MYOCARDIAL INFACTION

FACULTY OF NURSINGBACHELOR OF SCIENCE IN NURSING (POST REGISTRATION)ASSIGNMENT COVER PAGE

Students NameMUTHULINGAM KETHEESARANStudents ID LC0007000021 Students NRICYear/Semester1ST year / 2nd semester Lecturers NameMr. RegidorFacultyLINCOLN UNIVERSITY COLLEGE

ProgrammeBACHELOR OF SCIENCE IN NURSINGSubject NameClinical Practice 2 (LBNS 2207).Assignment Titlecase study on chronic kidney diseaseNo. of Pageexcluding this page) 45Required words2000Actual # of words 4390Date submittedDue Date

Soft copy includedYes /No

DECLARATION BY STUDENTS:

I certify that this assignment is my own work in my own words. All resources have been acknowledged and the content has not been previously submitted for assessment to LINCOLN or elsewhere. I also confirm that I have kept a copy of this assignment.

Signed:Date:

A case study of a Angina Pectoris patient admitted to the Teaching Hospital , Batticaloa

Student, Lincoln University College, Malaysia

Table of contents1.0 OBECTIVES OF CASE STUDY1.1 GENERAL OBJECTIVES1.2 SPECIFIC OBJECTIVES.2.0 BIOGRAPHIC DATA2.1.1 HEALTH HISTORY.2.1.1.1 DEMOGRAPHIC DATA.2.1.1.2 CHIEF COMPLAINTS.2.1.1.3 HISTORY OF PRESENT ILLNESS2.1.1.4 HISTORY OF PAST ILLNESS.2.1.2 FAMILY HISTORY2.1.3 HEALTH SEEKING PRACTICE2.1.4 PERSONAL HISTORY.2.2 SOCIO-ECONOMIC STATUS...3.0 ENVIRONMENTAL FACTOR4.0 DEVELOPMENTAL NEED AND TASK COMPARING WITH NORMAL ADULT CLIENTS4.1 Robert Havighursts Developmental Tasks4.2 Eric Eriksons Developmental Task5.0 Physical Assessment6.0 FINDINGS

7.0 DEFINITION, CAUSE AND PATHOPHYSIOLOGY OF CLIENTS DISEASES

8.0 Stages of Angina Pectoris8.1 COMPARISON OF..8.2 SIGNS AND SYMPTOMS..8.3 INVESTIGATION..8.4 COMPARISON OF MEDICAL MANAGEMENT.8.5 COMPARISON OF SURGICAL MANAGEMENT.8.6 COMPARISON OF NURSING MANAGEMENT.

9.0 DRUGS CARD OF MEDICINES10.0 SUMMARY OF CLIENT DAILY PROGRESS REPORT IN HOSPITAL11.0 DIVERSIONAL THERAPY USED FOR CLIENT12.0 APPLICATION OF NURSING THEORIES13.0 APPLICATION OF THEORY ON MY PATIENT14.0 NURSING CARE PLAN15.0 DISCHARGE TEACHING16.0 WHAT I LEARNED FROM THIS CASE STUDY17.0 CONCLUSIONS AND SUMMARY OF CASE STUDY18.0 REFERENCES

1.0 OBECTIVES OF CASE STUDY

1.1 GENERAL OBJECTIVES:- The general objective of the case study is to gather the comprehensive knowledge about the disease to gain the practical exercise about the Adult Health Problem and also to gain Practical experience working with a patient having chronic kidney disease and to give holistic patient care according to their need.1.2 SPECIFIC OBJECTIVES:-

The specific objectives of the case study are given below:-

To assess the patient and find out need of patient according to nursing process. establish a nurse-client relationship to the client, as well as to the family by rendering a therapeutic nurse-patient relationship; gather adequate information to be used in the development of the study present the clients personal data; illustrate the patients family tree and trace significant diseases which may be of relevance to the study trace the health history of the client and the family by collecting information both of the past and present illnesses; To provide holistic nursing care to the client to all ages using nursing process. To manage promptly as necessary to built up comfort. To provide psychological support to the patient To apply knowledge from the science, nursing theory and other related courses to plan and implement nursing care. To provide continuous care till discharge and follow-up care. Counsel and make aware the patient party about importance of continuity of medicine and psychological support to prevent from worsens. To provide the discharge teaching to the patient and family member.

2.0 BIOGRAPHIC DATA2.1.1 HEALTH HISTORY

2.1.1.1. DEMOGRAPHIC DATA NAME: Mr.S.Alahendran EDUCATION O/L DATE OF ADMISSION: 2015/5/20 DATE OF DISCHARGE: 2015/5/28 IP NO. : 66238/15 OCCUPATION: Cook MARITAL STATUS: married ATTENDING Consultant: Dr. Ahilan(consultant physician) INFORMATION SOURCE: patient and his son DIAGNOSIS: Angina Pectoris BLOOD GROUP: AB+ve BED NO: 3 WARD: Medical

2.1.1.2 CHIEF COMPLAINTS: Chest pain, Nausea and vomitting

2.1.1.3 HISTORY OF PRESENT ILLNESS: According to the patients, he come for Medical clininc, due Lower respiratory tract infection . His general condition is ill looking and oriented with time place and person. 2.1.1.4 HISTORY OF PAST ILLNESS: antihypertensive medicine.

ALLERGIESAccording to the patient, he doesnt have any allergic reaction to any factors..PREVIOUS HOSPITALIZATION: no any

2.1.2 FAMILY HISTORY: Type of family: joint No. of Family Members: 7

Table 1 Family Medical history

DISEASEFATHERS RELATIONMOTHERS RELATION

TuberculosisAbsent Absent

CancerAbsentAbsent

Heart diseaseAbsent Absent

JaundiceAbsentAbsent

EpilepsyAbsentAbsent

PsychologicalAbsentAbsent

HypertensionPresentPresent

2.1.3 HEALTH SEEKING PRACTICE: He belongs to literate family, According to Alagendran, they were not dependent in superstitious beliefs. If someone becomes ill in their family they take homemade medicine then some times go to hospital.

2.1.4 PERSONAL HISTORY: Health Habits: Smoker but has left 1-2 months ago, Non alcoholic, Non vegetarian. No food allergy. Maintain personal hygiene Religion belief and worship kuldeuta. Dietry history: Non vegetarian. Foods like egg-curry, rice, daal etc.

2.1 SOCIO-ECONOMIC STATUS:He belongs to middleclass family. The major source of income is Cook and business. They are the permanent residence of Kiran. They are well satisfied with their economic status. They have very good inter relationship in the community.

3.0 ENVIRONMENTAL FACTOR: Housing Pattern: Well facilitated

Waste disposal: They are practicing collective approach to manage the waste product. Such as temporary container, burning and making compost manure. The people from Kiran also come to take waste from there home.

4.0 DEVELOPMENTAL NEED AND TASK COMPARING WITH NORMAL ADULT CLIENTS

4.1 Robert Havighursts Developmental Tasks

Developmental TasksDescriptionPassed or Failed

1. Adjusting to decreasing physical strength and healthOlder adults also have to adjust to decreasing physical strength and health. The prevalence of chronic and acute diseases increase in old age. Thus, older adults may be confronted with life situations that are characterized by not being in perfect health,serious illness and dependency on people.Passed

2. Adjusting to retirement and reduced incomeA central developmental task that characterized the transition into old age is adjustment to retirement. The period after retirement has to be filled with new projects, but is characterized by few valid cultural guidelines. The achievement of this task may be obstructed by the management of another task, living in a reduced income after retirement.Passed

3. Adjusting to death of a spouseOlder adults may become caregivers to their spouses. Some older adults have to adjust to the death of their spouses. After they have lived with a spouse for many decades, widowhood may force older people to adjust to loneliness, moving to a smaller place,and learning about business matters.Failed

4. Establishing an explicit affiliation with one's aged groupThe development of a large part of the population into old age is historically recent phenomenon to modern cities. Thus, advancements understanding of the aging process may lead to identifying further developmental tasks associated with gains and purposeful lives for adults.Passed

5. Meeting social and civil obligationsOlder people might accumulate knowledge about life, and thus may contribute to the development of younger people and the society.Passed

6. Establishing satisfactory physical living arrangementsOder adults are generally challenged to create positive sense of their lives as a whole. The feeling that life has order and meaning results in happiness.Passed

4.2 Eric Eriksons Developmental Task

Integrity vs. DespairErikson felt that much of life is preparing for the middle adulthood stage and the last stage recovering from it. Perhaps that is because as older adults we can often look back on our lives with happiness and are contented, feeling fulfilled with a deep sense that life has meaning and we've made contribution to life, a feeling Erikson called integrity. On the other hand, some adults may reach this stage and despair at their experiences and perceived failure.My patient achieved happiness and contentment in his life based on his actions and speeches. He is faithful and devoted to his religion. He is ready to accept death completely and he has shared his experiences to his beloved grandchildren. Even though he accepted death fully but his faith and love for his worshipped God never changed.

5.0 Physical Assessment

Vital SignsAxillary T=97 degree F, PR= 90/ min, RR= 22/ min, BP= 150/80 mmHg. General surveyHeight= 5 ft and 4 inches, weight= 66 kilos,. No signs of distress noted upon assessment, able to smile, cooperate well, responsive to questions, conscious and alert, conversant. Well oriented. Show calmness during the examination. He has no IVF infused, and was asleep at initial assessment. Skin Skin is brown in color, rough, dry and warm. . Brownish discolorations that resemble wrinkles are observed on face.HeadSkull is round in shape, symmetrical. No masses noted. Facial movement is symmetrical, alopecia. Scalp is clear from dandruff and lice. No scars and wounds noted.EyesHas symmetrical eyebrows movement, shape and hair distribution. Eyebrows have same color with hair. Eyelashes are evenly distributed and curled outward. Eyelids have no discharges and bilaterally blink. Upper lid covers the small portion of the iris and cornea. Lacrimal duct openings (puncta) are evident at nasal ends of upper and lower lid with no tenderness noted. Palpebral conjunctiva are pinkish in color while the pupils constricted to light, round in shape. He is able to rotate eyes and has coordinated eye movements. EarsAuricle has same color with the skin, has symmetrical shape and located a little bit higher than the eye. Pinnas are symmetrical with no lesions noted. He has wet cerumen noted on both ears when pulled down and back for better visualization. he is able to hear on both ears.

NoseNose has uniform color and symmetrical in shape. Nasal hairs are very evident when light is flashed through the nasal passageways; its color is black. No nasal flaring observed upon respiration. Both nares are patent, air moves freely as client breathes through the nares. Nasal septum is straight and in midline. Nasal mucosa is pinkish in color, has no discharges and no lesions. No tenderness of sinuses noted. MouthLips are a little brownish in color, dry and has cracks. Tongue is in midline, pinkish in color with thin whitish coating on top. Able to move tongue freely (up & down, side to side). Soft palate is light pink in color while hard palate is lighter in color. Gums are pinkish in color. Plagues are present on his teethPharynxUvula is found well placed in midline of soft palate. Mucosa is pinkish in color. Tonsils are not inflamed.NeckTrachea is in midline. No tenderness of thyroid noted. No enlargement of the neck noted. he is able to flex and extend neck and move it laterally (L and R).Chest and LungsBreathing pattern is regular. Anteroposterior diameter to transverse diameter is in 1:2. Respiratory excursion is symmetrical (thumb separates to 2-3cm). No tenderness, lump, Presence of breath sound in all area of lungs

Heart and Central VesselsHeart sounds are regular. Pulsation of heart is heard in 4 anatomical areas but more audible in apical area upon auscultation. Back and ExtremitiesPeripheral pulses are symmetrical and regular. Nails are long and untrimmed, pinkish in color, and have a capillary refill time of 2 sec. after blanching; and no clubbing of fingernails were noted.. His hands are a little rough. Muscle strength is equal on both sides of the upper and lower extremities. He is able to stand and walk on both feet independently, and his movements are well coordinated. Toes point straight ahead. And he is able to sit up straight. AbdomenHis abdomens color is same with the rest of the part of the body. His umbilicus is coated with blackish dirt. Neurologic Assessment Cranial Nerves: able to identify aromas by smelling with eyes closed; able to see objects; pupil constricted to light sensation; able to move eyeball downward and laterally; able to blink eyes; able to smile, raise eyebrows, puff cheeks and close eyes; able to respond to questions being heard;) has rough and vibrating sound; able to shrug shoulders, elevate and flex arms and legs against resistance; able to protrude tongue and move it side to side.

6.0 FINDINGS:

Skin is goond tension of hair wet cerumen noted on both ears plaques are present Nails are long and untrimmed

History of illnessHe has a familial history of hypertension ,diabetic mellitus on her father mothers side and has positive distress due to her worsen condition. His assessment findings were Fasting blood sugar-9.3mmol/L,Troponin I-