Alabang-Zapote Road, Pamplona 3, Las Piñas City, 1740 Philippines

•www.perpetualdalta.edu.ph • Tel. No.: (02) 871-0639

College of Nursing

A Case Study on the Circulatory Disorder:

Myocardial Infarction

A Case Study
Presented to the College of
NURSING
University of Perpetual Help System DALTA

In partial fulfilment of the requirements for the course

Care of Clients with Life Threatening Conditions/Acutely ill/Multi-Organ Problems/ High
Acuity and Emergency Situation, Acute and Chronic- RLE

Prepared by:
Group 1-B
IGPIT, KEN JOMAR
JAZUL, ANGELICA
REYES, JEAN BRIENNE
SORIMA, CAMILLE
SUMARCA, KRIS DIMPLE
TAVARES, JELSEY KAYE

Clinical Instructor:
Mrs. Linda Sobrevega RN, MAN, LPT

October 25, 2021

 TABLE OF CONTENTS

Page

TITLE PAGE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

TABLE OF CONTENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

OBJECTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

CHIEF COMPLAINT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

PATIENT PROFILE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

DIAGNOSTIC AND LABORATORY EXAMINATIONS . . . . . . . . . . . . . . . . . . . . . . .

CLINICAL FINDINGS, SIGNIFICANT SIGNS AND SYMPTOMS . . . . . . . . . . . . . . .

PATHOPHYSIOLOGY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

PROBLEM LIST (PRIORITIZATION OF PROBLEMS) . . . . . . . . . . . . . . . . . . . . . . . .

NURSING CARE PLAN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

DRUG STUDY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

DISCHARGE PLANNING (M.E.T.H.O.D.S.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

REFERENCES . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
 INTRODUCTION
Myocardial Infarction is the process by which portions of myocardial cells in the heart

are irreversibly damaged. MI is caused by decreased blood flow in a coronary artery due to

atherosclerosis and obstruction of an artery by an embolus or thrombus, similar to unstable

angina. Other causes of an MI include vasospasm of a coronary artery; decreased oxygen supply;

and increased demand for oxygen. In each case, a profound imbalance exists between myocardial

oxygen supply and demand.

There are two clinical settings of MI—ST-segment elevation myocardial infarction

(STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI). STEMI is recognized

by characteristic changes on the electrocardiography (ECG). One of those ECG changes is the

typical elevation in the “ST segment” which is called STEMI. On the contrary, the absence of

ST-segment elevation and the presence of positive cardiac biomarkers such as troponin are called

NSTEMI.

Some of the symptoms that can be seen in patients having myocardial infarction are

pressure or tightness in the chest, pain in the chest, back, jaw, and other areas of the upper body

that lasts more than a 20 minutes or that goes away and comes back and shortness of breath.

According to Jarayadj et al. (2018), The most common form of CHD is the myocardial

infarction. It is responsible for over 15% of mortality each year, among the vast majority of

people suffering from non-ST-segment elevation myocardial infarction (NSTEMI) than ST-

segment elevation myocardial infarction (STEMI). An American dies due to myocardial

infarction (MI) every 60 seconds. The prevalence of myocardial infarction (MI) is higher in men

in all age-specific groups than women. In addition, the study estimated that globally, IHD affects

around 126 million individuals (1,655 per 100,000), which is approximately 1.72% of the world's
population. Nine million deaths were caused by IHD globally. Men were more commonly

affected than women, and incidence typically started in the fourth decade and increased with age.

(Khan et al., 2020)

STEMI has the highest rate of cardiovascular diseases with an average mortality rate of

10 percent based on the health facility records in the Philippines. More than 42,000 people were

admitted to hospitals due to acute myocardial or coronary syndrome, while 3,800 die every year

of heart attack based on 2017 PhilHealth data.

This study focuses on Mr. M.I, a 46-year-old man, admitted on October 25, 2021 at the

Perpetual Help Medical Center with chief complaints of DOB and nausea.
 OBJECTIVES

General Objective:

The primary concern of this study is to provide knowledge and enhance essential skills in care of
patients with myocardial infarction.

Specific Objectives:

1. To know and have a clear understanding of the factors that can lead to myocardial
infarction.

2. To establish rapport with the patient and significant others for an effective nurse-patient
interaction.

3. To illustrate and explain the pathophysiology of myocardial infarction.

4. To formulate an appropriate and a befitting nursing care plan.

5. To evaluate expected outcomes and determine achievements and effectiveness of care.

CHIEF COMPLAINT

Substernal crushing chest pain, difficulty of breathing, and nausea

PATIENT’S PROFILE

Client’s Initials : M.I.

Age: 46 years old

Height 5’9”

Weight 93 kg

Birthdate: 01/01/1975

Birth Place: Manila

Religion: Roman Catholic

Nationality: Filipino

Address: Las Pinas City

Occupation: Bus Driver

Vital Signs (Admission) Temp = 36.8ºC, PR =92 bpm, RR = 28

cpm, BP = 105/80 mmHg

Admitting Physician: Dr. S.T.M.

 Admitting Date: 10/25/2021

Admitting Time: 7:15 AM

Chief Complaint: Substernal crushing chest pain /Difficulty

of breathing / Nausea

Admitting Diagnosis: NSTEMI

Final Diagnosis: NSTEMI

 DIAGNOSTIC AND LABORATORY EXAMINATION

HEMATOLOGY DEPARTMENT

COMPLETE BLOOD COUNT (CBC)

SPECIMEN: BLOOD DATE: OCTOBER 25, 2021

EXAMINATION RESULT NORMAL ANALYSIS

VALUE

Red Blood Cell 4.26 4.50-5.50 x Patient with MI commonly develop anemia
10^12/L that causes decreased oxygen supply.
· Reference: Zafari et al., (2019).
(L) “Myocardial Infarction”

Hematocrit 0.33 0.37-0.47 L Indicates anemia, this is due to decreased

myocardial oxygen.
(L)

Hemoglobin 104 110-150 g/l Indicates anemia, this is due to decreased

myocardial oxygen.
(L)

White Blood Cell 8.17 4.50-10 x Normal

10^gl

Segmenters 0.78 0.50-0.70 This indicates inflammation where in it plays

a significant role in myocardial ischemia.
(H) High segmenters is among the indicators of
systemic inflammation.

Reference: Nalbant, A., et al(2016)

Eosinophils 0.02 0.00-0.05 Normal

Lymphocytes 0.14 0.20-0.40 This indicates inflammation where it plays a
significant role in myocardial ischemia. Low
(L) Lymphocytes is among the indicators of
systemic inflammation.

Reference: Nalbant, A., et al(2016)

Monocytes 0.06 0.00-0.07 Normal

Platelet Count 383 150-400 x Normal

10^g/L

MCV 77.00 80-100 fl Decreased MCV indicates small red blood

cells which result in a reduced capacity to
(L) carry oxygen to the tissues.

Reference: Eldridge, Lynne(2019).

MCH 24.31 26-34 pg Decreased MCH indicates insufficient

amount of hemoglobin per red blood cell
(L)
Reference: Healthline Media(2019).

MCHC 315 320-260 g/L In myocardial infarction, decreased MCHC

means that there is a lower concentration of
(L) hemoglobin within a given volume of red
blood cells, and hence, a reduced capacity to
carry oxygen to the tissues.

Reference: Eldridge, Lynne(2019).

 IMMUNOLOGY SECTION

SPECIMEN: BLOOD DATE: OCTOBER 25, 2021

EXAMINATION RESULTS NORMAL INTERPRETATION

VALUES

HS Troponin I 3668.70 Less than Release of troponin occurs as cardiac cells

ng/L 19.0 die during ischemia and demonstrate
measurable elevations two to three hours
after the ischemic event occurs.

Elevated troponin indicates myocardial

necrosis.

Reference: Tilton, David (2018). “Cardiac

Emergencies: Assessment, Angina and MI.”

HS Troponin T 512 ng/ml Less than The heart releases troponin into the blood
0.40 following an injury, such as a heart attack.
Very high troponin levels usually mean that
a person has recently had a heart attack.

Reference: Whitworth, Gerhard (2019).

 CK-MB 228ng/ml Less than Heart muscle damage can cause an increase
5.0 ng/ml in CK-MB, including decreased oxygen
(ischemia).

Major source of CK-MB is myocardium, an

elevated CK-MB level reflects myocardial
injury, including myocardial infarction.

Reference: Junpaparp, Parichart (2019).

X-RAY SECTION
EXAMINATION: CHEST PORTABLE
FINDINGS:
- Pulmonary vascularity is increased with hilar fuzziness.

- Heart is enlarged with flask-shaped configuration.

- Thoracic aorta is atheromatous.

- Right hemidiaphragm and costophrenic sulcus are obscured by the left cardiac border.

- No double density in the right cardiac border.

- No splaying of the left bronchus.

- Visualized bones are unremarkable.

IMPRESSION:

- Pulmonary Congestion.

- Enlarged cardiac shadow, presence of pericardial effusion on top of left ventricular

hypertrophy is not ruled out.

- Atheromatous aorta.
EXAM: ELECTROCARDIOGRAM REPORT DATE: OCTOBER 25,
2021
MEASUREMENT
RATE-ATRIAL - bpm PR: - sec. QRS: 0.08 sec AXIS: -50 deg.

VENTRICULAR 80’S bpm QTA: 0.36 sec. AT: sec.

INTERPRETATION:
‒ Atrial Fibrillation in controlled ventricular response

‒ Inferior and anterolateral wall ischemia

‒ Left ventricular hypertrophy

 PATHOPHYSIOLOGY

Predisposing Factor:
• Family History Precipitating Factor:
• Age: 46 • Smoking
• Race • Obesity
• Sedentary lifestyle

Disruption of atherosclerotic plaque

Leading to Obstruction/ Clotting cascade

• Decreased
Total occlusion of coronary artery
electrical
conduction
• Cardiac
dysrhythmia
(Atrial Decreased blood supply • Blood
Fibrillation) (Hypoxia) pressure of
• Elevated 105/80
troponin mmHg
level • Heart rate:
(3668.70 Myocardial Ischemia 92 BPM
ng/L) • Respiratory
rate: 28 cpm

• Sudden, MYOCARDIAL
crushing
substernal INFARCTION
chest pain
• Difficulty of
breathing
• Nausea
 PHYSIOLOGY OF THE HEART

The heart weighs between 7 and 15 ounces (200 to 425 grams) and is a little larger than

the size of the fist. By the end of a long life, a person’s heart may have beat (expanded and

contracted) more than 3.5 billion times. In fact, each day, the average heart beats 100,000 times,

pumping about 2,000 gallons (7,571 liters) of blood.

Location

The heart is located between the lungs in the middle of the chest, behind and slightly to the left of

the breastbone (sternum). A double-layered membrane called the pericardium surrounds the heart like a

sac. The outer layer of the pericardium surrounds the roots of the heart’s major blood vessels and is

attached by ligaments to the spinal column, diaphragm, and other parts of the body. The inner layer of the

pericardium is attached to the heart muscle. A coating of fluid separates the two layers of membrane,

letting the heart move as it beats.

Blood vessels

Arteries: carry oxygenated blood from the heart to the rest of the body. Arteries are strong and stretchy,

which helps push blood through the circulatory system. Their elastic walls help keep blood pressure

consistent. Arteries branch into smaller arterioles.

Veins: these carry deoxygenated blood back to the heart and increase in size as they get closer to the

heart. Veins have thinner walls than arteries.

Capillaries: they connect the smallest arteries to the smallest veins. They have very thin walls, which

allow them to exchange compounds with surrounding tissues, such as carbon dioxide, water, oxygen,

waste, and nutrients.

Chambers

The heart has 4 chambers. The upper chambers are called the left and right atria, and the lower

chambers are called the left and right ventricles. A wall of muscle called the septum separates the left and

right atria and the left and right ventricles. The left ventricle is the largest and strongest chamber in the

heart. The left ventricle’s chamber walls are only about a half-inch thick, but they have enough force to

push blood through the aortic valve and into the body.

The Heart Valves

Four valves regulate blood flow through the heart:

● The tricuspid valve regulates blood flow between the right atrium and right ventricle.

● The pulmonary valve controls blood flow from the right ventricle into the pulmonary

arteries, which carry blood to the lungs to pick up oxygen.

 ● The mitral valve lets oxygen-rich blood from the lungs pass from the left atrium into the

left ventricle.

● The aortic valve opens the way for oxygen-rich blood to pass from the left ventricle into

the aorta, the body’s largest artery.

The Conduction System

Electrical impulses from the heart muscle (the myocardium) cause the heart to contract.

This electrical signal begins in the sinoatrial (SA) node, located at the top of the right atrium.

The SA node is also called the heart’s “natural pacemaker.” An electrical impulse from this

natural pacemaker travels through the muscle fibers of the atria and ventricles, causing them to

contract. Although the SA node sends electrical impulses at a certain rate, the heart rate may still

change depending on physical demands, stress, or hormonal factors.

 PROBLEM LIST (PRIORITIZATION OF PROBLEM)

ACTUAL PROBLEM

PROBLEM PRIORITIZATION JUSTIFICATION

Acute Pain related to 1 This is the prioritized problem

decreased cardiac because pain is an unpleasant
perfusion as manifested by sensory and emotional
substernal chest pain experience that is associated
with actual or potential tissue
damage and can alter a
patient’s vital sign

Ineffective Cardiac Tissue 2 This is the second prioritized

Perfusion related to because if circulation is not
inadequate blood flow as treated, this could lead to
manifested by the ineffective tissue perfusion
objective cues

Ineffective Breathing 3 This is third prioritized actual

Pattern related to problem because when there is
interruption of oxygen an increase in respiratory rate,
supply to cardiac muscles there will be an increase in
as manifested by difficulty oxygen demand which is
in breathing inadequate to the patient
 POTENTIAL PROBLEM

PROBLEM PRIORITIZATION JUSTIFICATION

Risk for Decreased 1 This is the first prioritized

Cardiac Output related to potential problem because
infarcted muscle according to the ABC rule
airway, breathing and
circulation are of utmost
priority.

Risk for anxiety related to 2 This is the second prioritized

threat to health as problem because it is a normal
evidenced by verbalization part of life experience which
of “baka maulit pa ito occurs in response to certain
diyos ko yung mga anak stressors but if not treated, can
ko bata pa” by the client lead to anxiety disorder.
 ACTUAL NURSING CARE PLAN

A. Acute Pain

Assessment Diagnosis Planning Implementation Rationale Evaluation

Subjective: Acute pain related Short Term: Independent: Short Term:

“Masakit ang dibdib to decreased After 20 minutes of • Established To gain trust and Goal Met
ko” as verbalized cardiac perfusion as nursing intervention rapport with cooperation during After 20 minutes of
by the patient manifested by the patient will be patient and interviews nursing
substernal chest able to: relative intervention, the
Objective: pain • Report pain is patient was able to
• (+) facial lessened from • Assessed and For baseline data have a pain scale of
grimace 8/10 to 4/10 noted VS 4/10 and a
• (+) restlessness • Have decreased decreased in
• Sudden and discomfort discomfort
crushing • Acknowledged Pain is a subjective
substernal chest Long Term: the pain experience and Long Term:
pain with a pain After 7 hours of experienced and cannot be felt by Goal Partially Met
scale of 8/10 nursing convey others After 7 hours of
interventions, the acceptance of nursing
patient will be able client’s interventions, the
to: response to pain patient was able to
• Report complete report complete
relief of pain • Observed non- Clarification of relief of pain
verbal cues and verbal report
pain behaviors

• Determined It helps to
pain location determine patient’s
 and pain feelings,
characteristic by appropriate
interview and intervention and
monitored pain provide basis for
scale using comparison and
numerical pain evaluation of
scale therapy

• Provided a quiet Provides comfort

and calm
environment

• Taught patient To promote non –

how to promote pharmacological
comfort and pain management
relaxation using
non-
pharmacological
methods like:

- Desired
position
- Rest periods
- Use of extra
pillows for
comfort

Dependent:
• Provided To enhance
oxygen therapy myocardial
as necessary perfusion
• Administered To maintain
prescribed acceptable level of
analgesic pain and to
(Morphine) and eradicate pain
due medications
B. Ineffective Tissue Perfusion related to reduction of blood flow

Assessment Diagnosis Planning Implementation Rationale Evaluation

Subjective: Ineffective Cardiac Short Term: Independent: Short term:

"Naninikip ang Tissue Perfusion After 7 hours of • Assessed and For baseline data Goal Met
aking dibdib"as related to nursing recorded VS After 7 hours of
verbalized by inadequate blood interventions, the and O2 nursing
the patient flow as manifested patient will be able saturation q 4 interventions, the
by the objective to: hrs. patient
Objective: cues • Demonstrate demonstrated
• (+) dyspnea improvement in • Inspected for Systemic improvement in
• RR – 28 cpm vital signs pallor, cyanosis, vasoconstriction vital signs
• BP –105/80 - RR: 23 cpm and capillary may be evidenced (mentioned in
mmHg - BP: refill also noted by decreased skin planning)
• O2 Sat: 90% 120/80mmH strength of perfusion and
• Capillary refill: g peripheral pulse diminished pulses Long Term:
>2 secs - Capillary Goal Met
• Pale, cool refill time • Monitored and Decreased intake or After 3 months of
clammy, and <2 secs recorded client persistent nausea nursing
diaphoretic - 02 sat: 96% weight and I & may result in interventions, the
O reduced circulating patient maintained
Long Term: volume, which adequate tissue
After 3 months of negatively affects perfusion as
nursing perfusion and organ individually
interventions, the function. appropriate.
patient will be able
to: • Maintain This ensures
• Maintain optimal cardiac adequate perfusion
adequate output. of vital organs.
tissue These measures
perfusion as reduce venous
 individually compression/venou
appropriate s stasis and arterial
vasoconstriction.
e.g.
- warm, dry Exercise prevents
skin and • Encourage venous stasis and
balanced change in further circulatory
intake and lifestyle compromise
output - Avoiding
- vital signs crossed legs
within at the knee
normal when sitting
range - Changing
positions at
frequent
intervals
- Rising
slowly from
a
supine/sittin
g to standing
position
- Avoiding
smoking

Dependent: To prevent the

• Administer formation of further
aspirin as clotting
prescribed
To enhance
• Provide oxygen myocardial
therapy as perfusion
 necessary

Collaborative:
• Monitor Indicators of organ
laboratory data: perfusion and
ABGs, BUN, function.
creatinine, Abnormalities in
electrolytes, coagulation may
coagulation occur as a result of
studies therapeutic
measures
C. Ineffective Breathing Pattern related to interruption of oxygen supply to cardiac muscles

Assessment Diagnosis Planning Implementation Rationale Evaluation

Subjective: Ineffective Short Term: Independent: Short Term:

“Hirap akong breathing pattern After 30 mins of Goal Met
huminga” as related to nursing • Assessed and For baseline data After 30 minutes of
verbalized by the interruption of interventions, the noted nursing
patient oxygen supply to patient will be able respiratory rate interventions, the
cardiac muscles as to: and depth patient was able to
Objective: manifested by • Have a have a respiratory
• (+) facial difficulty in respiratory rate • Observed for Unusual breathing rate of 22cpm
grimace breathing of 22cpm breathing pattern may imply
• (+) restlessness pattern an underlying Long Term:
• (+) dyspnea Long term: disease process or Goal Partially
• RR-28 cpm After 7 hours of dysfunction Met
• O2 Sat: 90% nursing After 7 hours of
interventions, the • Place the patient To facilitate lung nursing
patient will be able in a semi expansion interventions, the
to: fowler’s patient was able to
• Maintain an position maintain an
effective effective breathing
breathing pattern, as
• Provided a quiet
pattern, as Provides comfort evidenced by
and calm
evidenced by tolerated breath
environment
tolerated breath rate and depth.
rate and depth
• Encouraged To relax muscles
sustained deep and increase
breaths by: patient’s oxygen
level
- Using
 demonstrati
on:
highlighting
slow
inhalation,
holding end
inspiration
for a few
seconds, and
passive
exhalation

• Encouraged To conserve energy

adequate rest and avoid
overexertion

Dependent:
• Administrati Administration of
on of oxygen can reduce
oxygen as shortness of breath,
ordered increase oxygen in
blood.
Collaborative:
• Refer to To assist in
Respiratory respiratory care
Therapist modalities that
include oxygen
therapy and
breathing treatments
 POTENTIAL NURSING CARE PLAN
A. Risk for Decreased Cardiac Output related to infarcted muscle
Assessment Diagnosis Planning Implemention Rationale Evaluation
Subjective: Risk for Decreased Short Term: Independent: Short Term:
“Masakit ang dibdib Cardiac Output After 30 mins of • Maintained To maintain trust Goal Met
ko” as verbalized by related to infarcted nursing intervention rapport with and for After 30 mins of
the patient. muscle the patient will be patient collaboration nursing
able to: intervention, the
Objective: • Manifest and • Assessed and patient was able
• (+) dyspnea express decrease recorded VS and Compensatory to manifest and
• (+) activity episodes of O2 saturation q 4 tachycardia is a express decrease
dyspnea common response episodes of
intolerance
for patients with
• PR – 92 bpm significantly low
dyspnea.
• RR - 28 cpm Long term: blood pressure to
• BP – 105/80 After 7 hours of reduce Long Term:
cardiac
mmHg nursing intervention output. Goal Partially
Initially,
• pale, cool the patient will be this compensatoryMet
clammy, and able to: response has a After 7 hours of
diaphoretic • Demonstrate nursing
favorable effect on
adequate cardiac cardiac output but
intervention the
• CXR reveals can be harmful
output as patient was able
atheromatous when it becomes
evidence by to demonstrate
aorta persistent.
normal vital adequate cardiac
signs and output as
· increase in • Assessed and For assessment evidence by
activity tolerance noted normal vital signs
and monitoring and increase in
characteristics of
heart sounds and activity tolerance.
checked for
peripheral pulses
& capillary refill
• Noted response Over exertion
to activity increases oxygen
appropriately and consumption and
promoted rest demand
while in semi
fowler’s position

• Noted cardiac To evaluate

output and other response to
functional therapeutic
parameters as interventions
appropriate

• Monitored and Reduced cardiac

recorded client’s output results in
weight with reduced perfusion
intake and output of the kidneys,
with a resulting
decrease in urine
output
Dependent:
• Administered To manage pain,
aspirin as ischemia and
ordered other heart
condition of the
patient

• Prepared
administration of To increase O2
oxygen supply
Collaborative: To help treat and
Refer to cardiologist prevent the
progression of the
disease
1.

1. T
o
e
a
r

c
o
B. Risk for Anxiety related to threat to health

Assessment Diagnosis Planning Implementation Rationale Evaluation

Subjective: Risk for Short Term: Independent: Short Term:

“baka mauulit Anxiety related After 30 mins of • Identified and For improved Goal Met
pa ito, diyos ko to threat to nursing intervention acknowledged collaboration After 30 mins of
yung mga anak health as the patient will be patient’s • To maintain nursing intervention
ko bata pa.” as evidenced by able to: perception of trust the patient was able to:
verbalized by verbalization of threat and
the patient “baka maulit pa ● Recognize and situation ● Recognize and
ito diyos ko express feelings express feelings
Objective: yung mga anak ● Identify causes, • Encouraged To provide care and ● Identify causes,
• Pulse rate - ko bata pa” by contributing expression of support contributing factors
92 bpm the patient feelings
factors ● Identify and use
• BP – 105/80
• (+) fearful
● Identify and use • Maintained Honest explanations available resources
attitude available confident can alleviate anxiety or appropriately
• Expression resources manner fear ● Demonstrate
of concern appropriately positive problem-
about ● Demonstrate solving skills
current and • Observed for Patient may not
positive verbal and non-
future events problem-solving express concern Long Term:
verbal signs of directly, but words and Goal Met
skills anxiety actions may convey After 3 months of
Long term: sense of agitation nursing intervention
After 3 months of • Oriented patient the patient will was
nursing to routine Predictability and able to adhere
interventions, the procedures and information can relaxation techniques
patient will be able expected decrease anxiety for to lessen anxiety.
to adhere relaxation activities also patient
techniques to lessen promoted
anxiety participation
when possible

• Provide privacy Conserves energy and

and rest periods enhances coping
and/or abilities
uninterrupted
sleep time and
quiet
surroundings

• Encouraged Promotes self

independence, confidence
self-care and
decision making
within accepted
treatment plan

• Encouraged Helps patient identify

discussion about realistic treatment and
post discharge goal
expectations and
home treatments

• Help patient to To help cope with fear

refocus on or anxiety positively
positive things

Recommended Promote positive

patient to perform problem-solving skills
spiritual activities
based on her belief
 DRUG STUDY
DRUG NAME MECHANISM OF INDICATIONS CONTRAINDICAT SIDE EFFECTS NURSING
ACTION IONS RESPONSIBILITIES

Generic Name: The antipyretic Prophylaxis of ● Hypersensitivi ● Bleeding ● Instruct the client
Aspirin effect is due to an transient ty to aspirin or ● Dyspepsia to take the
Brand Name: action on the ischemic attack other ● Epigastric medication after
Aspilet hypothalamus, and MI salicylates Distress meals and to
Classification: resulting in heat ● Bleeding ● Nausea remain in an
Antipyretics, loss by vasodilation disorders or ● Abdominal upright position for
nonopioid of peripheral blood thrombocytop Pain and 15-30 minutes after
analgesics vessels. Anti- enia Vomiting administration.
Dosage: inflammatory are ● Rash ● Advise patient to
80 mg/tab, 1 tab mediated by a ● Urticaria report tinnitus,
Route: Oral decrease in ● Anemia unusual bleeding of
Frequency: prostaglandin ● Tinnitus gums, bruising,
OD synthesis. black tarry stool, or
fever lasting longer
than 3 days.
● Instruct patient to
avoid alcohol with
this medication to
minimize possible
gastric irritation.
 DRUG NAME MECHANISM OF INDICATIONS CONTRAINDICA SIDE EFFECTS NURSING
ACTION TIONS RESPONSIBILITI
ES

Dilation of both To prevent chest ● Known ● Headache ● Check bp

Generic Name: arteries and veins; pain (angina) in history of ● Dizziness and pulse bp
veins initially people with a increased ● Orthostatic and pulse
Nitroglycerin
dilated reducing certain heart intracranial hypotension before
Brand Name: preload; higher condition (coronary pressure, ● Lightheaded administratio
doses dilate artery disease). severe ness n
Nitro-bid, Nitroglyn arterioles reducing anemia, ● Nausea ● Assess for
myocardial right-sided ● Flushing and report
Classification: workload and myocardial blurred
oxygen demand. infarction, vision or dry
Organic Nitrate-
or mouth.
Vasodilators
hypersensiti ● Monitor
Dosage: vity. patient
closely for
0.3–0.6-mg tablet change in
q3–5min levels of
consciousnes
Route: Oral s and for
dysrhythmia
s.
 DRUG NAME MECHANISM OF INDICATIONS CONTRAINDICA SIDE EFFECTS NURSING
ACTION TIONS RESPONSIBILIT
IES

Morphine binding Morphine is Contraindicated in ● Extreme ● Monitor

Generic Name: to opioid receptors indicated for the patients with known drowsiness blood
blocks transmission relief of severe hypersensitivity to ● Lightheaded pressure
Morphine sulfate
of nociceptive acute and severe morphine, morphine ness prior to
Brand Name: signals, signals chronic pain. salts, or any ● Nausea administrati
pain-modulating components of the ● Vomiting on.
Roxanol neurons in the product, in patients ● Loss of ● Monitor
spinal cord, and with respiratory appetite patient's
Classification: inhibits primary depression in the ● Dizziness respiratory
afferent nociceptors absence of rate prior to
Opioid Analgesics
to the dorsal horn resuscitative administrati
Dosage: sensory projection equipment, in on.
cells. patients with acute ● Reassess
10 to 30 mg q4 hrs or severe bronchial pain after
Route: asthma and in any administrati
Oral patient, who is on of
suspected of having morphine.
paralytic ileus ● Monitor for
respiratory
depression
and
hypotension
frequently
up to 24
hours after
administrati
on.
 DISCHARGE PLANNING

MEDICATIONS

- Instructed and explained to the client that the medication is important to continue
depending on the duration that the doctor ordered for the total recovery of the patient

- Taught the patient the proper dosage and the right time to take the medication

- Informed and discussed the possible side effects and reactions that these drugs might
produce and seek medical attention if symptoms arise

- Home medications and instructions are as follows:

- Aspirin 80mg/Tablet, take one tablet once a day (1PM)

EXERCISE

- Encouraged the client to do simple exercise such as walking

- Instructed the client to remember to cool down at the end of your exercise by
gradually walking slower for the last 3minute of your exercise

- Encouraged the patient to exercise at the same time daily to establish a habit and
to minimize any variables that may impact your exercise (timing of meals,
medications, work schedule)

TREATMENT

- Have scheduled rest periods for a day

- Consider walking everyday for exercise and endurance

- Perform stress relieving techniques like deep breathing exercises whenever

stressed
HEALTH TEACHING

Did health teachings on the following:

- Monitoring of blood pressure before and after taking due medications

- Regular medical check-up

- Exercise appropriately as tolerated; exercises such as walking, aerobics or Zumba

depending on the liking of the client

- Maintain weight that is suitable for height and age

- Different ways to manage stress such as relaxation techniques or listening to music

OUT-PATIENT

- Instructed the client to return to their attending physician for scheduled follow up check-
up

- Advised the client to report immediately if he/she experienced untoward symptoms such
as chest pain, headache, dizziness, or vomiting

DIET

- Eat vegetables, whole grains and fruit frequently

- Choose healthier fats and oils like avocado, dark chocolates, eggs, fish (e.g. Tuna)

- Aim for two to three serves of fish and seafood per week
REFERENCES:

● https://emedicine.medscape.com/article/226141-clinical
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sudanese-patients-2161-0703.1000120.php?aid=11517
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