CASE STUDY

PRESENTATION ON
MYOCARDIAL INFRACTION

Faculty Mrs. Abida. R

Group Members:
1. Natalia Bernard
2. Muhammad Hameed
3. Reena Devi
PRE-TEST

Q1: What is Myocardial Infarction?

Q2: What are the causes of MI?

Q3: Do you know about the diagnostic test of MI?

3 MINUTES

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 OBJECTIVES:
1. Define myocardial infraction And It’s Pathophysiology

2. Explain Causes, Sign And Symptoms Related To The Disease

3. Discuss Case Scenario Of The Patient Containing Past History And Present
Complications
4. Physical Assessment Data
5. Integrate Diagnostic Tests And Lab Reports Of The Patient
6. List Down Relevant Nursing Diagnosis (Actual And Potential)
7. Look Into Medical Management Of The Patient
8. Talk About Teaching Plans Which Were Shared With The Patient
9. Documentation/ Sample Charting
10. References

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 DEFINITION
Myocardial infraction is the destruction of myocardial
tissues in the region of the heart due to inadequate
supply of blood to the cardiac muscle because of reduced
coronary blood flow. It is also called heart attack.

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 PATHOPHYSIOLOGY
When the flow of blood to the heart is blocked ,most often by
build up of a fat, cholesterol and other substances
(thrombus) which form a PLAQUE in the coronary arteries
that supply blood to the heart. The interrupted blood flow
can damage or destroy part of the heart muscle or the tissue
that eventually leads to the heart attack.

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 Video
HEART ATTACK (ACS & MI). (N.D.). RETRIEVED
JANUARY 23, 2020, FROM
HTTPS://WWW.YOUTUBE.COM/WATCH?V=QLLGUA
NPKIC&T=1S

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PATIENT’S BIOGRAPHIC DATA

Name: S.B
Age: 69yrs
Sex: Female
MR#: A74-402-1219
Date of Admission: 02-12-2019
Hospital: LNH
Ward: CARDIAC
Marital status: widow
Religion: Islam
Language: Urdu
Occupation: HOUSE WIFE
Education level : UN EDUCATED
Home: (Karachi)
Diagnosis: Myocardial infraction
Allergies: not known
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REASON FOR ADMISSION/ CHIEF
COMPLAINT (IN PATIENT’S WORDS)
The patient complained of chest pain on exertion,
radiating to the left arm + shortness of breath with
productive cough since 1 week.

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PAST HISTORY OF THE PATIENT
• k/c HTN IHD and asthma
• Previous surgery appendectomy
• 2 cyst removal hysterectomy
• Recent admission at KPT keemarhi hospital with
NSTEMI, then got admitted at NICVD 30/11 with
NSTEMI.

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 FAMILY HISTORY OF ILLNESS

CANCER -- DIABETES Husband

HEART DISEASE Father HYPERTENSION Father

SICKLE CELL -- OTHERS --

DISEASE

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 PATIENT PSYCHOLOGICAL DATA
1. SOCIAL SUPPORT A: How the patient’s family provide The patients family are very
SYSTEM support during his/her illness? supportive. Her son spends the
B: How does the illness affect night looking after her and her
his/her work/study? daughter-in-law takes over during
the day. The patient says that she
is unable to carry out her daily
Household work

2. EMOTIONAL How does the patient appear? She appears irritable

RESPONSES Happy/sad/anxious/irritable

3. COGNITIVE What is the patient level of She is partially aware of her illness
RESPONSES knowledge of his/her illness?
4. HEALTH Does the patient use alcohol / Yes hookah smoker
BEHAVIORS tobacco / illegal drugs?
5. VALUES AND What are the patient’s beliefs about She believed that she will become
BELIEFS hospitalization? better by getting treated in the
hospital and through receiving
medication.
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POSSIBLE / ACTUAL CAUSE OF THE DISEASE IN YOUR
PATIENT RELATED WITH LITERATURE
P R E S E N T I N M Y PAT I E N T F O U N D I N L I T E R AT U R E

Ischemic heart disease Heart disease

Hypertension Hypertension
Hookah smoker Tobacco smoking
Age 69 Age >50
Family history (father) Family history
Acute coronary Stress
syndrome (ACS) ACS

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 CLINICAL SIGN AND SYMPTOMS OF THE DISEASE
IN YOUR PATIENT VS LITERATURE
P R E S E N T I N M Y PAT I E N T F O U N D I N L I T E R AT U R E

Chest pain Pressure, pain or aching

sensation in your chest
SOB
Shortness of breath
Productive cough Fatigue
Light headedness dizziness
Restlessness Nausea/heart burn
Cold sweats
Irregular heart beat

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ASSESSMENT OF THE PATIENT

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1 . I N T E G U M E N TA R Y S Y S T E M ( S K I N & M U C U S M E M B R A N E )

Skin: intact, color varies from light to deep brown

Mouth and Throat: Pink gums, normal mucus membrane, 30 adult teeth,
normal throat.
Hair and Nails: Evenly distributed Hair. Normal capillary refill (2.5 sec)

2 . S E N S AT I O N

Eyes: vision intact, white sclera

Tongue: Taste intact, pink in color, central position
Ears: normal voice tones audible in both ears
Touch: Able to feel sensation in hands & feet

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3 . R E S P I R AT O R Y S Y S T E M 4 . C A RD I OVA S CU LA R SYSTE M

Rate: Characteristics/ comments: Pulse Rate Comments

• 29/min • Bilateral basal crepts
heard on auscultation 103 bpm • S1 s2 audible +s3
• O2 sat • low air entry on left side (murmurs)
91%
with • ABG shows SO2
concentration 63.2%

Blood
Pressure:

140/80 mmHg ↑

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5. GASTROINTESTINAL SYSTEM 6. URINARY SYSTEM

Weight: 47kgs Color of urine reddish

Height: 145cm (hematuria),Foleys catheter intact.
Appetite: Normal
24 hours output : 1100 ml
Bowel Sounds: Normal (5-30 /min)
Patient Diet: low fat + low salt
Bowel Movement: 1-2 stool per day
• Comments: soft abdomen, non
tender, GS audible

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7 . M U S C U L O S K E L E TA L 8. COMFORT
SYSTEM
7 out of 10 on verbal pain scale use
Describe Self-Care activities (COLDERA)
(eating, bathing, dressing,
Characte sharp, burning
ambulating and toileting) r
Onset 1 week back
Partially dependent due to
illness
i.e. cooking, bathing, toileting, Located Chest wall, radiates to left
dressing. arm
Duration On exertion (1 week)

Relieve With rest and medication

Associate SOB
d
Disturbed sleep pattern due to SOB and cough, ≤ 4 hours of sleep

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9. NEUROLOGICAL SYSTEM 10. IMMUNE SYSTEM

Orientation: (time, place and Temperature: 37 c°

person) normal
Comments: my patient Allergies: DUST
was fully conscious and
oriented to time, place
and person
GCS 15/15

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DIAGNOSTIC TESTS & LAB INVESTIGATION

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Sr Name of Patient results Clinical significance /indicator
No. investigation
1 Electrocardiogra ST depression An ECG records the electrical activity of
m seen indicating MI the heart including the hear rate and
rhythm and detects any cardiac
abnormalities.
2 NT PRO BNP 929 pg/ml Higher than normal results indicates that
you have some degree of heart failure
Normal: and the higher the value more severe
<125 pg/ml the failure.

3 Tropin I 1.0 ng/ml It measure the level of tropinin protein in

the blood which are released when the
Normal: heart muscles have been damaged
0-0.4 ng/ml such as when heart attack has occurred.
4 Chest X ray Normal heart size Chest radiography provides clues to an
with sign of alternative diagnosis and relieves
pulmonary edema complaints of MI such as heart failure.
5 ABGs PH: 7.39 Test use to measure the acidity or
PCO2: 48.1 alkalinity of Ph and the level of O2
mmHg and CO2 in the blood .it is also used
PO2: 32.6 mmHg to check function of lungs and 22
SO2: 63.2 % kidneys.
NON- PHARMACOLOGICAL &
SURGICAL PROCEDURE:

Coronary angiogram
+
LHC (left heart
catheterization)

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NURSING CARE PLAN

INEFFECTIVE
BREATHING PATTERN

ACTUAL DIAGNOSIS 1

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Assessment Actual Goal Nursing Rational Outcome
Diagnosis Intervention Criteria
Subjective: Short term:
The patient states 1. A sitting
Ineffective The client will 1. Place the Pt in GOAL MET
that she is position permits
Breathing experience proper body maximum lung
experiencing decreased alignment for At the end of
Pattern excursion and
shortness of difficulty in maximum our Shift
r/t Hypoxia AEB chest expansion.
breath with breathing and a breathing pattern.
shortness of patient was
productive cough RR reduced from
breath, use of 2. To detect early able to
for 1 week 29 to 24/min.
accessary 2. Reassess and signs of maintain
muscles and O2 record RR and respiratory effective
Objective: Long term:
Saturation 91% depth q4 hrs compromise
•Pt is breathing breathing
At the end of
fast and irregular hospitalization pattern and
3. Administer O2 3. To maintain
client will be able enough supply respiratory
• V/S as follows- therapy as
to maintain of O2 in blood rate within
O2 Sat- 91% ordered by the
normal acceptable
TEMP- 98◦F respiration and physician i.e. 2L
PULSE- 103 bpm 4. To help relieve range
breath effectively anxiety and
RR- 29/min at the time of 4. The nurse will
B.P- 140/80 promote
discharge demonstrate
mmHg relaxation.
i.e. O2 sat breathing
ABGs shows between 95-98% technique for Pt
SO2: 63.2 % at RA
5. Reassess ABG 5. To monitor
level according to oxygenation
physician’s order and ventilation
status
6. Nebulize as
6. To loosen
ordered
secretions and
improve
breathing

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NURSING CARE PLAN

ACUTE PAIN
ACTUAL DIAGNOSIS 2

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Assessment Actual Goal Nursing Rational Outcome
Diagnosis Intervention Criteria
Subjective: Short term: 1. To differentiate
“I am having 1.Reassess for V/S angina pain from
Acute Pain After 8 hrs of Short term:
severe chest pain” and symptoms of pain r/t other
r/t insufficient nursing GOAL MET
as verbalized by pain, such as facial causes.
O2 reaching the interventions the Pt verbalized
patient grimacing and decreased
heart muscles client will 2. Helps to
• Pt rates her rubbing of jaw/neck. sensation of
secondary to verbalize relief decrease
pain as 7 on a Myocardial from chest pain chest pain and
2. Instruct Pt to perception and
scale of 0-10 Infarction AEB and SOB. normal
perform relaxation response to pain
breathing range.
Pt rating pain as techniques such as
Objective: 7 on 0-10 pain Long term: 3. Useful for pain
deep and slow
•Restlessness scale, restless control by Long term:
After 3 days of breathing
•On O2 therapy 2L behavior and coronary GOAL MET
nursing Pt was able to
•Pt looks lethargic Trop I test 3. Administer Anti- vasodilation
interventions the demonstrate
and week due to positive client will be able anginal drugs as effect
pain and difficulty improved
to demonstrate a ordered
4. To block breathing
breathing decrease episode i.e. Ditiazem HCL
pattern and
• V/S as follows- sympathetic
of angina through stimulation, decrease
O2 Sat- 95% 4. Administer Beta-
proper reduce HR and episode of
TEMP- 98◦F blockers as ordered
PULSE- 98 bpm
interventions lowers Myocardial angina pain.
demand
RR- 24/min
B.P- 140/80
mmHg
5. Administer O2 5. Increase
therapy by means amount of O2
of nasal prong as available for
indicated Myocardial
uptake and
thereby may
relieve
discomfort.

6. Obtain an ECG on 6. Stat ECG

admission and then records changes
each time chest that can give
pain recurs evidence of
further cardiac
damage and
location of MI

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NURSING CARE PLAN

ACTIVITY
INTOLERANCE
RISK nsg DIAGNOSIS

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Assessment Actual Goal Nursing Rational Outcome
Diagnosis Intervention Criteria
Subjective: After 72 hours of 1.For baseline
Patient verbalized Activity nursing 1.Monitor VS. data. GOAL MET
while changing intolerance interventions the
clothes “ I am client will be able 2.Assess motor 2.To identify Pt was able to
r/t Imbalance demonstrated an
unable to move” to demonstrate function. causative
between increase in
she also states she progressive factors and
myocardial activity level by
want to go to the increase in extent of
oxygen supply 3.Note gradual
washroom but she tolerance for
and demand AEB contributing weakness tolerance to
unable to walk activity with
generalized factors to fatigue. active range of
weakness. heart
Objective:
3.To identify motion and
rate/rhythm and willingly
• Patient is 4.Evaluate degree precipitating
BP within participated in
immobilized patient’s normal of deficit. factors.
necessary
• Requires limits activities.
assistance or 5. Encourage rest 4.To identify No intolerance
supervision to initially. Plan care severity of symptoms
do daily with rest periods condition. noted.
activities. between activities
• Alterations in 5. To reduce
heart rate and fatigue &
BP with myocardial
activity. workload
6.Increase 6. Progressive
activity/exercise activity provides a
gradually such as controlled
assisting the demand on the
patient in doing heart, increasing
PROM to active or strength and
full range of preventing
motions overexertion.

7. Assist patient 7. To protect from

with activities injury and
promote
independence.

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PHARMACOLOGY

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 Drug Name Classification Dose & Route Nursing consideration

Inj CLEXANE Anti thrombotic SC 60mg HS DO NOT give by IM injection,

agent recent surgery or injury.
Administer deep SC injection. do
not mix with other injections

Tab Ascard NSAID analgesic PO 75mg OD DO NOT CRUSH AND ensure that
(aspirin) pt does not chew sustained release
preparation.

Tab LOW PLAT ANTI PLATELET PO 75mg OD Allergy to low plat,bleedidng

AGENT disorders, pregnancy and recent
surgery. provide small frequent
meal is GI is upset.

Inj RISEK Proton pump I/V 40mg STAT Give on empty stomach 1hr before
inhibitor or 2-3hrs after meals

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 Drug Name Classification Dose & Route Nursing consideration
Tab HERBESSOR Antianginal agent anti PO 30mg BD Monitor pt vital sign while drug is
hypertensive being given for therapeutic use.
Do not cut chew or crush.

Tab LIPIGET ANTIHYPERLIPIDIMIC PO 20mg HS OBTAIN LIVE FUNCTION TEST and

agent periodically during therapy

Tab SUSTAC Vasodilator PO 2-6 mg OD IN terminating treatment of

angina gradually reduced the
dose to avoid withdrawal
reaction.
Inj LASIX LOOP diuretics I/V 40mg STAT Reduce dose if given with other
hyoertensive,readjust dose
gradually as bp responds.
NEB with clenil Glucocorticoid Q 6*H 2cc with It is prescribed to prevent
4H 3cc N/S 0.9% asthmatic attack, not using
within the attack .rinse mouth
after using.

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 PLANNED
PATIENT HEALTH
TEACHING

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Patient’s Objectives Content Strategies Time Evaluation
needs
Discussion 4 mins
To understand Medicine adherence is
the importance important to reduce the chance
of medication of reoccurrence of the disease
compliance and process. Explanation 2 mins
regularly Regular follow ups is necessary
Attendant attending follow to see that whether the patient
verbalizes ups. is going well or not.
that Teaching
patient is not helped the
keeping a family
balanced To provide Everyone's bodies are different
knowledge about and require different amount members
diet, not Explanation and patient
balance diet to and types nutrients according
taking avoid further to disease process through 3 mins gain further
medication complications i.e. Fruits, vegetables, whole video knowledge
regularly and towards disease grains, pulses, fish etc and
not attending process. Low salt + Low fat diet information.
follow ups
with
physician Small and regular exercises is
important to maintain healthy Discussion
Guide for small weight and meets the demands through
exercises for a of daily life i.e. Walking for 3 mins
healthy life. 15mins at least 4 days a week pamphlet
Stretching (flexion, extension, and demo
adduction, abduction) 37
38
 VIDEO
YouTube. (2020). Heart Failure Treatment: Lifestyle
Changes. [online] Available at:
https://www.youtube.com/watch?v=1zQ2YEjmJe8
[Accessed 20 Feb. 2020].

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40
 DOCUMENTATION/ SAMPLE CHARTING
A 69 yr old female came into ER with complaint of chest pain on exertion, radiating toward the left arm and
rated it 7 of scale of 0-10. According to the Pt she was in her usual state of health when 1 week back she
started experiencing heart burn which got worse and was now having shortness of breath on activity.
There is a history of ischemic heart disease ,hypertension and asthma. Before coming to LNH she was
previously admitted to KPT kemarhi hospital and NICVD with NSTEMI.

 Pt’s V/S are: Temp-98*F, P-103 bpm, B.P-140/80, R.R-29/min, O2 sat- 91% on RA.
 I/V cannula 22G inserted on the R hand. No sign of pain or swelling observed at the site.
 Pt ECG is taken and chest X ray done.
 Cardiology is consulted and the pt is given Tab; Ascard 75mgand immediately is nebulized
with clenil 2ml N/S 0.9%
 Troponin I test is done and report is positive
 Pt is conscious and oriented with GCS 15/15, orally allowed, FOLLEYS catheter inserted and
initial urine level is measured.
 Blood and urine c/s sampling done and sent to the lab.
 All alarming signs explained to attendant and counseling done. 41
POST-TEST
1. Describe Pathophysiology of MI.

2. What is the sign symptom of MI?

3. Name of any one drug which gives to MI patient?

4. What is Troponin I Test?

5. Give any 3 lifestyle changes or prevention of MI.

6 MINUTES

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REFERENCES
1. About Heart Attacks. (n.d.). Retrieved January 20, 2020, from https://
www.heart.org/en/health-topics/heart-attack/about-heart-attacks
2. HEART ATTACK (ACS & MI). (n.d.). Retrieved January 23, 2020, from
https://www.youtube.com/watch?v=QllguanpKic&t=1s
3. Heart Attack. (n.d.). Retrieved January 24, 2020, from
https://watchlearnlive.heart.org/?moduleSelect=hrtatk
4. Hinkle, J. L., Cheever, K. H., & Brunner, L. S. (2018). Brunner & Suddarths
textbook of medical-surgical nursing. Philadelphia: Wolters Kluwer.

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