaxed, no
cardiac abnormalities by electrical adverse
measuring the electrical activity activity of the reaction
generated by the heart as it heart, to observed.
contracts. The machine that confirm the  St segment
records the patient's ECG is diagnosis of elevation
called an electrocardiograph. MI. observed in
the ecg
tracing.
 Date Performed/
Medical Client’s Reaction to
Changed/ General Description Indication/Purpose
Management/Treatment Treatment
Discontinued

 Blood Chemistry Date Performed:  blood tests check electrolytes, the  Blood chemistry  Troponin I is
February 2021 minerals that help keep the body's was ordered to elevated
fluid levels in balance and which check for  Elevated
are necessary to help the muscles, abnormalities cholesterol,
heart, and other organs work related to the triglyceride and
properly. condition LDL
 Lower than
normal is the
HDL
 Medical Date Performed/
Client’s Reaction
Management/Treatmen Changed/ General Description Indication/Purpose
to Treatment
t Discontinued
 Arterial blood gas Date Performed:  An ABG is a blood test that  It was ordered  paCO2 is
February 2021 measures the acidity, or pH, to determine elevated
and the levels of oxygen (O2) the exact level  paO2 is
and carbon dioxide (CO2) of oxygen in decreased.
from an artery. the arterial
level.
3. DIET

TYPE OF DIET DATE INDICATION

High Fiber
Packed with vitamins and
Apples, bananas, spinach, minerals needed for bodily
collard greens, carrots, February 2, 2021 functions. Good sources of
sweet potatoes, squash, fiber to help with
green beans, cauliflower, constipation.
peaches, etc.
Vitamin C-rich foods
Vitamin C helps your body
use iron more efficiently. It
Broccoli, tomatoes, February 2, 2021
is also an antioxidant and
peppers, oranges,
helps boost immunity
strawberries, cantaloupe
Grains and Starches
Carbohydrates are our
primary energy source and
Whole grain breads and
choose whole grains when
cereals, brown rice, pasta,
February 2, 2021 possible. B-vitamins
whole wheat tortilla,
provide energy and whole
oatmeal, whole wheat
grains are a good source of
English muffin, tabouli,
fiber.
injera
Water and other fluids
Water keeps you hydrated,
energized and can help
Water is the best fluid to
February 2, 2021 relieve constipation. Being
drink. Diluted juice (1/4
hydrated is important for
cup juice, 3/4 cup water) is
milk production.
also a good option.
4. ACTIVITY AND EXCERCISE
GENERAL
TYPES OF EXECISE INDICATION/PURPOSE
DESCRIPTION

 DEEP BREATHING Breathing is an important  It helps to maintain

technique to ease pain and good air entry into the
stress. It is best to inhale lungs.
through the nose and exhale
through the mouth.

 BED REST WITH MI patients are restricted to

COMMODE ON do hard physical activities,  bed rest are ideal way
BEDSIDE commode on the bedside to of decreasing the
facilitate excretory needs. cardiac workload.

D. EVALUATION

As patient received the proper intervention that was appropriate for his condition

which is myocardial infarction, we still continue to monitor his condition. The client was

educated to, proper food intake, activities and exercise that helped the patient.

During the time of intervention, we gave enough teaching to the client and her significant

other to make the recovery faster. For the discharge planning, It is one of the important role of

nurses to ensure the continuity of health and optimum care as the patient leaves the hospital

premises by teaching the patient about his condition, medications, self-care strategies and

importance of follow-up care and check-ups.

The patient was advised and understands that his medications should be taken at the same time

of each day. The patient was also educated about his home medications. With regards to the

patient’s weekly check-ups, the nurses will be conducting home visitation for the continuation

of optimum care and to monitor the recovery and health improvement of the patient. Health

teachings before discharging the patient was also conducted. The patient fully understands that

he will have a change in his diet. He was also instructed to stop smoking so that there will be

no triggers to his condition

III. CONCLUSION
Myocardial Infarction is commonly known as the heart attack. This is a life threatening

condition in which it affects the area of myocardium and it is permanently destroyed. This

occurs when the flow of the blood to the heart is blocked by plaques or the fatty deposits in

the coronary arteries.

Having this exposure to the cardiovascular ward, we have encountered a case of

myocardial infarction that help us to understand the theoretical side of it and experienced

firsthand the condition. We have practiced our clinical nursing skills and gave care to the

client. This will also serve as a guide to get an accurate data and assessment from the client. It

will help to gain a nurse-patient relationship more effective.

IV. RECOMMENDATION

A. To the student Nurse: This case study is recommended to student nurses who will go

to have a future study about Myocardial Infarction. To fill in the gaps of this study and

come up with a better nursing care management to cases like MI.

B. To the Patient: This study is suitable to the patient who experienced myocardial

infarction, beneficial to the patient for it will be one of his basis when myocardial

infarction attack happens again and seek medical advice immediately.

C. To the Health care provider: To focus on giving a high quality health education and

intervention to the client to prevent any complication and danger to the patient with

myocardial infarction. They must also promote common nutritional teaching to impart

knowledge to the patient and family members.

D. To the Institution: This study will work for coming up into an intervention of

promoting health programs among staffs who are into the institution with similar

background to the case. It will serve as information to trigger programs to promote the

importance of early detection of cardiovascular diseases and monitoring of signs and

symptoms of MI.
V. REVIEW OF RELATED LITERATURE

Cardiovascular Disease is a crucial and ever-growing phenomenon in the United Kingdom. It

is responsible for nearly one-thirds of all deaths and resulting to a more notable morbidity

(Stewart, Manmathan et. al., 2017). Globally, overall CVD affects approximately 32.2% of all

persons with T2DM (Type 2 Diabetes Mellitus). CVD is a major cause of mortality among

people with T2DM, accounting for approximately half of all deaths over the study period.

Coronary artery disease and stroke were the major contributors (Einarson, Ludwig, et. al.,

2018)

Myocardial Infarction’s etiology is considered complex and not completely understood. A

growing number of risk factors have been shown to be associated with the development,

progression, treatment and prognosis of myocardial infarction, and different types of

myocardial infarction. Up until now, still it is a challenge to identify the precision risk factors

for the different types of myocardial infarction for the early diagnosis, treatment and prognosis

of the disease (Zhan, Shi, et. al., 2019). In the article entitled “Evaluation of myocardial

viability in myocardial infarction patients by magnetic resonance perfusion and delayed

enhancement imaging” it shows that DE-MRI combined with microvascular perfusion may be

effective to detect viable myocardium in patients with MI and may provide a means of

predicting whether revascularization will be effective.

The first goal for healthcare professionals in management of acute myocardial infarction (MI)

is to diagnose the condition in a very rapid manner. As a general rule, initial therapy for acute

MI is directed toward restoration of perfusion as soon as possible to salvage as much of the

jeopardized myocardium as possible. This may be accomplished through medical or

mechanical means, such as percutaneous coronary intervention (PCI), or coronary artery

bypass graft (CABG) surgery (Zafari and Abdou, 2019).

Analysis of observational natural experiments based on risk stratification of patients by

clinicians must include adjustment for risk of patients selected to receive different treatments,

including adjustments related to comorbidity. Methods must be developed to identify and

adjust for death or severity of illness and comorbidity in groups of patients prior to the
assignment of treatment plans, perhaps based on surrogates such as prior hospitalization or by

random samples of these groups from the Medicare data base. Without such methodological

attention in advance, comparisons of outcomes with different treatments will be suspect.

Substantial reductions in mortality over the last 25 years have not changed the status of AMI

as the leading cause of death. The availability of powerful new drugs and technologies holds

promise for even further improvements, but their effectiveness in the elderly is often unclear.

This workshop highlighted the value of available patient and administrative records in

evaluating the effectiveness of these measures in the elderly. Moreover, it provided direction

to future research in assessing the long-term outcomes of AMI and in identifying those

diagnostic and treatment modalities most appropriate for clinical trials. This research will be

essential in ensuring survival and high quality of life for many elderly in the face of increasing

health care costs.

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