V Myocardial infarction (MI) or acute myocardial
infarction (AMI), commonly known as a heart attack is
the interruption of blood supply to part of the heart,
causing some heart cells to die. This is most
commonly due to occlusion (blockage) of a coronary
artery following the rupture of a vulerable
atherosclerotic plague, which is an unstable collection
of lipids(fatty acids) and white blood
cells(especiallymacrophages) in the wall of an artery.
The resulting ischemia(restriction in blood supply)
andoxygen shortage, if left untreated for a sufficient
period of time, can cause damage or death (infarction)
of heart muscle tissue (myocardium).
V The researchers decided to choose this case because
they wanted to acquire more knowledge about
Myocardial infarction. They wanted to use the
knowledge that they have acquired in promoting
awareness to the people especially to the poor that
they should seek for medical care in order to prevent
the development and progression of complications
related to HPN. The researchers also wanted to focus
on preventive measures. Complications may occur
and the researchers would not want that to happen, so
they will focus more on information campaign as part
of primary prevention of health.
V This study will help the nursing profession by
providing information about the proper
management and care for hypertensive patient. It
will also educate the people, especially those with
hypertension and vulnerable individuals to seek
medical care in order to prevent such illnesses. It
will increase awareness about the importance of
having a healthy lifestyle and recommended food
preferences.
V This study will discuss the background of
myocardial infarction and its signs and symptoms
and the proper nursing care management of the
medical condition will also be tackled.
V However, this study will help a lot in the duties
in the area of nurses.
V NAME: A.M.A.
V ADDRESS: Near Globe Tower, Turbina, Calamba City,
Laguna, Philippines
V SEX: FEMALE
V CIVIL STATUS: Widowed
V BIRTHDATE: November 12, 1937
V BIRTH PLACE: Calamba City, Laguna
V AGE: 72y0m11d
V NATIONALITY: Filipino
V OCCUPATION: Retired
V ADMISSION DATE: November 23, 2009
V ADMISSION TIME: 04:34 pm
V The patient was admitted at Calamba Medical
Center last November 23, 2009 due to the
complaint of vomiting.
V Few hours prior to admission the patient was
experiencing epigastric pain with associated
vomiting
V
V When the patient experiences CVA, the patient
takes herbal medicine.
V The family has a history of high blood pressure
and diabetes.
§§§
§ §
§
1. Size, shape Inspection Rounded Normocephalic Normal findings states
(normocephalic Symmetrical no signs of abilities
and Palpation and symmetrical, shape
symmetry of with frontal,
the skull. parietal, and
occipital
prominences);
Smooth skull
contour
2. Presence Palpation Smooth, uniform Plain and smooth Normal findings states
consistence; when palpated no signs of
of nodules, Inspection absence of nodules abnormalities
masses and or masses
depressions.
3. Facial Inspection Symmetric or All movements are The face has no
slightly well procured movement disabilities
features. Palpation asymmetric facial
features;
palpebral fissure
equal in size;
symmetric
nasolabial
4. Presence Inspection No edema and Eyes are not Normal findings states
hollowness exopthalmic and
of edema no signs of edema no signs of disabilities
and
hollowness in
the eye.
§
ely istrite Hir is t i
Hir lss e t i
1. eess f Is ecti cers t e
rt , t erere sis f
lti le scl; ir l ss
t ic ess
r M y e t ic r
t iess f t i
ir.
2. ext re Is ecti Sil y; resiliet ir Oily ir Oily ir e t
iliess i ility t clese
lti
ir r erly
er t e
scl . ifecti sis f lesis r l fiis sttes
3.
resece Is ecti
sis f
f ifecti ifestti scl
l ti r lities
ifesttis.
§
Syetric r e ets r l fiis sttes
1. Fcil Is ecti All
re ls ell
sis f
sli tly
fet res, sy etric f ci l rc re r lities
sy etry f fet res;
fcil le r l fiss res
eq l i size;
e ets. sy etric
s l il fl s
§
1. air Inspection Symmetrical and in Clean and evenly Normal findings states
line with each
distribution, other; maybe distributed no signs of
alignment, black, brown or abnormalities
skin quality blond depending
on race; evenly
and distributed
movement.
1. Evenness of Inspection Evenly distributed; Equally distributed Normal findings states
turned outward
distribution Palpation and turned no signs of
and direction outward eyelashes abnormalities
of curl.
!"
1. Surface Inspection Upper eyelids cover No signs of Normal findings states
the small portion of
characteristics the iris, cornea, and discharge and no signs of
and position. sclera when eyes discoloration, able abnormalities
(in relation to are open; eyelids to close eyes,
meet completely
cornea, when the eyes are blinking normally
ability to closed; symmetrical
blink and
frequency of
blinking)
#$%#&'!(
1. Color, Inspection Pinkish or red in Smooth in texture Normal findings states
color; with
texture and Palapation presence of small no signs of
the presence capillaries; moist; abnormalities
of lesions in no foreign bodies;
no ulcers
the bulbar
conjunctiva.
2. Color, Inspection Pinkish or red in Pinkish in color and Normal findings states
color; with
texture and Palpation presence of small no lesions no signs of
the presence capillaries; moist; abnormalities
of lesions in no foreign bodies;
no ulcers
the
palpebral
conjunctiva.
&
1. Color and Inspection White in color; Sclera is yellowish in Abnormal. Yellowish
clear; no yellowish
Clarity discoloration; color sclera due to lack of
some capillaries nutrition
maybe visible
#
1. Clarity and Inspection No irregularities Clear and smooth Normal findings states
on the surface;
texture looks smooth; in texture no signs of
clear or abnormalities
transparent
!
1. Shape and Inspection Anterior chamber Transparent Normal findings states
is transparent; no
color noted visible anterior chamber no signs of
materials; color abnormalities
depends on the
person·s race
%)!
Inspection Color depends on upil size is 3mm Normal findings states
1. Color, the person·s race;
size ranges from no signs of
shape and 3-7 mm, and are
e
abnormalities
symmetry of ual in size;
size. e ually round
*&!+#"
1. Palpability Palpation No edema or No tenderness Normal findings states
tenderness over
and lacrimal gland no signs of
tenderness of abnormalities
lacrimal
gland.
,'&%
%&
2. Texture, Palpation , firm, and not Smooth in texture, Normal findings states
tender; pinna
elasticity and recoils after it is no tenderness no signs of
areas of folded abnormalities
tenderness
!#-§&%!''
#-%./'
%'
1. Color and Inspection Pink color; moist; Pink and moist Normal findings states
slightly rough;
texture of thin whitish Tongue moves no signs of
the mouth coating; moves freely and no pain abnormalities
floor and freely; no felt
tenderness
frenulum.
2. Position, Inspection Central position; Located and Normal findings states
pink color;
color and smooth tongue positioned in the no signs of
texture, base with center abnormalities
movement prominent veins
and the base
of the
tongue.
3. Any Palpation Smooth with no No tenderness Normal findings states
Inspection palpable nodules,
nodules, lumps, or no signs of
lumps or excoriated areas abnormalities
excoriated
area.
'#"(%
1. Color, Inspection Light pink, No presence of Normal findings states
Palpation smooth, soft
shape, palate; lighter exostoses (bony no signs of
texture and pink hard palate growth) abnormalities
presence of , more irregular
texture
bony
promnences.
2. Position of Inspection Positioned in No damage on 5th Normal findings states
midline of soft
the uvula palate and 10th cranial no signs of
and mobility nerve abnormalities
(while
examining
the palates)
) #,#"#!
1. Color and Inspection Pink and smooth No swollen or Normal findings states
posterior wall
Texture. inflamed no signs of
abnormalities
2. Size, color Inspection Pink and smooth; No presence of Normal findings states
no discharge; of
and normal size discharge; pinkish no signs of
discharge of abnormalities
the tonsils.
3. Gag Reflex Inspection Present The patient has no Abnormal. Due to
gag reflex stroke she experienced
before
0 §0
§§#'! ,
1. Breathing Inspection Quiet, rhythmic, effortless Normal findings states
and effortless
Patterns. respirations no signs of
abnormalities
0§0§
1. Axillary, Inspection No tenderness, No masses and Normal findings states
masses, or nodules
subclavicular nodules no signs of
and abnormalities
supraclavicul
ar lymph
nodes.
0§
1. Skin Inspection Unblemished skin; Not uniform in Abnormal. Due to aging
uniform color
Integrity. color and no lesions
§
%&
1. !uscle size Inspection Proportionate to The muscle is Normal findings states
the body; even in
and both sides proportionate to no signs of
comparison the body; even in abnormalities
on the other both sides
side.
2. Inspection No fasciculation No presence of Normal findings states
and tremors
Fasciculation tremors on the no signs of
and tremors patient abnormalities
in the
muscles.
3. !uscle Palpation Even and firm The muscles of the Normal findings states
muscle tone
Tonicity patient is normally no signs of
firm abnormalities
#'''%
Level of Alert
# Alert
# Normal
Consciousness riented riented to person Normal
#
rientation Coherent Coherent Normal
Language Test Able to remember Able to state what are the things Normal
Recall that happened to her past
#!(
CN$I Able to smell and recognize stimuli Able to identify scent of the Normal
( lfactory) 20/20 alcohol Abnormal
$ $
CN II ( ptic) (+)E &; lateral upward and Cannot read in near vision Normal
CN downward; pupils react to light Normal
$ III, IV, VI Pupils react to light. There is
( cculomotor, Able to feel and clearly identify constriction and eyes are able to Normal
Trochlear, stimulus, with bilateral facial move in unison Abnormal
Abducens) sensation Able to feel my finger on her face Normal
CN V (+)corneal reflex facial symmetry while covering her eyes Normal
(Trigeminal) Able to hear clearly, can maintain Facial symmetry Normal
CN VII (Facial) balance Cannot hear normal volume tone
CN VIII (+)gag reflex, uvula at the center Able to swallow and able to
(Vestibulocochl Able to shrug shoulders against identify the taste of the food
ear) resistance and able to turn head Can shrug shoulders against
CN IX, X aside against resistance resistance and can turn head side
(Glossopharyn Able to move tongue from side to to side
geal, Vaus) side Able to protrude tongue and
CN XI move side to side
(Accessory)
CN XII
( %ypoglossal)
V The researchers utilized Gordon¶s Typology in
assessing the patterns of functioning of our patient
in her life. How does she manage, and takes care
of herself based on the eleven patterns.
=
=
menstrual history:
age of menarche: approximately
14 years old
Nullipara
shares confidence and problems with her husband before.
Whenever she has problems, she automatically relies to God for help.
h
She is Roman Catholic
she can¶t attend mass every Sunday
due to old age
have belief in life.
= = =
p
p
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KK.12.34 +'- (120-150)g/L 130
=emoglobin (0.37-0.47) 0.38
=ematocrit (5-10 x 10^9/L) 14.0
WBC (4-4.5x10^12/L) 4.3
RBC
!//#'! %#' 0.55-0.65 0.88
Segmenters 0.25-0.35 0.12
Lymphocytes 150-400x100^9/L 221
Platelet Count
"#"!& 80-96 88.4
'CV 27-31 30
'C= 32-36% 34
C=C
!" # ' (.47-4.64 uIV/ml)EIA .204
TS= (1.45-3.48 pg/ml)EIA .91
FT3 (0.71-1.85 ng/dl)EIA .84
FT$
KK.15.34 !' 163 (0-16 U/L) 1
CK B
!' 163 (0.52-1.25 mg/dl) 0.9
Creatinine (137-145 mmol/L) 138
Sodium (3.6-5 mmol/L) 2.9
Potassium (0-16 u/L) 5
CK B
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IV. Pathophysiology
& Schematic Diagram
In an MI, an area of the myocardium is permanently destroyed; a condition in which the blood supply to
the heart muscle is partially or completely blocked. The heart muscle needs a constant supply of oxygen-
rich blood. The coronary arteries, which branch off the aorta just after it leaves the heart, deliver this
blood. MI is usually caused by the reduced blood flow in a coronary artery of an atherosclerotic plaque
and subsequent occlusion of the artery by a thrombus. Coronary artery disease can block blood flow,
causing chest pain. In unstable angina and acute MI are considered to be the same process but different
appoints along a continuum. specifically coronary atherosclerosis (literally ùhardening of the arteries,
which involves fatty deposits in the artery walls and may progress to narrowing and even blockage of
blood flow in the artery., As an atheroma grows, it may bulge into the artery, narrowing the interior
(lumen) of the artery and partially blocking blood flow. With time, calcium accumulates in the atheroma.
As an atheroma blocks more and more of a coronary artery, An atheroma, even one that is not blocking
very much blood flow, may rupture suddenly. The rupture of an atheroma often triggers the formation of
a blood clot (thrombus), the supply of oxygen-rich blood to the heart muscle (myocardium) can become
inadequate. The blood supply is more likely to be inadequate during exertion, when the heart muscle
requires more blood. An inadequate blood supply to the heart muscle (from any cause) is called
myocardial ischemia. If the heart does not receive enough blood, it can no longer contract and pump
blood normally. Other causes of MI include vasospasm, (sudden constriction or narrowing) of a
coronary artery, decreased oxygen supply (e.g. from acute blood loss, anemia, or low blood pressure),
and increased demand for oxygen (e.g. rapid heart rate, thyrotoxicosis, or ingestion of cocaine). In each
case, a profound imbalance exists between myocardial oxygen supply and demand. The area of
infarction develops over minutes to hours. As the cells are deprived of oxygen, ischemia develop, cellular
injury occurs,, and the lack of oxygen results in infarction, or the death of cells. The area of the heart
muscle supplied by the blocked artery dies.
V In Myocardial Infarction,
inadequate coronary
blood flow rapidly results
in myocardial ischemia in
the affected area. The
location and extent of the
infarct determine the
effects on cardiac
function. Ischemia
depresses cardiac
function and triggers
autonomic nervous
system responses that
exacerbate the
imbalance between
myocardial oxygen
supply and demand.
Persistent ischemia
results in tissue necrosis
and scar tissue
formation, with
permanent loss of
myocardial contractility in
the affected area.
Cardiogenic shock may
develop because of
inadequate CO from
decreased myocardial
contractility and pumping
capacity.
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etabolic:
hypercholesterolemia.
S: arthralgia, back
pain.
isc: fever,
hypersensitivity
reactions.
Binds to an Ther. class. Contraindicated CNS: dizziness, Assess patient
enzyme on antiulcer GERD/maintena in: drowsiness, routinely for
gastric parietal agents nce of healing in fatigue, headache, epigastric or
cells in the erosive =ypersensitivity weakness. abdominal pain
presence of Pharm. class. esophagitis etabolic and frank or
acidic gastric proton pump Duodenal alkalosis and CV: chest pain. occult blood in
p=, preventing inhibitors ulcers (with or hypocalcemia the stool, emesis,
the final without anti- (Zegerid only) GI: abdominal or gastric
transport of infectives for Use Cautiously pain, acid aspirate
hydrogen ions =elicobacter in: regurgitation, Lab Test
into the gastric pylori ) Liver disease constipation, Considerations
lumen Short term (dose reduction diarrhea, onitor CBC
treatment of may be flatulence, nausea, with differential
active benign necessary) vomiting. periodically
gastric ulcer Geri: Increased during therapy
Pathologic risk of hip Derm: itching, » ay cause l
ëmeprazole hypersecretory fractures in rash. AST, ALT,
conditions, patients using alkaline
including high-doses for > 1 isc: allergic phosphatase,
Zollinger-Ellison year reactions. and bilirubin
syndrome Bartter's » ay cause
Reduction of syndrome, serum gastrin
risk of GI hypokalemia, concentrations
bleeding in and respiratory to l during first
critically ill alkalosis 1²2 wk of
patients (Zegerid only) therapy. Levels
ëTC: ëB: Lactation: return to normal
=eartburn Pedi: Pregnancy, after
occurring lactation, or discontinuation
Btwice/wk children <1 yr of omeprazole
(safety not » onitor INR
established) and
prothrombin
time in patients
taking warfarin
Increases water Ther. class. Treatment of Contraindicated in: GI: belching, cramps, Assess patient for
content and laxatives chronic constipation Patients on low- distention, flatulence, abdominal
softens the stool in adults and galactose diets diarrhea. distention, presence
Lowers the p= of Pharm. class. geriatric patients of bowel sounds, and
the colon, which osmotics Adjunct in the Use Cautiously in: Endo: hyperglycemia normal pattern of
inhibits the management of Diabetes mellitus (diabetic patients). bowel function
diffusion of portal-systemic Excessive or » Assess color,
ammonia from the (hepatic) prolonged use (may consistency, and
colon into the encephalopathy lead to dependence) amount of stool
blood, thereby (PSE) ëB: Lactation: produced
reducing blood Pedi: Safety not PSE
ammonia levels. established Assess mental
Therapeutic status (orientation,
Effect(s): level of
Relief of consciousness) before
constipation and periodically
Decreased blood throughout course of
ammonia levels therapy
with improved Lab Test
mental status in Considerations
Lactulose PSE ± blood ammonia
concentrations by
25²50%
» ay cause l blood
glucose levels in
diabetic patients
» onitor serum
electrolytes
periodically when
used chronically.
ay cause diarrhea
with resulting
hypokalemia and
hypernatremia
§
. §§
§ §
§
Subjective: Risk for Within 8 hours of
7 1. to determine if After 8 hours of
´nagsusuka decreased nursing 1. auscultate BP. Compare hypertension is due to nursing intervention:
akoµ as cardiac output intervention, the both arms and obtain common problems or if it A. the patient
verbalized by related to patient will be lying, sitting, and standing related to a much more maintained
the patient changes in able to: pressures when able serious complication hemodynamic
ëbjective: electrical A. maintain 2. monitor V/S 2. decreased cardiac stability such as the
(+) nausea conduction hemodynamic 3. note response to activity output results to blood pressure. Goal
(+) vomiting stability such as and promote rest irregularities that may was met.
(+) slight the blood pressure appropriately require further evaluation/ B. the patient
dyspnea B. report 4. provide small, easily monitoring reported decreased
V/S: decreased episodes digested meals. Limit 3. to avoid overexertion episodes of dyspnea,
BP- 130/90 of dyspnea, angina caffeine intake that can compromise angina. Goal was
PR- 104 bpm 5. have emergency myocardial function met.
RR- 20 breaths/ equipment/ medications 4. to avoid increase and
min available stimulation of myocardial
T- 36 C § §7 workload resulting to
1. administer supplemental increased heart rate
oxygen, as indicated 5. to provide immediate
2. maintain IV/ =ep- Lock life- saving therapies when
access as indicated cardiac arrest suddenly
3. monitor serial ECGs, occurs
chest x-ray and laboratory 1. to reduce ischemia and
data dysrhythmias
4. administer medications 2. to administer emergency
as indicated drugs upon persistent lethal
dysrhythmias or chest pain
3. to provide information
regarding progression/
resolution of infarction
4. to avoid potential
complications and have
appropriate management
§
§ § § § §§
Subjective: Risk for Within 8 hours of 1. note patient·s age, 1. to provide information After 8 hours of
´ nagsusuka deficient fluid nursing intervention, current level of hydration, regarding ability to tolerate nursing
akoµ as volume related the patient will be and consciousness fluctuations in fluid level and intervention:
verbalized by to vomiting able to: 2. monitor I/ë balance risk for creating or failing to A. the patient
the patient A. avoid fluid 3. Weigh patient and respond to problem avoided fluid
ëbjective: volume deficiency compare with recent 2. to ensure accurate picture volume deficiency .
(+) slurred B. reduce, or if weight history of fluid status Goal was met.
speech noted possible, alleviate 4. assess skin turgor/ oral 3. to determine trends with B. the patient·s
(+) nausea vomiting mucous membranes fluid status vomiting was
(+) vomiting 5.monitor V/S 4. to check for any alleviated. Goal
- Poor skin 6. encourage oral intake of manifestation of possible was met.
turgor fluids dehydration
V/S: 7. provide supplemental 5. BP and heart/ respiratory
BP- 130/90 fluids, as indicated rate often increase initially
PR- 104 BP 1. reinforce need for when either fluid deficit or
RR- 20 breaths/ adequate rest excess is present
min 2. administer medications 6. to avoid deficiency in fluid
T- 36 C as indicated volume
7. fluids may be given in this
manner if patient is unable
to take oral fluid, is NPë for
procedures, or when rapid
fluid resuscitation is required
1. to limit adverse effects of
vomiting
2. to avoid potential
complications and have
appropriate management
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