Question

Read from chapter 31 to 33 for Quiz # 8 (Next Week)

Analyze the following Case Study:

Myocardial Infarction

Patient Profile

F.M. is a 68-year-old white man who comes to the emergency department (ED) in the early afternoon with a 2-day history of severe chest pain. The pain started on wakening the previous day. The pain increased during the night, but his wife could not convince him to go to the hospital. He comes to the ED today because the pain is severe and no longer relieved by rest.

Subjective Data

Describes recurring chest pain for the past 6 months that was relieved by rest; the pain is a feeling of heaviness in chest with no radiating pain to arm or jaw or accompanying complaints of nausea or dizziness

Recently the chest pain has become severe and is no longer relieved by rest; is now complaining of being slightly nauseated

His father died of a heart attack at age 62

Denies alcohol or drug use

Smokes one pack of cigarettes per day

Describes his lifestyle as sedentary

Objective Data

Physical Examination

Blood pressure 180/96, pulse 98, temperature 99.8° F, respirations 20

Height 5’11”,weight 210 lbs, BMI 29.3 kg/m²

Alert and oriented to person, place, and time

Skin diaphoretic and clammy

Heart rhythm regular, no murmurs or extra heart sounds

Lungs are clear to auscultation

Diagnostic Studies

Hemoglobin 14 g/dL

Chemistry panel is normal

Cardiac markers – pending

Electrocardiogram showing changes that correlate with non–ST-segment–elevation myocardial infarction (NSTEMI)

Interprofessional Care

0.9% NaCl infusing into IV catheter at 75 ml/hr

Nitroglycerin and morphine given with relief of pain

Discussion Questions

What are F.M.’s modifiable risk factors for coronary artery disease (CAD)? What are his nonmodifiable risk factors?

What is the difference between chronic stable angina pain and pain associated with myocardial infarction?

What diagnostic studies are indicated for F.M.?

Case Study Progression

F.M. is diagnosed as having a myocardial infarction (MI).

What is the priority nursing care for F.M.?

What other interventions do you anticipate for F.M. at this time?

What are common complications after an MI?

Case Study Progression

After an uneventful hospital stay, F.M. is preparing for discharge.

Prior to F.M.’s discharge from the hospital after having an MI, what patient teaching should he receive?

Answer 1

1. The modifiable risk factors are hypertension, cigarette smoking, and obesity. the non- modifiable risk factors are

age, family history that his father died with stroke.

2. The pain of stable angina is similar to the pain of myocardial infarction. but in the case of MI the pain is more severe, and the pain stays for longer time and the pain do not relief with nytroglycerin.

3. the diagnostic tests indicated for F.M. are electrocardiogram, cardiac markers, chest x-ray, heart sounds, weight, blood pressure, pulse rate, respiratory rate, skin test, height, temperature, haemoglobin levels and other laboratory data.

4.the priority nusing care includes:

• monitor the chest pain
• regular blood pressure, pulse rate and respiratory rate monitoring.
• regulr ECG monitor.
• life style modifications.
• medication preferrence.

5.the other interventions are prescribing some h2 receptors blockers are proton pump inhibitors are essential for this patient because he is using medications which can cause gastritis. there is chance of hospital acquired infections so, it is necessary to prescribe antibiotics.also check the creatinine and bolld glucose levels regularly. quit cigarette smoking because it can lead to disturbed blood gases.

6. common complications are disturbed heart rhythm, heart failure, caronary artery disease, diabetis mellitus, pericarditis and ventricular aneurysm.

7. the patient teaching should include about the medications, exercise, diet and life style modifications.

medications:

• take all the medications without skipping
• take medications along with you while going outside of the house.
• if any side effects of medication appeared then immediately consult the physician
• take regular blood pressure monitoring

exercise:

• practice warm up exercises.
• try to walk regularly and do not jog
• use elevator instead of using steps..
• practice yoga and meditation to avoid stress.

food:

• limit salt intake in your food.
• take fruits, vegetables.
• include fibre rich food.
• take less fatty food,
• take food rich in potassium,magnesium and calcium.
• avoid eating too much of bananas it can cause hypotension.
• take food more times in a day instead of taking it in asingle time.

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