Question

 Myocardial Infarction

 Patient Profile

 F.M. is a 68-year-old white man who comes to the emergency department (ED) in the early afternoon with a 2-day history of severe chest pain. The pain started on wakening the previous day. The pain increased during the night, but his wife could not convince him to go to the hospital. He comes to the ED today because the pain is severe and no longer relieved by rest.

 Subjective Data

•  Describes recurring chest pain for the past 6 months that was relieved by rest; the pain is a feeling of heaviness in chest with no radiating pain to arm or jaw or accompanying complaints of nausea or dizziness

•  Recently the chest pain has become severe and is no longer relieved by rest; is now complaining of being slightly nauseated

•  His father died of a heart attack at age 62

•  Denies alcohol or drug use

•  Smokes one pack of cigarettes per day

•  Describes his lifestyle as sedentary

 Objective Data

 Physical Examination

•  Blood pressure 180/96, pulse 98, temperature 99.8" F, respirations 20

•  Height 5'11",weight 210 Ibs, BMI 29.3 kg/m

•  Alert and oriented to person, place, and time

•  Skin diaphoretic and clammy

•  Heart rhythm regular, no murmurs or extra heart sounds

•  Lungs are clear to auscultation

 Diagnostic Studies

•  Hemoglobin 14 g/du

•  Chemistry panel is normal

•  Cardiac markers-pending

•  Electrocardiogram showing changes that correlate with non-ST-segment-elevation myocardial

•  infarction (NSTEMI)

 Interprofessional Care

•  0.9% NaCl infusing into IV catheter at 75 mL/hr

•  Nitroglycerin and morphine given with relief of pain

 Discussion Questions

 1. What are F.M.'s modifiable risk factors for coronary artery disease (CAD)? What are his

 nonmodifiable risk factors?

 2. What is the difference between chronic stable angina pain and pain associated with myocardial

 infarction?

 3. What diagnostic studies are indicated for F.M.?

 Case Study Progression

 F.M. is diagnosed as having a myocardial infarction (MI).

 4. What is the priority nursing care for F.M.?

 5. What other interventions do you anticipate for F.M. at this time?

 6. What are common complications after an MI?

 Case Study Progression

 After an uneventful hospital stay, F.M, is preparing for discharge.

 7. Prior to F.M.'s discharge from the hospital after having an MI, what patient teaching should he

 receive?

 8. Would F.M. benefit from any referrals and why?

Answer 1

1) F.M.’s modifiable risk factors for coronary artery disease are sedentary lifestyle, habit of smoking cigarettes, hypertension and heavy weight. These modifiable risk factors can be eliminated by making few changes in the diet and lifestyle.

The non modifiable risk factors are male gender, elderly age and family history.

2)The differences between the pain associated with chronic stable angina and pain associated with myocardial infarction are :

In chronic stable angina the pain occurs only after exercise or exertion. It is usually short lived, felt as a tightness in the chest and will be relieved with rest.

In myocardial infraction the pain is severe, perceived as heaviness on the chest, present for longer duration (more than 20minutes) and doesn’t relieve on taking rest.

3)The diagnostic studies indicated are electrocardiogram, echocardiogram, coronary angiography, biochemical markers, radionuclide imaging, complete blood picture, blood glucose, lipid profile and renal function tests.

4) The priority nursing care for MI is to reduce the pain and discomfort. First assess the pain, site and severity. Evaluate cardiovascular system, monitoring blood pressure, heart rate, respiratory sounds. Provide medication timely and give assurance to the patients psychologically and make sure the patient is calm and comfortable.

5) The interventions anticipated for this patient here are coronary angiogram. Depending on the degree of blockage per cutaneous coronary intervention(angioplasty with or without stent). In very severe case coronary artery bypass graft is done.

6) Complications after myocardial infraction are heart failure, myocardial rupture and aneurysmal dilatation, ventricular septal defect, Mitral regurgitation, cardiac arrhythmia sand acute pericarditis.

7) Prior to discharge the patient should be educated about the diet, medication, care to be taken, lifestyle to be followed like abstinence from smoking cigarettes and avoiding over exertion, keeping body weight and blood pressure in check. He should be taught mainly about the early signs of another attach of MI and what to do if another attack precipitates.

This is a brief discussion on the given topic. Hope this helps you.

Please feel free to give your feedback and if you need further elaborate explanation on this topic.

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