med surg care study

8/11/2019 Med Surg Care Study

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CASE STUDY

By:

SHIUNY SOLIH

IUTHISAM HASSAN LATHYF

NAASHITHA NAASIR

SUBAATHAA ABDHULLAH


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INTRODUCTION

This case study is based on 82 year old patient Hussain Ahmed who resides at Jasthukafaage/ B.eydhafushi with a family of 3 girls and 1 boy. He was an active fisherman and retired 15 years

back as his children didnt want him to work since he was getting old. Therefore in order to earn

for his family his son came to male. When we inquired about his diet, his son explains that his

father preferred eating spicy food and mostly had garudhiyya and rice and avoided vegetables

with less fluid intake. Moreover he also was a smoker, but he quit smoking 20 years back.

Furthermore his walking had decreased 3 years ago.

According to his son one week back his father started having breathing difficulty, chest painfollowed by fever and cough for which local medication was given. However the fever

deteriorated and his father became disoriented and restless. Thus they took him to the atoll

hospital from where they were referred to IGMH.

He also explained that there was no past medical history of his father and also his family has no

history of cardiovascular diseases.

Myocardial infarction

Heart attack or myocardial infarction is a medical emergency in which some of the hearts blood

supply is suddenly and severely reduced or cut off causing the heart muscle myocardium) to die

because it is deprived of its oxygen supply

PATHOPHYSIOLOGY

In an MI, an area of the myocardium is permanently destroyed. MI is usually caused by reduced

blood flow in a coronary artery due to rapture of an atherosclerotic plague and subsequentocclusion of an artery by a thrombus. In unstable angina the plague ruptures, but the artery is not

completely occluded. Because unstable angina and acute MI are considered to be the same

process but different points along a continuum, the term acute coronary syndrome (ACS) may be

used in lieu of these diagnoses. Other causes of MI include vasospasm ( sudden constriction or

narrowing) of a coronary artery or decreased oxygen supply ( acute blood loss, anemia or low


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blood pressure), and increased demand for oxygen (e.g.; from a rapid heart rate, thyrotoxicosis or

ingestion of cocaine). In each case a profound imbalance exist between myocardial oxygen

supply and the demand.

Coronary occlusion, heart attack, MI are terms used synonymously, but the preferred term is MI.

the area of infarction develops over minutes to hours. As the cells are deprived of oxygen

ischemia develops, cellular injury occurs, and the lack of oxygen result in infarction, or the death

of cells. The expression time is muscle reflects the urgency of appropriate treatment to

improve patients outcomes. (Smeltzer s. C., Bare, L.Hinkle, & Cheever, 2008)

INCIDENCE

Potential for intervention

There are 32.4 million myocardial infarctions and strokes worldwide every year. Patients with

previous myocardial infarction (MI) and stroke are the highest risk group for further coronary

and cerebral events. Survivors of MI are at increased risk of recurrent infarctions and have an

annual death rate of 5% - six times that in people of the same age who do not have coronary

heart disease. Similarly, patients who have suffered a stroke remain at an increased risk of a

further stroke (about 7% per annum).

There is considerable scientific evidence that specific interventions will reduce the risk of further

vascular events in patients with MI and stroke. If these interventions are appropriately

implemented, nearly one third of the fatal and non-fatal MI and strokes could be prevented.

http://www.who.int/cardiovascular_diseases/priorities/secondary_prevention/country/en/index1.

html
http://www.who.int/cardiovascular_diseases/priorities/secondary_prevention/country/en/index1.htmlhttp://www.who.int/cardiovascular_diseases/priorities/secondary_prevention/country/en/index1.htmlhttp://www.who.int/cardiovascular_diseases/priorities/secondary_prevention/country/en/index1.htmlhttp://www.who.int/cardiovascular_diseases/priorities/secondary_prevention/country/en/index1.htmlhttp://www.who.int/cardiovascular_diseases/priorities/secondary_prevention/country/en/index1.html


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CLASSIFICATIONS OF MI

Types of heart attack

Heart attacks can be classified by a measurement known as the ST segment. The ST segment is

an electrical measurement recorded by an ECG. It corresponds to the level of damage inflicted

on the heart.

The higher the ST segment, the greater the damage is likely.

Acute coronary syndrome

A heart attack is a form of acute coronary syndrome (ACS); where there is a significant blockage

in the coronary arteries.

There are three main types of ACS:

ST segment elevation myocardial infarction (STEMI)

non-ST segment elevation myocardial infarction (NSTEMI)

unstableangina

The three types are described in more detail below.

ST segment elevation myocardial infarction (STEMI)

A STEMI is the most serious type of heart attack where there is a long interruption to the blood

supply. This is caused by a total blockage of the coronary artery, which can cause extensive

damage to a large area of the heart.

A STEMI is what most people think of when they hear the term heart attack.

Non-ST segment elevation myocardial infarction (NSTEMI)

An NSTEMI can be less serious than a STEMI. This is because the supply of blood to the heart

is only partially blocked, rather than completely blocked.

As a result, a smaller section of the heart is damaged. However, NSTEMI is still regarded as a

serious medical emergency.
http://www.nhs.uk/conditions/Angina/Pages/Introduction.aspxhttp://www.nhs.uk/conditions/Angina/Pages/Introduction.aspx


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Unstable angina

Unstable angina is the least serious type of ACS although, like NSTEMI, it is still regarded as a

medical emergency.

In unstable angina, the blood supply to the heart is still seriously restricted, but there is no

permanent damage so the heart muscle is preserved.

http://www.nhs.uk/Conditions/Heart-attack/Pages/Diagnosis.aspx

CLINICAL MENIFESTATION

The first symptom of acute myocardial infarction is usually, severe chest pain. The pain is

similar to angina pectoris but is more severe and persistent and is not relieved by nitrate. It may

be described by heavy crushing such as a truck sitting on my chest. Radiation to the neck, jaw,

back, shoulder or left arm is common. Some individuals, especially who are elder or diabetic,

experience no pain, thereby having a silent infarction. Infarctions often stimulate a sensation of

unrelenting indigestion. Nausea and vomiting may occur because of reflex stimulation of

vomiting centers by pain fibers. Vasovagal reflexes from the area of infarcted myocardium also

may affect the gastrointestinal tract. Catecholamine release results in sympathetic stimulation,

producing diaphoresis and peripheral vasoconstriction that causes the skin to become cool and

clammy. Fever may develop in the first 24 hours and persist for 1 week because of inflammatoryactivity within the myocardium.

A variety of cardiovascular changes may be found on physical examination. With an acute

myocardial infarction, blood pressure may initially decease. Abnormal extra heart sounds (s3, s4)

reflect ventricular dysfunction. Inflammation causes pericardial friction rub, along with a variety

of cardiac murmurs. (L.McCance & Huether, 1994)
http://www.nhs.uk/Conditions/Heart-attack/Pages/Diagnosis.aspxhttp://www.nhs.uk/Conditions/Heart-attack/Pages/Diagnosis.aspx


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RISK FACTORS OF MI

NON MODIFIABE RISK FACTORS

Personal elements that cannot be altered or controlled are

Age

Gender (men are at high risk when compared to women)

Family history

Ethnic background

MODIFIABLE RISK FACTORS

Elevated serum cholesterol level

Smoking

Hypertension

Impaired glucose tolerance (e.g. diabetes)

Obesity Physical inactivity

Stress

(Ignatavicius & Workman, 2002)


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DIAGNOSTIC TEST FOR MI

The diagnosis of MI is made on the basis of ECG, serial enzyme alterations, radio-nucleotide

imaging, and physical examination (L.McCance & Huether, 1994)

Electrocardiography

An electrocardiogram (ECG) is an important test in suspected heart attacks. An ECG should be

carried out within 10 minutes of being admitted to hospital.

An ECG measures the electrical activity of your heart. Every time your heart beats, it produces

tiny electrical signals. An ECG machine records these signals onto paper, allowing your doctor

to see how well your heart is functioning.

An ECG is painless and takes about five minutes to perform. During the test, electrodes (flat

metal discs) are attached to your arms, legs and chest. Wires from the electrodes are connected to

the ECG machine, which records the electrical impulses.

There are two reasons why an ECG is so important:

it helps confirm the diagnosis of a heart attack

it helps determine what type of heart attack you have had, which will help

determine the most effective treatment for you


Serial 12 lead ECG may reveal characteristic changes, such as serial ST-segment depression in

non-Q-wave MI (subendocardial MI that affects the inner most myocardial layers) and ST-

segment elevation In Q-wave MI (transmural MI with damage extending through all myocardial

layers). The q waves are considered abnormal when they appear greater than or equal to 0.04

second wide and their height is greater than 25% of the R wave height in that lead. An ECG can

also identify the location of MI, arrhythmias, hypertrophy, and pericarditis. (Pagana & Pagana,

1998)
http://www.nhs.uk/Conditions/Heart-attack/Pages/Diagnosis.aspxhttp://www.nhs.uk/Conditions/Heart-attack/Pages/Diagnosis.aspxhttp://www.nhs.uk/Conditions/Heart-attack/Pages/Diagnosis.aspx


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Blood tests

Damage to your heart from a heart attack causes certain proteins to slowly leak into your blood.

Enzymes are special proteins that help regulate chemical reactions that take place in your body.

If you have had a suspected heart attack, a sample of your blood will be taken so it can be tested

for these heart proteins (known as cardiac markers). Your protein levels will be measured

through a series of blood samples taken over the course of a few days.

This will allow damage to your heart to be assessed, and also help determine how well you are

responding to treatment.


CPK level can rise within 6 hours after damage. If damage is not persistent, the level peaks at 18

hours after injury and returns to normal in 2 to 3 days. Serial cardiac enzymes and proteins may

show a characteristic rise and fall of cardiac enzymes, specifically CK-MB, and the protein

troponin T and I, and myoglobin to confirm the diagnosis of MI. (Pagana & Pagana, 1998)

AST

This test is used in the evaluation of patients with suspected coronary occlusive heart disease or

suspected hepatocellular disease. The enzyme is found in a very high concentration within highly

metabolic tissues such as heart muscle.

When disease or injury affects the cells of these tissues, the cell, lyses. The AST is released,

picked up by the blood and the serum level rises. The amount of AST elevated is directly related

to the number of cells affected by the disease or injury. Furthermore the elevation depends on the

length of time that the blood is drawn after injury. Serum AST level becomes elevated 8 hours

after the cell injury, peaks at 2436 hours, and returns to normal in 3 to 7 days. If the cellular

injury is chronic then level will be persistently elevated. (Pagana & Pagana, 1998)
http://www.nhs.uk/Conditions/Heart-attack/Pages/Diagnosis.aspxhttp://www.nhs.uk/Conditions/Heart-attack/Pages/Diagnosis.aspxhttp://www.nhs.uk/Conditions/Heart-attack/Pages/Diagnosis.aspx


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Leukocyte level

Laboratory testing may reveal elevated white blood cell count and erythrocyte sedimentation rate

due to inflammation, increased glucose levels following the release of catecholamines, and

changes in electrocytes- all of which provide information about the patients potential for

developing arrhythmias and can identify the cause of an arrhythmia that accompanies chest

discomfort.

(Kowalak, 2003)

Chest X-ray

A chestX-ray can be useful if diagnosis of a heart attack is uncertain and there are other possible

causes of your symptoms, such as a pocket of air trapped between the layers of your lungs

(pneumothorax).

A chest X-ray can also be used to check whether complications have arisen from the heart attack,

such as a build-up of fluid inside your lungs (pulmonaryedema).

Echocardiogram

An echocardiogram is a type ofultrasound scan that uses sound waves to build up a picture of

the inside of your heart.

This can be useful to identify exactly which areas of the heart have been damaged and how this

damage has affected your hearts function.

Coronary angiography

Coronary angiography can help determine whether a blockage or narrowing has occurred in the

coronary arteries and, if so, to locate the exact location of the blockage or narrowing.

The test involves inserting a thin tube, known as a catheter, into one of the blood vessels in your

groin or arm. The catheter is guided into your coronary arteries using X-rays.
http://www.nhs.uk/conditions/X-ray/Pages/Introduction.aspxhttp://www.nhs.uk/conditions/oedema/Pages/Introduction.aspxhttp://www.nhs.uk/conditions/Ultrasound-scan/Pages/Introduction.aspxhttp://www.nhs.uk/conditions/CoronaryAngiography/Pages/Introduction.aspxhttp://www.nhs.uk/conditions/CoronaryAngiography/Pages/Introduction.aspxhttp://www.nhs.uk/conditions/Ultrasound-scan/Pages/Introduction.aspxhttp://www.nhs.uk/conditions/oedema/Pages/Introduction.aspxhttp://www.nhs.uk/conditions/X-ray/Pages/Introduction.aspx


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Hematology 25/02/2014 3:06PM

Test Result Reference range Remarks

Haemoglobin 11.2 12-18 g/dl Normal

PCV 31.3 35-48% Low

Total leucocyte 10.47 4-11 *10^3 /uL Normal

Di ff erential leucocyte count

Neutrophils 88.6 40-72% High

Lymphocytes 5.9 20-40% Low

Monocytes 5.3 2-10% Normal

Eosinophils 0.0 1-6% Low

Basophils 0.2 0-1% Normal

Platelet count 206 15-400 *10^3 /uL Normal

E.S.R 77 1-10 mm/1Hr High


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MEDICATIONS

CEFTRIAXONE

Generic name:ceftriaxone sodium

Availability:250mg, 500mg, 1g, 2g injection.

Indication: infections caused by susceptible organisms in lower respiratory tract, skin and skin

structures, urinary tract, bones and joints; also intra-abdominal infections, pelvic inflammatory

disease, uncomplicated gonorrhea, meningitis and surgical prophylaxis.

Indication related to the patient

To treat infection

Route and dosage

Moderate to severe infections

Adult: IV/IM 1-2g q12-24h x 4-14days. (max: 4g/day)

Child: IV/IM 50-75mg/kg/day in 2 divided doses x 4-14days (max: 2g/ day)

Bacterial Otitis media

Child: IM 50mg/kg(max:1g)

Meningitis

Adult: IV/IM 2g q12h

Child: IV/IM 100mg/kg/day in 2 divided doses (max:4g/day)

Surgical prophylaxis

Adult: IV/IM 1g 30-120 min before surgery

Uncomplicated gonorrhea

Adult: IM 250 mg as single doses


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Hyper-secretory disease

Adult: PO 40mg b.i.d. (doses up to 240mg/day have been used).

IV 80mg b.i.d. ; adjust based on acid output.

Route and Dose of patient

40 mg, IV BD

Renal impairment/Hepatic Impairment dosage adjustment

Adjustment not needed

Hemodialysis Dosage adjustment: drug not removed

Adverse effects

(1%)GI: diarrhea, flatulence, abdominal pain.

CNS: headache, insomnia

Skin: Rash.

SIDE EFFECTS RELATED TO THE PATIENT

Patient doesnt show any signs of side effects from this medication yet


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T.ECOSPRIN

Generic name:Aspirin

Availability:81mg chewable tablets;325mg,500mg tablets; 81mg, 165mg, 325mg, 500mg,

650mg, 975mg enteric coated tablets; 650mg, 800mg sustained released tablets; 120mg, 200mg,

300mg, 600mg suppositories.

Indication:to relieve pain of low to moderate intensity. Also for various inflammatory

conditions, such as acute rheumatic fever, systemic lupus, rheumatoid arthritis, osteoarthritis,

bursitis and calcific tendonitis and to reduce fever in selected febrile conditions. Used to reduce

recurrence of TIA due to fibrin platelet emboli and risk of stroke in men, and to prevent

recurrence of MI; as prophylaxis against MI in men with unstable angina.

Unlabeled uses: As prophylactic against thromboembolism; to prevent cataract and progression

of diabetic retinopathy; and to control symptoms related to gluten sensitivity.

Indications of patient

To prevent recurrence of MI; as prophylaxis against MI in men with unstable angina.

Route and dosage

Mild and moderate pain, fever

Adult: PO/PR 350-650 mg q4h (max: 4g/day)

Child: PO/PR 10-15mg/kg in 4-6hr (max: 3.6g/day)

Arthritic conditions

Adult: PO 3.6-5.4g/day in 4-6 divided doses.

Child: PO 80-100mg/kg/day in 4-6 divided doses (max:130mg/kg/day)

Thromboembolic disorders

Adult: PO 81-325mg daily


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TIA prophylaxis

Adult: PO 650mg b.i.d.

MI prophylaxis

Adult: PO 80-325 mg/day

Route and dose of patient

75mg, PO, OD

ADVERSE EFFECTS

(1%) Body as a whole:hypersensitivity (urticarial, bronchospasm, anaphylactic shock

(laryngeal edema).

CNS:Dizziness, confusion, drowsiness.

Special senses:tinnitus, hearing loss.

GI:nausea, vomiting, diarrhea, anorexia, heartburn, stomach pains, ulceration, occult bleeding,

GI bleeding.

Hematologic:thrombocytopenia, hemolytic anemia, prolonged bleeding time,.

Skin: petechiae, easy bruising, rash.

Urogenital: impaired renal function.

Other:prolonged pregnancy and labor with increased bleeding.


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T.ATORIN

Generic name:atorvastatin calcium

Availability:10mg, 20mg, 40mg tablets.

Indication:adjunct to diet for the reduction of LDL cholesterol and triglycerides in patients with

primary hypercholesterolemia and mixed dyslipidemia, prevention of cardiovascular disease in

patients with multiple risk factors.

Indication of patient:Prevention of cardiovascular disease in patients with multiple factors.

Route and dosage

Hypercholestolemia/ prevention of cardiovascular disease

Adult: PO start with 10-40mg daily, may increase up to 80mg/day.

Child/adolescent (10-17y): PO start with 10mg daily, ma increase up to 20 mg/day.

10mg, HS, PO

Adverse effects

(1%)body as a whole:back pain, asthenia, hypersensitivity reaction, myalgia, rhabdomyolysis.

CNS:headache.

GI:abdominal pain. Constipation, diarrhea, dyspepsia, flatulence, increased liver function tests.

Respiratory:sinusitis, pharyngitis

Skin:rash.


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T.AZITHROMYCIN

Generic name:Azithromycin

Availability:500mg, 600mg tablets, 100mg/5m, 200mg/5ml, 1g/packet oral suspension; 500mg

injection; 1% ophthalmic; Zmax:extended release: 176mg/5ml oral suspension.

Indication:pneumonia, lower respiratory infection, pharyngitis/tonsillitis, gonorrhea,

nongonococcal arthritis, skin and skin structure infections due to susceptible organisms, otitis

media, mycobacterium avium-intracellulare complex infections, acute bacterial sinusitis.

Zmax:acute bacterial sinusitis and community acquired pneumonia.

AzaSite:bacterial conjunctivitis

Unlabeled use:bronchitis, helicobacter pylori gastritis.

Indication in patient: Infection

Route and dosage:

500mg , PO OD

Bacterial infections

PO 500mg on da 1, then 250mg q24h for 4 more days

IV 500mg daily for at least 2days, administer 1mg/ml over 3h or 2mg/ml over 1h

Child (6m or older): PO 10mg/kg on day 1, then 5mg/kg for 4 more days (max: 250mg/day)

Acute bacterial sinusitis

Adult: PO 500mg once daily 3 days. Zmax: single one time dose of 2g.

Child (6m or older): PO 10mg/kg once daily x 3days


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Otitis media

Child(older than 6 mo): PO30mg/kg as a single dose or 10 mg/kg once daily (not to exceed

500mg/day) for 3 days or 10mg/kg as a single dose on day 1 followed by 5mg/kg/day on days

2-5

Gonorrhea

Adult: PO 2g as a single dose

Chancroid

Adult: PO 1g as a single dose

Child: PO 20mg/kg as single dose(max: 1 g)

Bacterial conjunctivitis

Adult: ophthalmic 1 drop b.i.d x 2 days than daily x 5 days

Renal impairment dosage

CrCl less than 10mL/min: use with caution

Adverse reaction

(1%)CNS:headache, dizziness.

GI:Nausea, vomiting, diarrhea, abdominal pain; hepatotoxicity, mild elevations in liver function

tests.


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INJ.LASIX

Generic name:furosemide

Availability:20mg, 40mg, 80mg tablets; 10mg/ml, 40mg/5ml oral solutions; 10mg/ml injection

Indication:treatment of edema related with CHF, cirrhosis of liver, and kidney disease,

including nephrotic syndrome. May be used for management of hypertension, alone or in

combination with other antihypertensive agents, and for treatment of hypercalcemia. Has been

used concomitantly with mannitol for treatment of severe cerebral edema, particularly in

meningitis.

Indication in patient : Treatment for hypertention and hypercalcemia

Route and dosage

20 mg Iv,OD

Edema

Adult: PO 20-80mg in 1 or more divided doses up to 600mg/day if needed IV/IM 20-40mg in 1

or more divided doses up to 600mg/day.

Child :PO 2mg/kg, may be increased by 1-2mg/kg q6-8h (max: 6mg/kg/dose)

Neonate: PO 1-4mgg/kg q12-24h IV/IM 1mg/kg q12-24h

Hypertension

Adult: PO 10-40 mg b.i.d. (max: 480mg/day)

ADVERSE EFFECTS

(1%)CV:postural hypertension, dizziness with excessive diuresis, acute hypotensive episodes,

circulatory collapse.


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Metabolic:hypovolemia, dehydration, hponatremia, hypokalemia, hypochloremia, metabolic

alkalosis, hypomagnesemia, hypocalcemia (tetany), hperglcemia, glycosuria, elevated BUN,

hyperuricemia.

GI:nausea, vomiting, oral and gastric burning, anorexia, diarrhea, constipation, abdominal

cramping, acute pancreatitis, jaundice.

Urogenital:allergic interstitial nephritis, irreversible renal failure, urinary frequency.

Hematologic:anemia, leukopenia, thrombocytopenic purpura; aplastic anemia, agranulocytosis

(rare).

Special senses:Tinnitus, vertigo, feeling of fullness in ears, hearing loss(rarely permanent),

blurred vision.

Skin:pruritus, urticarial, exfoliative dermatitis, purpura, photosensitivity, porphyria cutanea

tarda, necrotizing angitis (vasculitis)

Bod as a whole:increased perspiration, paresthesias; activation of SLE, muscle spasms,

weakness, thrombophlebitis, pain at IM injection site.


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Nursing care given to the patient

On admission, patients vital signs, ECG taken and also severity, location, type, and

duration of pain was assessed and recorded.

Rational for: -

Vital signs: - respiration may be increased as a result of pain and associated

anxiety. Release of stress-induced catecholamine increases heart rate and blood

pressure.

ECG: - serial ECG and stat ECG record changes that can give evidence of further

cardiac damage and location of myocardial ischemia.

Severity, location, type, and duration of pain: - assisting the client in quantifying

pain may differentiate pre-existing and current pain pattern as well as identify

complication.

Oxygen administered as prescribed by the doctor.

Rational: -Increase myocardial supply of oxygen

Medication administered as prescribed by doctor.

Rational: -Morphine is an opiate analgesic and alters the clients perception of pain and

reduces preload time vasoconstriction. Nitrates relax the smooth muscle of coronary

blood vessels, decreasing ischemia and hence decreasing the pain.

Patient was on cardiac monitor for continuous monitoring.

Rational: -Monitoring ST is important because elevation of ST segment indicates

myocardial tissue injury; ST segment depression indicates decreased myocardial

perfusion.

Patient was on catheter, urine output monitored every 8 hourly and total 24hrs.

Rational: - Urine output less than 0.5ml/kg/hr may reduced renal perfusion and

glomerular filtration as a result of reduced cardiac output.

Bed rest provided as much as possible.

Rational: -Stress activates sympathetic nervous system and increase myocardial oxygen

needed.

Bed bath and care of pressure point (back care) given daily


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Rational: -Increases circulation and prevent skin damage (bed sore). (Black & Hawks,

2005)

Things that need to be improve

Urine output should be monitored every 2 hourly instead of 8 hourly

Rational: - Urine output less than 0.5ml/kg/hr may reduce renal perfusion and

glomerular filtration as a result of reduced cardiac output.

Change position every 2 hours.

Rational: -Increase circulation and reduce the time that weight deprives at any one area

of blood flow.

Provide mouth care every 8 hourly (during every shift).

Rational: - Oxygen therapy may dry mouth and frequent mouth care would be

refreshing.

Since patient is on bed rest, pain medication he is at a risk for constipation so ensure that

he is getting a more bulk diet and also laxatives are administered.

Rational: -straining during defecation increase myocardial work load.

Provide comfortable, quite environment for the client and family.

Rational: - A comfortable environment enhances coping mechanism and reduces

myocardial workload and oxygen consumption. (Black & Hawks, 2005)


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Discharge plan

Discharge plan begins on the day of admission. During patients stay at hospital the

relatives are explained about the care given and how it can be done at home. Possible side effects

of medications are explained to the patients relatives. They could notify the nurse if such side

effects are seen in patient. If patient feels unrelieved pain, decreased activity tolerance, sudden

onset of SOB, weight gain, would seek immediate medical essential so patient should be shown

to a doctor.

Diet

Eat five servings of fruits and vegetables each day

Fruits and vegetables contain substances that help to prevent heart attacks and strokes. They

protect blood vessels and heart and brain tissue.

You should eat at least five servings of fresh fruit and vegetables every day (400-500 grams

daily)

One average size banana, apple, orange, or mango would be a serving of fruit. Two table spoons

of cooked vegetables or one big tomato would be a serving of vegetable.

Avoid salt and salty foods

Many preserved foods like pickles and salt fish, contain a lot of salt. In addition, fast food, like

French fries, often has a lot added salt. Prepared foods, such as frozen dinners, can also be very

salty.

Try not to add salt in your food. A good guideline is to use less than 1 teaspoon (5 grams) of salt

each day.

Eat more fiber

Fiber protects against heart attack and strokes. Sources of fibre include beans, lentils, peas, oats,

fruits and vegetables.

Eat at least two servings of oily fish a week


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Fish oils contain good fats called omega 3 fatty acids, such as EPA (eicosapentanoic acid) and

HAD (docosahexaenoic acid). They protect people from heart attacks and strokes by preventing

blood clots. One serving of fish is about the size of a peak of playing cards. Fish oil supplements

are also good.

Limit fatty foods

All fats are high in energy and will make you gain weight unless you burn them off by staying

active. Some fats are more likely to increase your risk of heart attack and stroke;

Saturated fats and trans-fats lead to bad cholesterol in your blood, and increase you risk

of heart of heart diseases. Try to restrict use of these fats.

Unsaturated fats are risky, but they still make you gain weight. You should eat them in

moderation

Cooking tips for reducing fat

Use only a very little cooking oil.

Instead of frying foods, bake, boil, grill, steam, roast, poach, or microwave them.

Trim the fat and skin off meal before cooking.

Eat chicken instead of red meat like beef, pork, and mutton. (Avoiding Heart Attackd and

strokes: Dont be a victim - protect yourself, 2005)


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Health education

To extend and improve the quality of life, a patient who has had an MI must learn to adjust

his/her life style to promote heart-healthy living. With this in mind the nurse and patient develop

a programmed to help the patient achieve desired out comes.

Changing life style during convalescence and healing

Adaptations to an MI are a process and usually require some modifications of the lifestyle. Some

specific modifications include:

Avoiding any activity that produces chest pain, extreme dyspnea, or undue fatigue.

Avoiding extremes of heat and cold

Lose weight, if indicated.

Stopping smoking and use of tobacco, avoiding second-hand smoke.

Using personal strengths to support lifestyle changes.

Developing heart-healthy eating patterns and avoiding large meals and hurrying while

eating

Modifying meals to align with the therapeutic life style changes (TLC) or dietary

approaches to stopping hypertension (DASH) diet.

Adhering to medical regimen, especially in taking medications.

Following recommendations that ensure blood pressure and blood glucose are in control.

Pursuing activities that relieve and reduces stress.

Adopting activity program

Additionally, the patient needs to undertake an orderly program of increasing activity and the

exercise for long term rehabilitations as follows:

Engaging in regimen of physical conditioning with a gradual increase in activity

intensity.

Walking daily, increasing distance and time as prescribes

Monitoring pulse rate during physical activity until the maximum level of activity

is attained.


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Avoiding activities that ensure the muscle; isometric exercise, weight-lifting, any

activity that requires sudden burst of energy.

Avoiding physical exercise immediately

Alternately activity with respiration periods( some fatigue is normal and expected

during convalescence)

Participating in daily program of exercise that develops into program of regular

exercise for a lifetime. (Black & Hawks, 2005)


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REFLECTION

During this case study we were able to gain a lot of knowledge about MI and what nursing care

should be given to a MI patient. We also learned about the diagnostic tests which could be done

to diagnose MI. Moreover we gained some knowledge of why the tests are done and how they

interpret the result. We also included health education and what kind of a diet MI patient should

take, which provided us with more knowledge about health education.

It could have been more effective if we got the opportunity to stay and care for the patient during

the patients stay at hospital. Thus we could gain more knowledge about patient condition and

observe him in order to get more information about his condition.


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Reference list

Avoiding Heart Attackd and strokes: Dont be a victim - protect yourself.(2005). Geneva,

Switzland: WHO.

Black, J. M., & Hawks, J. H. (2005). Medical Surgical Nursing: Clinical Management for

Positive Outcomes.Philadelphia, USA: Elsveier Inc.

H.beers, M. (2004). The Merck Manual of medical information(2nd ed.). New York, USA:

Merck & Co., Inc.

Henry, J. A. (2008).New guide to medicine and drug.London: Dorling Kindersley limited.

hockenberry, & wilson. (2007). wong's nursing care for infants and children.canada: mosby

elsevier.

Ignatavicius, D. D., & Workman, M. L. (2002).Medical Surgical Nursing Critical Thinking for

Collaborative Care(4th ed.). philadelphia, USA: W.B Saunders Company.

Kowalak, J. P. (2003). Critical care challenges.USA: Lippincott Williams and Wilkins.

L.McCance, K., & Huether, S. E. (1994).Pathophysiology The Biologic Basic for Disease in

Adult and Children(3rd ed.). St. louis, USA: Mosby Year book Inc.

Medicine net. (n.d.). Retrieved April 1, 2014, from medicine net website:

www.medicinenet.com/scrpit/main/mobileart.asp?articalkey=379

NHS choices. (n.d.). Retrieved 04 1, 2014, from NHS choices website:


Pagana, K. D., & Pagana, T. J. (1998).Mosby's Manual of Diagnostiv and Laboratory Tests.St.

Louis, USA: Mosby Inc.

Smeltzer, s. C., Bare, B. G., L.Hinkle, J., & Cheever, K. H. (2008).Brunner and Suddarths text

book of Medical Surgical Nursing.Philadelphia, USA: Lippincott Williams and Wilkins.

Smeltzer, S., & Bare, B. (2001).Brunner and Suddarth's textbook of medical surgical nursing(9

ed.). philadelphia, Washington, USA: Lippincott Williams and wilkins.

WHO . (n.d.). Retrieved 03 28, 2014, from WHO website:

http://www.who.int/cardiovascular_diseases/priorities/secondary_prevention/country/en/i

ndex1.html

wilson. (2013).pearsons nurses drug guide.USA: pearson education.


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