Question

Clinical Situation

A 50-year old man presented to the emergency department (ED) after experiencing crushing pain in his chest, profuse sweating, and nausea. He was diagnosed with a myocardial infarction and given intravenous medication to dissolve a clot that was obstructing a major coronary artery. While in the ED, he overheard the nurse practitioner say, "some of his heart muscle had died."

Choose one (1) of the following DB Comment Options - Use APA Format for All Citations.

1. Discuss the altered physiology presented in the clinical situation.
2. Draw from your personal nursing practice - link the clinical situation to your personal nursing practice.
3. Discuss clinical assessments, decisions, and interventions for the situation presented.
4. Discuss anticipatory, safe, and deliberate nursing care for the situation presented.  
5. Discuss how the altered physiology, noted in the clinical situation, affects aspects of wellness. Address at least three (3) of       the following aspects of wellness: Physical, intellectual, emotional, social, cultural, or economic.

Answer 1

1.ALTERED PHYSIOLOGY;

• morphological features of myocardial infarction mainly depends on location,severity,and rare for development of coronary obstruction mainly due to atherosclerosis and thrombosis.
• Coronary arterial obstruction diminish the blood flow to the myocardium,
• Finally it causes ischemia,myocardial dysfunction.
• Coronary artery atheromatous plaque undergoes some changes includes intraplaque hemorrhages, erosion or ulceration or rupture or fissuring.
• After that exposed to subendothelial collagen and necrotic plaque contents,platelets present, finally it activate, release their granule contents gets aggregate to form microthrombi.
• Vasospasm stimulated by mediators release from platelets,
• tissues factor get activate coagulation pathway and also adding the bulk of thrombus,
• Finally thrombus expand compeletly occlude the vessel lumen,
• develops ischemia, myocardial dysfunction and finally myocyte death.

2.CLINICAL SITUATION TO NURSING PRACTICE;

• Nursing practitioners assess the clinical situation by their symptoms, laboratory test and electrocardiogram.
• By their past history, similar illness, similar attack able to assess the clinical situation of patients.
• 
  D personal clinical situation of MI to the Nursing practice 7 Myocardial Infarction Ruptur, Fisswing Erosion Onygen Imbalonce severe anenia 2) Bevere Respiratory failure 3) Tachy a nathima 2) Hypertension о солонату Єлеотлоlia dysfunction a spasm Obata ucted cornary attery Endo coudium Zone 01 Necrosis Obstructed artery Right - left cucumplen coronary artery coronary auti wiorary arty artãy ordusion
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3.CLINICAL ASSESSMENT:

• Symptoms,
• Laboratory test,
• Electrocardiography.
• Symptoms-chest pain, rapid weak pulse, diaphoresis, nausea and vomiting, raised JVP,
• Laboratory evaluation-measure the blood level of proteins, that protein released from damaged myocyte.
• Cardiac specific proteins-cTnT and cTnI, creatine kinase is a enzyme expressed in myocardium and skeletal muscle.
• ECG-ST elevation,
• chest x-ray for checking pulmonary edema.
• Echo cardiography-to know ventricular function.

​​​​​​​DECISION AND INTERVENTION:

• immediate management,
• surgery

​​​​​​​IMMEDIATE MANAGEMENT;

• In first 24 hours, patient should be admitted urgently to hospital, because development of significance risk of death,
• Analgesics-morphine sulphate 5-10 mg or diamorphine 2.5-5 mg

​​​​​​​Anti thrombotic therapy:

• anti platelet therapy-75-325mg aspirin,
• Anticoagulant-un fractionated heparin, fractionated heparin or penta saccharide(fondaparinux -2.5mg daily),
• Anti anginal therapy-sublingual glyceryl trinities(300-500mcg).

​​​​​​​SURGERY;

• angioplasty,
• Coronary artery bypass surgery.

​​​​​​​4.ANTICIPATORY,SAFE AND DELIBERATE;

• immediate antithrombatic therapy,analgesics,anti anginal therapy,reperfusion therapy
• Electrocardiogram for monitoring the activities of myocardial muscle,
• Evaluate the cardiac biomarkers-creatine kinase,troponin T and troponin I,
• Past history of patients,
• Similar attack in family or past,
• How many attack occurred previously,
• Other blood test.

​​​​​​​5.ALTERED PHYSIOLOGY IN THE CLINICAL SITUATION:

• Diminish blood flow to myocardial area,develops ischemia and myocardial dysfunction,
• Onset of ATP elevation,
• Loss of contractility,
• ATP reduced to 50% of normal and 10% from normal in 10-40 mints,
• Irreversible cell injury,
• Microvascular injury.
• Physical activity-not able to daily activities,care to be taken for an every minute.
• Emotions-patient present in the depressed emotion,fear of death,severe pain.
• Social-patient not always combined to the social systems,development of complication.

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