2. INTRODUCTION
Myocardial infarction (MI), also known as
"heart attack," is caused by decreased or
complete cessation of blood flow to a portion of
the myocardium. Myocardial infarction may be"
silent," and go undetected, or it could be a
catastrophic event leading to hemodynamic
deterioration and sudden death.
3. HISTORY COLLECTION
CHIEF COMPLAINTS
• Chest pain and left arm pain [for 6 hrs]
• Shortness of breathing [for 6 hrs]
• Vomiting [one episode]
• Fever [100.6 F]
HISTORY OF PRESENT ILLNESS
MR X. was admitted in the XXX Hospital with complaints of
central chest pain[ retrosternal ] radiating down to the left arm. He
had an episode of vomiting ,shortness of breathe, palpitations and
fever 100.6 F.
4. INVESTIGATION
• ECG [ 12 leads ]
ST segment elevation [ On V2,V3,V4 ]
Q wave development
5. INVESTIGATIONS
• TRO T raised
• CK- MB raised
• OTHER INVESTIGATIONS
#Complete blood count [ NORMAL ]
#ESR and CRP raised
6. HISTORY COLLECTION
HISTORY OF PAST ILLNESS
PAST MEDICAL HISTORY
Hypertension for past 6 years
PAST SURGICAL HISTORY
No significant of past surgical history
PAST MEDICATION HISTORY
He intake Amlodipine 5mg for Hypertension[past 6 years].
7. .
PERSONAL HISTORY
• Smoker, smoke 12 sticks per day from 10 years
• Regular bowel and bladder pattern
• No allergy to any food and drug.
PHYSICAL EXAMINATION
As physic. was examined
1. LEVEL OF CONSCIOUSNESS: Conscious
2. VITAL SIGNS
TEMPERATURE : 100.6 F
PULSE : 86 bpm
RESPIRATION : 15 Breath per min
BP : 100/75mm of Hg
4. ACTIVITY : DULL
3. CARDIO VASCULAR ASSESSMENT : Hearing of murmurs sounds
8. DISEASE CONDITION
ANTEROSEPTAL MYOCARDIAL INFARCTION
Antero septal myocardial infraction denotes, where the part of
the heart muscle dies and scars due to poor blood supply[caused by
atherosclerosis]. In this case tissue damage is around the anteroseptal
wall, the area between the left and right ventricles.[It is a historical
nomenclature based on electrocardiographic (EKG) findings]
9. COMPARTIVE STUDY
BOOK PICTURE PATIENT’S PICTURE
CAUSES
1. Smoking
2. Alcohol consumption
3. Diabetes mellitus
4. Coronary artery disease
5. High blood pressure
6. High level of blood cholesterol
CAUSES
1.SMOKING
2.HYPERTENSION
CLINICAL FEATURES
1.Chest and shoulder pain
2.Shortness of breathe
3.Diaphoresis
4.Decreased urinary output
5. Vomiting
6. weakness and palpitations
7.lack of consciousness
8.sleep disturbance and fever
CLINICAL FEATURES
1.Chest and shoulder pain
2.Shortness of breathe
3.Palpitation
4.Vomiting
10. Book picture Patient’s picture
DIAGNOSIS
1.History collection
2.Physical examination
3.Electrocardiogram
4.Lab analysis i.e. blood test , Troponin T , HDL,
LDL , CK- MB , ESR, CPR .
DIAGNOSIS
1.History collection
2.Physical examination
3. Electrocardiogram
4. Lab analysis i.e. blood test , Troponin T , HDL,
LDL , CK- MB , ESR, CPR .[raised]
MEDICAL MANAGEMENT
1.IV nitro-glycerine
2.Morphine sulfate
3. beta – adrenergic blockers
4.Thrombolytic therapy
5.Antidysrhythmic drugs
6.Anti platelet therapy
7. Anticoagulant therapy
MEDICAL MANAGEMENT
1.IV analgesic : 5 mg morphine
2.Anti platelet therapy : aspirin 75 mg
3. Anticoagulant therapy : heparin
4.beta – adrenergic blockers : propranolol
SURGICAL MANAGEMENT
1.PTCA[ Percutaneous Transluminal coronary Angioplasty]
2.Stent placement
3.CABG[ CORONARY ARTERY BYPASS GRAFT]
4.TMR[ Transmyocardial Laser Revascularization]
SURGICAL MANAGEMENT
Patient doesn’t go under any surgery
13. .
SURGICAL MANAGEMENT
• PTCA[ Percutaneous Transluminal coronary Angioplasty]
• Stent placement
• CABG[ CORONARY ARTERY BYPASS GRAFT]
• TMR[ Transmyocardial Laser Revascularization]
NURSING PROCESS
• Acute pain related to tissue ischemia as evidenced by patient reporting of chest
pain.
• Decreased cardiac output related to changes in myocardial contractility.
• Impaired gas exchange related to interruption of blood flow to alveoli.
• Hyperthermia related to inflammatory process caused by myocardial cell death.
• Anxiety related to hospitalization and fear of death.
14. ASSESSMENT DIAGNOSIS GOAL PLANNING RATIONALE IMPLEMENTETION EVALUATION
SUBJEVTIVE
DATA :
OBJECTIVE
DATA:
Pain score
increased 8/10.
Fatigue
Weak pulse
Restlessness
Acute pain
related to tissue
ischemia as
evidenced by
patient
reporting of
chest pain.
Client is
relieved
from
pain
Monitor the vital
sign, ECG, oxygen
saturation and
pain score
regularly.
Provide high
fowlers position
with cardiac
table.
Provide complete
bed rest.
Administer
nitrates like drug.
Provide
diversional
To identify the
baseline data.
To push the
diaphragm down
and create a
enough space for
breathing .
Rest indicate
sleep and provide
comfort.
For coronary
vasodilation.
To provide
comfort.
Monitored
baseline data.
Provided fowlers
position with
cardiac table.
Provided complete
bed rest.
Administered drug
Morphine 5 mg
Provided comfort.
Chest pain was
relieved as
evidenced by
decrease in pain
score 4/10.
15. ASSESSMENT DIAGNOSIS GOAL PLANNING RATIONALE IMPLEMENTETION EVALUATION
SUBJEVTIVE
DATA :
Patient said
that he have a
shortness of
breathing and
palpitation.
OBJECTIVE
DATA:
respiratory
rate 15bpm
palpitation
reveals tactile
spo2 :92%
Impaired gas
exchange
related to
interruption of
blood flow to
alveoli.
To
improve
the
breathe
pattern
and aid
in
respirati
on.
Monitor the vital
sign, ECG, oxygen
saturation and
pain score
regularly.
Provide well
ventilated
environment.
Provide complete
bed rest.
Administer
oxygen therapy
with face mask
Administer
inotropic drugs
To identify the
baseline data.
To prevent
suffocations
Rest indicate
sleep and provide
comfort.
To aid in
breathing
To improve
ventricular
contractility.
Monitored
baseline data.
Provided well
ventilated
environment
Provided complete
bed rest.
Administered O2
therapy.
-
Client’s
breathing
pattern was
improved
evidenced by
normal
breathing
sounds and
respiratory rate
and spo2 98%.
16. HEALTH EDUCATION
• Maintaining a healthy weight
• Avoid smoking
• Avoid alcohol
• Eating healthy food
• Regular aerobic exercise
• Reducing stress
• Making sure to get enough sleep
• Follow the prescribed drugs
19. .
SUMMARY
MR X. was admitted in the XXX Hospital with complaints of central chest
pain[ retrosternal ] radiating down to the left arm. He had an episode of
vomiting ,shortness of breathe and palpitations.
He was admitted on CCU for proper and he undergone for
treatment. Hence the general condition was much improved through out the
treatment procedure being hospitalized.
BIBLIOGRAPHY
• Brunner and Siddharth “ A Textbook of medical surgical nursing ’’, Third
Edition; page no. 103-1034.
• Lewis’s “ Medical Surgical Nursing ’’, Second Edition ; page no.781-800.
• NET SOURCE: https://www.healthline.com/health/acute-myocardial-
infraction.
