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INTRODUCTION

A. Discussion of the Health Condition

This is the case of a 61-year-old male patient that was diagnosed with Acute

Myocardial Infarction.

According to Brunner and Suddarth’s Textbook of Medical-Surgical

Nursing 11th Edition, Volume 1 (2010), Acute myocardial infarction (MI) is

defined as death or necrosis of myocardial cells. It is a diagnosis at the end of

the spectrum of myocardial ischemia or acute coronary syndromes. Myocardial

infarction occurs when myocardial ischemia exceeds a critical threshold and

overwhelms myocardial cellular repair mechanisms that are designed to

maintain normal operating function and hemostasis. Ischemia at this critical

threshold level for an extended time period results in irreversible myocardial

cell damage or death.

Signs and symptoms

 Chest pain that occurs suddenly and continues despite rest and

medication is the primary presenting symptom. ECG may be abnormal

or normal.

 the signs and symptoms cannot be distinguished from those of unstable

angina.

 Pain may radiate to the jaw, neck, shoulders, and arm (usually left)

 Pain may be accompanied by cool skin, pallor, clammy diaphoresis,

tachycardia, and tachypnea if stimulation of the sympathetic nervous

system occurs.
Diagnosis

 Patient history description of presenting symptom; history of previous

illnesses and family health history, particularly of heart disease).

Previous history should also include information about patient’s risk

factors for heart disease.

 ECG within 10 minutes of pain onset or arrival at the emergency

department; echocardiography to evaluate ventricular function.

 Serial serum enzymes and isoenzymes (creatinine kinase and

isoenzymes), myoglobin, and troponin; other laboratory test known as

cardiac biomarkers

 Troponin levels: Troponin is a contractile protein that normally is not

found in serum; it is released only when myocardial necrosis occurs

 Complete blood cell count

 Comprehensive metabolic panel

 Lipid profile

Medical Management

 Oxygen administration is initiated at the onset of chest pain.

 Reperfusion via emergency use of thrombolytic medications or percutaneous

coronary intervention (PCI)

 Coronary artery bypass or minimally invasive direct coronary artery bypass

(MIDCAB)
B. STATISTICAL DATA

Local

Myocardial Infarction ranks high as a cause of mortality in many developed

countries. With the trend towards globalization, socioeconomic, cultural and

demographic transitions are taking place in many less developed countries, In the

Philippines, myocardial infarction and unstable angina accounted for 16.5% and

13.2% of total deaths, respectively, in 2000, increasing to 17.6% and 12.8% of total

deaths, respectively, in 2004.

Myocardial Infarction Philippine Statistic Authority (2010) Retrieved from:


https://psa.gov.ph/content/death-philippines-2010

International

Myocardial infarction is the leading cause of death in the United States (US) as

well as in the most industrialized nations throughout the world. Approximately

800,000 people in the US are affected and in spite of a better awareness of

presenting symptoms, 250,000 died prior to presentation to a hospital. The survival

rate for US patients hospitalized with MI is approximately 90% to 95%. This

represents a significant improvement in survival and is related to improvements in

emergency medical response and treatment strategies.

In general, MI can occur at any age, but its incidence rises with age, the actual

incidence is dependent upon predisposing risk factors for atherosclerosis, which are

discussed below. Approximately 50% of all MI’s in the US occur in people younger

than 65 years of age. However, in the future, as demographics shift and the mean

age of the population increases, a larger percentage of patients presenting with MI

will be older than 65 years.

Ali Ahmadi et., (2015) Journal of Research in Medical Sciences: The official journal of United States
University of Medical Sciences Retrieved from: www. ncbi.nlm.nih.gov/ articles/ PMC45901907/
C. SCOPE AND LIMITATION

On March 21 & 28 2018, student nurses were assigned at Laguna Medical Center,

Santa Cruz, Laguna Medicine ward from 6 am to 2 pm shift under the supervision of

clinical instructor, Ms. Ma. Janice M. Bernardo. Patient X was received lying in bed,

with IVF of D5W 1 liter at full level regulated at KVO 10 gtts/min. The student nurses

include head to toe physical assessment, monitoring and recording of vital signs, IV

regulation, computation of intake and output, recording of present observation,

formulating nursing care plan, implementation of therapeutic management, and health

teachings as part of their duty.

Patient X was very cooperative and open to communicate. He is not shy to share his

experiences regarding his condition. The student nurses develop rapport with the

patient. With this, they were able to easily gather information.

D. BACKGROUND OF THE STUDY

This case study aims to identify patient’s problems and health needs in order to

promote the general health of the patient by providing proper interventions through the

application of nursing process.

The student nurses chosen the case because they would like to be aware about Acute

Myocardial Infraction and to broaden their knowledge about the management and

treatment of this disease. And for the student nurses to practice their skills in

formulating and implementing nursing care plan, in conducting a thorough assessment

to help in managing the patient’s case and to develop their sense of teamwork as they

execute their case study with the help of the concepts in Medical – Surgical Nursing

Course, Human Anatomy and Physiology and other science related studies.
General Objectives:

At the end of the case study the Group 1 (RLE) from BSN III-A will be able to

gain knowledge and comprehend their case even more, and also to further understand

and gain extensive knowledge from the case.

Specific Objectives:

 To identify the chief complaints and admitting diagnosis of our patient so that

we can give specific nursing interventions.

 To determine the family and personal health history of our patient that may

affect present health condition

 To identify the cause and effect of the main problem through a correct analysis

of the pathophysiology of the case.

 To determine the medical management given through identifying the

significant implication of the laboratory and diagnostic examinations ordered

as well as the medical orders and its rationale.

 To make a nursing care plan for the different health problems encountered by

the client.

 To establish an ideal plan of care for a specific diagnosis or problem of the

client.

 To evaluate the effectiveness of the actual nursing care plan that was

established.

 To impart health teachings to the client giving emphasis on his medications,

exercises, treatment, out- patient follow- up and diet

 To give referrals and follow-up for the health promotion of the client.

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