ACUTE

CORONARY
SYNDROME
(STEMI INFERIOR
WALL)
(GROUP 4)
 Table of Contents
01 02
ANATOMY 03
INTRODUCTI PATHOPHYSI
AND
ON OLOGY
PHYSIOLOG
Y

04 05 06
PATIENT’S REVIEW PHYSICAL
PROFILE SYSTEM ASSESSMENT
 Table of Contents
07 08
THEORETIC 09
LABORATOR
GENOGRAM AL
Y
FRAMEWOR
K

10 11 12
PHARMACOL DISCHARGE
NURSING
OGY PLAN
CARE PLAN
INTRODUC
TION
 WHAT IS ACS STEMI INFERIOR
ACUTE CORONARY WALL?
SYNDROME
 It is an umbrella term for situations where the blood
supplied to the heart muscle is suddenly blocked.
 The blockage can be sudden and complete, or it can
come and go – clot, break open, then clot again. In either
case, the heart tissue is dying, even if it’s just a few cells
or a whole big section of the heart.
 WHAT IS ACS STEMI INFERIOR
STEMI WALL?
 STEMI is one of three conditions that fall under acute
coronary syndrome, a disease that happens because of
limited or no blood flow to a part of your heart. The
other two conditions are non-ST elevation heart attacks
(NSTEMI) and unstable angina.
 There are three coronary arteries that provide blood flow
to your heart muscle. Depending on which arteries
contain the blockage, damage will happen in different
 WHAT IS ACS STEMI INFERIOR
INFERIOR STEMI WALL?
 Inferior Wall Myocardial Infarction also known as
Inferior Wall STEMI occurs from a coronary artery
occlusion with resultant decreased perfusion to that
region of the myocardium.
 These types of STEMI usually involve the right
coronary artery (RCA), which supplies the inferior
(bottom) side of your heart, or the left circumflex (LCX)
artery which supplies the side wall of your heart. The
 CAUSES
Smoking
High blood pressure
High cholesterol
Overexertion
 CAUSES
Drugs, including cocaine and
excessive alcohol
Diabetes
Obesity
Stress
 RISK FACTORS
Age
Gender
Family history
Infection
Race and ethnicity
 SIGNS AND
SYMPTOMS
Central chest pain
Crushing sensation
Fatigue
Diaphoresis
Shortness of breath
 SIGNS AND
SYMPTOMS
Pain that radiates from the
neck, jaw, left arm
Dizziness or light-
headedness
Cold sweat
Nausea and vomiting
 DIAGNOSTIC TESTS

BLOOD TEST CHEST X-RAY CORONARY

ANGIOGRAP
HY
 DIAGNOSTIC TESTS

ECHOCARDIO ELECTROCARDI RADIONUCL

GRAM OGRAM IDE
(ECG) IMAGING
(THALLIUM
STRESS
 TREATMEN
T
IMMEDIATE TREATMENT
Immediate treatment for STEMI focuses on
removing the blockage from the artery and restoring
blood flow to the heart as quickly as possible. Additional
immediate treatments that may be given include:
● Anticoagulants
● Medication to slow or calm the heart
● Pain medication
● Oxygen
 TREATMEN
SURGICAL OPTIONS T
CORONARY ARTERY BYPASS GRAFTING
Depending on the damage done to the artery that
was blocked and plaque buildup discovered in other
major arteries, the cardiologist may recommend
bypass surgery.
 TREATMEN
MEDICATIONS T
Once the immediate threat from the blocked
artery has been addressed, your doctor may
prescribe the following medications to help
prevent future heart attacks:
● Anticoagulants
● Statins
● Vasodilators
 TREATMEN
T
CARDIAC REHABILITATION
PROGRAMS
 PREVENTIO
N
• Eat heart-healthy foods
• Exercise
• Avoid use of tobacco and cocaine
• Limit alcohol use
• Manage stress
• Take your medications as prescribed
 
 ANATOMY
AND
PHYSIOLOG
Y
 CARDIOVASCULAR SYSTEM
The cardiovascular
system consists of the
heart, blood vessels, and
blood. Its primary function
is to transport nutrients
and oxygen-rich blood to
all parts of the body and to
carry deoxygenated blood
ANATOMY OF STEMI
ANATOMY OF STEMI
ANATOMY OF STEMI
ANATOMY OF STEMI
ANATOMY OF STEMI
ANATOMY OF STEMI
ANATOMY OF STEMI
ANATOMY OF STEMI
ANATOMY OF STEMI
PATHOPHYSIO
LOGY
PATHOPHYSIOLOGY
PATIENT’S
PROFILE
NAME: R.D.T.

AGE: 60 y/o

SEX: Male

DATE OF BIRTH: March 1, 1962

ADDRESS: Anilao, Bongabong, Oriental Mindoro

CIVIL STATUS: Married

RELIGION: Catholic

OCCUPATION: Farmer, Vulcanizing Shop Owner

ADMITTING ACS STEMI INFERIOR WALL

DIAGNOSIS:

DATE OF November 16, 2022

ADMISSION:

HOSPITAL NO. : 1239168

CHIEF Chest pain; Shortness of breath

COMPLAINT:
 PATIENT’S PROFILE
PRESENT HEALTH
CONCERN:
After being transferred from the intensive care unit, the
patient is in the medical ward (November 21, 2022). He
was advised for a complete bed rest by the doctor. He
claims in the interview that this is the worst chest ache he
has ever experienced. The patient’s diagnosis is Acute
Coronary Syndrome STEMI inferior wall.
 PATIENT’S PROFILE
PAST HEALTH HISTORY:
He was first admitted to the Oriental Mindoro Southern
District Hospital in Roxas, Oriental Mindoro with the same
chief complaint of chest pain and shortness of breath. The
patient has hypertension, and the doctor has advised him to
take maintenance catapres and losartan.
 PATIENT’S PROFILE
FAMILY HISTORY:
The patient's parents died when they were young, so
they don't know what caused their parents' deaths. He has
five siblings, and his eldest brother died due to a kidney
problem. The second is his sister, who died due to lung
problem. The third in the siblings has a hypertension. Next
is our patient who has hypertension and ACS. The youngest
sibling has no history of any disease.
 PATIENT’S PROFILE
LIFESTYLE AND HEALTH
PRACTICE PROFILE
Vegetables make up the majority of his diet, although he
also enjoys fried fish and other fatty meals. After waking up
and before commencing work at the farm every morning, he
has made it a habit to drink coffee. He claimed to have two
cups of coffee every day. He exercises every day by
working in the farm. He also works in his own vulcanizing
shop. He only drank water after meals and only urinated
twice a day when he was brought to the hospital.
REVIEW
SYSTEM
REVIEW SYSTEM
CARDIOVASCULAR
SYSTEM
The patient’s acute coronary
syndrome describes a range of
conditions associated with sudden,
reduced blood flow to the heart. Cell
death results in damaged or
destroyed heart tissue. 
PHYSICAL
ASSESSME
NT
 PHYSICAL ASSESSMENT
VITAL SIGNS (NOVEMBER 16,
2022)
• Blood Pressure: 130/90 mmHg
• RR: 22 bpm
• PR: 83 bpm
• O2: 99%
• Temperature: 36.8 ˚C
 PHYSICAL ASSESSMENT
VITAL SIGNS (NOVEMBER 22,
2022)
• Blood Pressure: 110/90 mmHg
• RR: 20 bpm
• PR: 99 bpm
• O2: 99%
• Temperature: 35.6 ˚C
 PHYSICAL ASSESSMENT
GENERAL SURVEY OF THE PATIENT

APPEARS STATED AGE

Patient seems appropriate for stated age.
LEVEL OF CONSCIOUSNESS
Alert and oriented.
SKIN
Brown skin
NUTRITIONAL STATUS
Patient seems well nourished and like to eat nutritious
food.
 PHYSICAL ASSESSMENT
GENERAL SURVEY OF THE PATIENT
OBVIOUS PHYSICAL DEFORMITIES
No obvious physical deformities seen.
FACIAL EXPRESSION
Normal.
SPEECH
Answer questions with low tone of voice.
HEARING
The patient has normal hearing.
PERSONAL HYGIENE
Well groomed.
 PHYSICAL ASSESSMENT
HEAD TO TOE ASSESSMENT
AREA METHOD FINDINGS INTERPRETATION
INTEGUMENTARY
SKIN Inspection; Skin is brown Normal
Palpation
Warm to touch

HAIR Inspection Hair is smooth Normal

No signs of infection and infestation
observed

NAILS Inspection: Nail is soft and smooth Normal

Palpation
Positive capillary refill test
 PHYSICAL ASSESSMENT
HEAD TO TOE ASSESSMENT
AREA METHOD FINDINGS INTERPRETATION
HEAD
SKULL AND Inspection; Head is in regular face and size Normal
FACE Palpation
No lesion
No evidence of skin condition and manifestations
No tenderness upon palpation
Equal movement of face
EYES AND Inspection Eyes are aligned Normal
VISION
No eye infections
No excessive tearing
Equal; Round; Symmetric
EARS AND Inspection Symmetrical ears and equal in size aligned on the Normal
HEARING outer cantus of the eye
No tenderness and masses
Has normal hearing
 PHYSICAL ASSESSMENT
HEAD TO TOE ASSESSMENT
AREA METHOD FINDINGS INTERPRETATION
NECK
NECK Inspection; Symmetrical in head Normal
MUSCLES Palpation
Symmetrical movement of head muscles
Full range of movement
LYMPH Palpation Smooth; Sharply edged; Elastic in consistency; Not Normal
NODES fused with the skin or underlying tissues; Not painful
during palpation

TRACHEA Inspection The trachea is placed in the midline of the neck Normal
AND THYROID
GLAND Thyroid gland and along with cricoid cartilage rises
during swallowing
No masses present
 PHYSICAL ASSESSMENT
HEAD TO TOE ASSESSMENT

AREA METHOD FINDINGS INTERPRETATION

CHEST Inspection; The chest wall is intact with no tenderness Normal
Percussion and masses
LUNGS Auscultation Wheezing and rales sound can be heard when Abnormal
patient is breathing
ABDOMEN Inspection: The abdomen has a symmetric contour Normal
Palpation
Soft abdomen
GENOGRA
M
GENOGRAM
THEORETIC
AL
FRAMEWO
RK
 THEORETICAL FRAMEWORK
SELF-CARE DEFICIT THEORY
BY: DOROTHEA OREM

The act of assisting others in the provision

and management of self-care to maintain or
improve human functioning at the home level
of effectiveness.” It focuses on everyone’s
ability to perform self-care, defined as “the
practice of activities that individuals initiate
and perform on their own behalf in maintaining
life, health, and well-being.”
 THEORETICAL FRAMEWORK
SELF-CARE DEFICIT THEORY
BY: DOROTHEA OREM
“The condition that validates the existence
of a requirement for nursing in an adult is the
absence of the ability to maintain continuously
that amount and quality of self-care which is
therapeutic in sustaining life and health, in
recovering from disease or injury, or in coping
with their effects. With children, the condition
is the parent’s inability (or guardian) to
maintain continuity for the child the amount
LABORATO
RY
 LABORATORY
CLINICAL CHEMISTRY (November
16,2022)
ANALYSIS METHOD RESULT RANGE
SGOT IFCC 110.6 U/L 0.000-40.00
URIC ACID URICASE 250.4 umol/L 155.0-428.0
GLUCOSE OXIDASE 6.003 mmol/L 4.100-5.900
SGPT IFCC 50.87 U/L 0.000-40.00
BUN U.V 4.713 mmol/L 2.100-7.100
CHOLESTEROL CHOP-PAP 6.740 mmol/L 0.000-5.180
TRIGLYCERIDES GPO-PAP 1.159 mmol/L 0.000-1.700
CREATININE JAFFE 110.6 mmol/L 53.00-115.0
HDL DIRECT 1.43 mmol/L 1.000-1.500
LDL REL 4.780 mmol/L 0.000-3.500
VLDL REL 0.527 mmol/L 0.000-1.000
 LABORATORY
SEROLOGY REPORT (November 16,17,
2022)
EXAMINATIONS NORMAL RESULT RESULT
VALUES Nov.16 Nov.17
TROPONIN --1 <0.30ng/ml 30.75 ng/ml <40.97 ng/mL
NT PRO-BNP 75 y/o and above --- ---
<450.00pg/ml    
     
75 y/o and below 2515.40 492.97 pg/mL
<125.00 pg/ml pg/mL
CRP <10mg/L --- ---
CKMB <5.00ng/ml 15.60 ng/mL 6.21 ng/mL
D-DIMER <0.5 mg/L --- ---
 LABORATORY
ELECTROLYTES TEST (November 16,
2022)
TEST REFERENCE RESULTS
VALUE
SODIUM (Na+) 135-148 mmol/L 136.6

POTASSIUM (K+) 3.5-5.3 mmol/L 3.85

CHLORIDE (CL) 98-107 mmol/L 108.9

 LABORATORY
HEMATOLOGY REPORT (November
16,17, 2022)
TEST RESULTS REFERENCE RESULTS
Nov.16 RANGE Nov.17

WHITE CELL 12.4 4.0-11.0 10.8

COUNT

NEUTROPHILS 0.78 0.40-0.60 0.62

LYMPOCYTES 0.10 0.20-0.40 0.16
MONOCYTES 0.09 0.01-0.03 0.12
EOSINOPHILS 0.02 0.00-0.04 0.10
 LABORATORY
HEMATOLOGY REPORT (November
16,17, 2022)
PROTIME (PT) APTT
Nov.16

CONTROL (TIME): 10.0-14.0 CONTROL (TIME): 22.0-38.0

SECONDS SECONDS
PATIENT (TIME): 16.1 SECONDS PATIENT (TIME): 50.8 SECONDS
INR 1.42
REFERENCE RANGE INR: 0.70-
1.30
% ACTIVITY 76%
 LABORATORY
HEMATOLOGY REPORT (November
16,17, 2022)
PROTIME APTT
Nov.17

CONTROL (TIME): 10.0-14.0 CONTROL (TIME): 22.0-38.0

SECONDS SECONDS
PATIENT (TIME): 14.8 SECONDS PATIENT (TIME): 50.8 SECONDS
INR 1.30
REFERENCE RANGE INR: 0.70-
1.30
% ACTIVITY 82%
 LABORATORY
LIPID PROFILE REPORT (November 17,
2022)
ANALYSIS METHOD RESULT RANGE

GLUCOSE OXIDASE 6.510 mmol/L 4.100-5.900

CHOLESTEROL CHOD-PAP 6.765 mmol/L 0.000-5.180

TRIGLYCERIDES GPO-PAP 2.162 mmol/L 0.000-1.700

LDL REL 4.562 mmol/L 0.000-3.500

 LABORATORY

ECG (NOVEMBER 15, 2022)

Normal sinus rhythm

Cardiac electric axis normal
aVF V3 V6 Abnormal T wave
 LABORATORY

2D ECHOCARDIOGRAPHY (NOVEMBER 18, 2022)

CONCLUSION:
Concentric left ventricular hypertrophy with segmental wall
motion abnormality with mildly abnormal systolic and
diastolic functions.
Dilated right ventricle with normal function.
Normal pulmonary artery pressure.
Atheromatous aorta.
PHARMACO
LOGY
 PHARMACOLOGY
NAME OF DRUG MECHANIS INDICATION CONTRAINDICATI ADVERSE EFFECTS
DRUGS CLASSIFICATI M OF ON
ON ACTION
FENOFIBRAT Antihyperlipidemi activates hypertriglyceride Known loss of appetite, nausea,
E 200mg tab c Agents peroxisome mia, primary hypersensitivity, pains in stomach, side,
proliferator hypercholesterole severe renal or abdomen, possibly
OD
activated mia, or mixed impairment, including radiating to the back,
P.O. receptor alpha dyslipidemia. those with end-stage vomiting.
(PPARα), renal disease and those
   
increasing receiving dialysis,
lipolysis, active liver disease,
activating gallbladder disease.
lipoprotein
 
lipase, and
reducing
apoprotein C-
III.
 PHARMACOLOGY
NAME OF DRUG MECHANI INDICATION CONTRAINDICA ADVERSE
DRUGS CLASSIFICAT SM OF TION EFFECTS
ION ACTION
OMEGA Antilipemic or mediate anti- cardiovascular Hypersensitivity gastrointestinal
GOLD Lipid-regulating inflammatory disease, trouble, indigestion,
Agents effects and hypertriglyceri heartburn, diarrhea,
1cap
increase demia, type 2 nausea, and
BID levels of EPA diabetes, flatulence.
or DHA has cancer,
P.O.
shown to depression,
decrease the heart failure,
levels of asthma.
PGE2 and 4
series-LT
 PHARMACOLOGY
NAME OF DRUG MECHANIS INDICATION CONTRAINDICATI ADVERSE EFFECTS
DRUGS CLASSIFICATI M OF ON
ON ACTION
ENOXAPAR Low Molecular blocking the prevention of known hemorrhage,
IN Weight Heparin body's ischemic hypersensitivity to elevation of serum
(LMWH) natural complications enoxaparin or any aminotransferases,
0.6cc
clotting in unstable heparin products, fever,
q12 factors. angina and in active major thrombocytopenia,
non-Q-wave bleeding such as nausea, anemia,
myocardial Gastrointestinal ecchymosis
infarction bleed, history of
heparin-induced
thrombocytopenia
within the past 100
days or presence of
circulating
antibiotics.
 PHARMACOLOGY
NAME OF DRUG MECHANIS INDICATION CONTRAINDICATI ADVERSE EFFECTS
DRUGS CLASSIFICATI M OF ON
ON ACTION
CARVEDIL Alpha- and relaxes congestive asthma, bronchitis, peripheral edema,
OL beta- adrenergic smooth heart failure, emphysema, severe sleep disorder, skin
blocker muscle in left ventricular liver disease, or a reaction, dry mouth,
6.25 mg
vasculature, dysfunction serious heart anemia, sweating,
BID leading to following condition such as nausea, vomiting
reduced myocardial heart block, "sick
 
peripheral infarction, sinus syndrome," or
vascular hypertension slow heart rate
resistance
 
and an
overall
reduction in
blood
pressure
 PHARMACOLOGY
NAME OF DRUG MECHANIS INDICATION CONTRAINDICATI ADVERSE EFFECTS
DRUGS CLASSIFICA M OF ON
TION ACTION
ATORVAST Dyslipidaem inhibits hyperlipidem Hypersensitivity, diarrhea,
ATIN iç Agent HMG-CoA ia active liver arthralgia,
reductase, disease or insomnia, muscle
80mg
the enzyme unexplained cramps, vomiting,
OD that persistent rash, blood sugar
catalyzes elevation of abnormalities,
the serum increasing serum
conversion transaminase, transaminase
of HMG- porphyria, levels.
CoA to pregnancy,
mevalonic lactation
acid
 PHARMACOLOGY
NAME OF DRUG MECHANIS INDICATION CONTRAINDICATI ADVERSE EFFECTS
DRUGS CLASSIFICATI M OF ON
ON ACTION
RANOLAZ anti-anginal inhibits treatment of patients receiving bloating or
INE rapid chronic concomitant swelling of the
 
delayed angina therapy with face, arms, hands,
375mg
rectifier CYP3A4 inducers lower legs, or feet,
BID potassium or strong chest tightness,
current, CYP3A4 difficult or labored
thus inhibitors breathing,
delaying lightheadedness,
action rapid weight gain.
potential
and
prolonging
 PHARMACOLOGY
NAME OF DRUG MECHANIS INDICATION CONTRAINDICATI ADVERSE EFFECTS
DRUGS CLASSIFICATI M OF ON
ON ACTION
ASPIRIN nonsteroidal anti- inhibit the pain, fever, bleeding disorders like Drowsiness, dizziness,
inflammatory activity of the juvenile hemophilia and others, nausea and vomiting,
80mg
drugs (NSAIDs). enzyme now rheumatoid active peptic ulcer, diarrhea, heartburn,
OD called arthritis, asthmatic, impaired anorexia, rash
cyclooxygenas kawasaki disease, renal and renal
  e (COX) which Antiplatelet, function and G6PD
leads to the rheumatic fever. deficiency.
formation of
 
prostaglandins
(PGs) that
cause
inflammation,
swelling, pain
and fever.
 PHARMACOLOGY
NAME OF DRUG MECHANIS INDICATION CONTRAINDICATI ADVERSE EFFECTS
DRUGS CLASSIFICATI M OF ON
ON ACTION
CLOPIDOG antiplatelet inhibits reduction of hypersensitivity, depression,
REL agents; platelet platelet atherosclerosis pathologic bleeding, dizziness, fatigue,
aggregation aggregation events in lactation headache, chest pain,
75mg
inhibitors by patient at risk edema, abdominal
OD irreversibly for such events pain, rash
inhibiting the including
binding of recent MI,
ATP to acute coronary
platelet syndrome,
receptors stroke, or
peripheral
vascular
disease
 PHARMACOLOGY
NAME OF DRUG MECHANIS INDICATION CONTRAINDICATI ADVERSE EFFECTS
DRUGS CLASSIFICA M OF ON
TION ACTION
TRIMETAZI fatty acid inhibits symptomatic Parkinson rare causes of GI
DINE oxidation beta- treatment of disease, disorders, nausea
inhibitors oxidation stable angina Parkinsonian and vomiting,
35mg
of fatty pectoris in symptoms, fever, rash,
BID acids by patients tremors, restless respiratory illness,
blocking inadequately leg syndrome, anemia
long-chain controlled or and other related
3-ketoacyl- intolerant to movement
CoA first line disorders.
thiolase, therapies.
which
enhances
 PHARMACOLOGY
NAME OF DRUG MECHANIS INDICATION CONTRAINDICATI ADVERSE EFFECTS
DRUGS CLASSIFICA M OF ON
TION ACTION
PANTOPRAZOL proton-pump suppresses the gastro- hypersensitivity to blood dyscrasia, hepatic
E 40mg inhibitors final step in esophageal reflux drug, class, impairment,
gastric acid Disease (GERD), components anaphylaxis, headache,
IV
production by acid peptic nausea/vomiting,
OD forming a Disease diarrhea, abdominal
covalent bond pain, fever, rash,
  to two sites of dizziness, flatulence
the (H+,K+)-
ATPase
enzyme system
at the secretory
surface of the
gastric parietal
cell.
 NURSING
CARE PLAN
NURSING CARE PLAN
NURSING CARE PLAN
NURSING CARE PLAN
NURSING CARE PLAN
DISCHARGE
PLAN
 DISCHARGE PLAN
DIETARY INTAKE

● •Educate the patient about the importance of having

healthy and balanced diet. Advise the patient to avoid
foods that are high in cholesterol.
● Advise the patient to eat fruits especially rich in
potassium and magnesium like banana, avocado, mango,
pineapple, and other green-leafy vegetables.
● Educate the patient to drink coffee in moderation and
maintain to drink 8-10 glasses of water everyday.
 DISCHARGE PLAN
PHYSICAL ACTIVITY

● Advise the family of the patient to provide support and

assist the patient whenever he will move or walk.
● Advise the patient to take rest and relax to gain his
strength.
● Advise the patient and his family to limit or avoid heavy
works that could be exhausting to the patient, and it may
lead to some health complications.
 DISCHARGE PLAN
HEALTH TEACHING

● Provide enough information to the patient and to his

family so they will have sufficient knowledge for
prevention and controlling the risks of unstable level of
blood pressure and glucose level.
● Educate them about taking his medications as directed
and prescribed by the physician. Take it regularly in right
time and right amount.
THANK
YOU!!!
(GROUP 4)