NIGHTINGALE INSTITUTE OF

NURSING
CASE PRESENTATION

SUBJECT : medical surgical nursing

TOPIC : MYOCARDIAL INFARCTION

SUBMITTED TO:- SUBMITTED BY:-

SUBMITTED ON:-
 IDENTIFICATION DATA
DEMOGRAPHIC DATA
NAME OF THE PATIENT :- shyam shankar
AGE :- 40 years
GENDER :- male
MARITAL STATUS :- married
RELIGION :- hindu
EDUCATION :- C.A
OCCUPATION :- pvt. job
ADDRESS :- 402 , vasantkunj, n-delhi
WARD :- ward 2
NAME OF THE HOSPITAL :- bhagwati hospital
DATE OF ADMISSION :- 10th june, 2021
PROVISIONAL DIAGNOSIS :- chest pain
FINAL DIAGNOSIS :- MYOCARDIAL INFARCTION
CHIEF COMPLAINTS:-
The client was admitted to the hospital due to chest pain since 1 day.

SOCIO ECONOMIC STATUS:-

Middle class
Nuclear family
Monthly income of the family- Rs-20000-/-
FACILITIES:-
Proper ventilation
Water - tap water
Drainage- closed drainage
Toilet- attached to house
Social relationship with neighbours-good
 FAMILY HISTORY:-
S. Name Age/ Relationshi Marital status Educatio Occupation Health status
No of the sex p with n
family patient
member
1 Shyam 40/m Self Married B.a Pvt.job unhealthy
Shankar
2 Renu 38/f Wife Married 12th Housewife Healthy
shankar
3 Suraj 18/m Son Unmarried 12th Student Healthy

4 Pinki 15/f Daughter Unmarried 10th Student healthy

 FAMILY TREE:-

female

Shyam renu shanker

shankar 40/m 38/f
male

patient

suraj 18/m pinki 15/f

FAMILY MEDICAL HISTORY:-

The client shyam shankar of 40 years old belongs to a nuclear family.he
doesn’t have any history of hereditary diseases.
PERSONAL HISTORY:-
Diet - vegetarion Bath
- daily
Sleeping pattern - regular at night for 7 to 8 hrs
Urinary elimination pattern - 2 to 3 times a day
Bowal elimination pattern - 1 time in a day Hobbies
- reading,net surfing,eating
Bad habbits - no bad habbits

PAST MEDICAL HISTORY:-

The client have past medical history of chest pain since 1 day.
PAST SURGICAL HISTORY:-
The client doesn’t have any past surgical history.
PRESENT MEDICAL HISTORY:-
The client was admitted in the hospital with
complaints of chest pain since 1 day after the investigations.he was
diagnosed with MYOCARDIAL INFARCTION.

PRESENT SURGICAL HISTORY:-

The client doesn’t have any present surgical history.

PHYSICAL EXAMINATION
IDENTIFICATION DATA
NAME OF THE PATIENT :- Shyam shankar
AGE :- 40 years
GENDER :- male
DIAGNOSIS :- MYOCARDIAL INFARCTION
VITAL SIGN
TEMP. :- 99’f
PULSE :-88b/min
RESPIRATION :-24 b/min
BLOOD PRESSURE :-130/80 mmhg
ANTHROPOMETRIC MEASUREMENTS
HEIGHT :- 170CM
WEIGHT :- 60 KG
GENERAL APPEARANCE AND MENTAL STATUS
CONSCIOUS :- Conscious
ATTITUDE :-Calm
BODY BUILT :-average
POSTURE :-erect
GAIT :-co-ordinated
HEAD AND FACE
HEAD :-no lesions,scar,wound
FACE :-patient was anxious
HAIR AND SCALP
COLOUR :-Black
DISTRIBUTION :- disturbed
DANDRUFF :-not present
INFECTION :-no infection present
SKIN
COLOUR :-Black
TEXTURE :- smooth
TEMPRATURE :-warmth
EYE
EYE BROW :-present
EYE LIDS :-present
EYE LASHES :-present
PUPIL :-reactive to light
VISUAL ACTIVITY :-normal 6/6
CONJUNCTIVA :-no infection
EAR
LOCATION :-on either side of the cranium ot approximately eye level
DISCHARGE :-no discharge
HEARING ACTIVITY :-normal
NOSE
NOSTRILS :-clear
NASAL SEPTUM :-normal, no deviation
NASAL POLYPS :-not present
DISCHARGE :-not discharge
MOUTH AND PHARYNX
LIPS :-pink colour
TEETH :-yellowish
TONGUE :-red in colour
PHARYNX :-exudate
NECK
THYROID GLAND :- not enlarged
LYMPH NODES :-Non-palpable, non tender
CHEST
INSPECTION :-normal symmetry
PALPATION :-no abnormal masses found
AUSCULTATION :-deep shallow breathing S1 and S2, heart sound heard
PERCUSSION :-abnormal sounds present
ABDOMEN
INSPECTION :-no scars,leasions
PALPATION :-bowal sound heard
AUSCULTATION :- no presence of fluid distension
PERCUSSION :- not tenderness

NAILS
SHAPE :-elongated
NAIL BED ANGLE :-160’ angle
CAPILLARY REFILLS :- immediate
BACK
CURVATURE :-patient was having normal body curvature.
EXTERMITIES
UPPER EXTERMITIES :-normal range of motion
LOWER EXTERMITIES :-normal range of
motion EXTERNAL GENITALIA
HEMORRHOIDS :-not present
FISSURE :-not present
FISTULA :-not present
IMPRESSION:- The patient Mr. Shyam Shanker,40 years male was admitted in
BHAGWATI HOSPITAL with complaints of chest pain since 1 day.

INVESTIGATION

 BLOOD TEST :-
CBC
KFT
LFT
CARDIAC ENZYME
 CHEST X-RAY
 ECG
 ECHO
MEDICATION
S.NO NAME OF DRUGS DOSE ROUTE FREQUENCY CLASSIFICATION
1 Inj. Tazopip 4.5gm I/V TDS Antibiotic

2 Inj. Luponex 40mg Subcutaneous BD Low molecular

weight heparin
group

3 Tab. clonaz 0.25 mg P/O HS Benzodiazepine

4 Tab. Ecospirin 75mg P/O BD Antiplatelet agent

5 Tab. Clopidet 75 mg P/O BD NSAIDS

6 Tab. Lipicure 20 mg P/O HS Lipid lowering

agent

Frequency Classification
 NURSING CARE PLAN

ASSESSMENT DIAGNOSIS SCIENTIFIC PLANNING INTERVENTION RATIONALE EVALUATION

EXPLANATION
Short Term Goal: Independent: Short Term Goal:
Subjective: Acute chest
Occlusion of - After 15-30 1. Assess 1.) To determine - Goal Met, AEB:
Pain related to
The client reports coronary artery minutes rendering characteristics of what appropriate Patient will be able
of chest pain Coronary care and chest pain (PQRST) interventions will to verbalized
radiating to the left Artery interventions, the be going to apply decreased/relieved
arm, neck and back. occlusion patient will be able for better pain (chest and to
 P- Upon doing secondary to Decreased blood to verbalized implementation radiating areas)felt,
Myocardial flow to the decreased/relieved of care. AEB:
some exertion
Infarction myocardium pain (chest and to 2. Obtain history of
activities radiating areas)felt, previous cardiac 2.) It provides  Decreased
Q- Stabbing pain AEB: pain and familial information that
R- to left arm, feeling of
history of cardiac may help to
neck and back problems from the differentiate fatigue
Decreased blood  Decreased
S- 10 out of 10 S.O. current pain from  Improve
supply (ischemia) feeling of
T- last more than previous breathing
15 minutes fatigue problems and  Skin is within
 Improve complications the normal
Objective: breathing thus it is a big
Anaerobic color
metabolism  Skin is within 3. Assess for help to perform  Vital signs
 Restlessness the normal respirations, BP and such
within normal
color heart rate with each interventions.
 Facial range:
 Vital signs episodes of chest
grimacing BP=120/80
pain. 3.) An increase in
 Easy Lactic Acid within normal PR= 60-100bpm
vital signs
Fatigability formation range: RR= 12-20 cpm
happens as as the
 Pallor BP=120/80 body compensate Temp= 36.5
PR= 60-100bpm to pain, which  Pain rate scale
 Cold and
Pain RR= 12-20 cpm 4. Maintain bed rest can lead to other
clammy skin from 10 down
Temp= 36.5 during pain, with serious
 With Oxygen to 8 as 10 is the
 inhalation at  Pain rate scale position of comfort. complications highest
2-4 Lpm doing if
from 10 down
 Shortness of continuous to
to 8 as 10 is the Long term Goal:
5. Maintain relaxing increase.
breath highest environment
 Vital signs - Goal Met, AEB:
conducive for rest. 4.) To reduce
taken as: Long term Goal: Patient experienced
oxygen
BP=150/90 an improved feeling
consumption thus
PR=109 bpm - After 1 hour of of control and
decreased oxygen
RR= 26 cpm rendering care and comfort AEB:
demand.
Temp= 35.0 interventions, the 6. Instruct patient to  Able to sleep
patient will be able avoid/limit activities 5.) To promote and rest
to have an improved that causes to calmness, reduce comfortably
feeling of control increase cardiac competing stimuli
and comfort AEB: workload and reduces  Improve
( lifting heavy anxiety thus it breathing
 Able to sleep objects, running, decreases oxygen  Vital signs
and rest stressful task) demand. within normal
comfortably range:
6.) To prevent BP=120/80
 Improve triggering the PR= 60-100bpm
breathing heart to the need RR= 12-20 cpm
 Vital signs 7. Instruct of more oxygen Temp= 36.5
within normal patient/family in due to exertion,
medication effects, thus, limiting  Pain rate scale
range: from 10 down
side-effects, activities
BP=120/80 contraindications decrease to 2 as 10 is the
PR= 60-100bpm and symptoms that myocardial highest
RR= 12-20 cpm need to report oxygen demand
Temp= 36.5 and workload on
 Pain rate scale Collaborative: the heart.
from 10 down - Administration of
to 2 as 10 is the medications and 7.) To promote
highest oxygen knowledge and
supplementation: compliance with
the said
1.Administer oxygen therapeutic
regimen and for
better action.
2. Administer
analgesics as
ordered, such as
morphine sulfate

1.) To promote
3. Administer beta- adequate oxygen
blockers such as supply
metropolol as 2.) Morphine
ordered. Sulfate is the
drug of choice to
control MI pain,
it decreases the
4. Perform a 12-lead afterload and
ECG and monitor preload
for cardiac changes (workload) of the
heart, decrease
oxygen demand,
Thus, reduces
pain

3.) To block
sympathetic
stimulation,
reduce heart rate
and lowers
myocardial
demand.

4.) ECG record

changes that can
give evidence of
further cardiac
damage and
location of MI,
thus ECG
monitoring is
important for
better prevention
of damage due to
MI.
MYOCARDIAL
INFARCTION
DEFINATION
Antero septal myocardial infraction is a heart problem where part
of the heart muscle dies and scars due to poor blood supply. In
this case tissue damage is around the anteroseptal wall , the area
between the left and right ventricles.

cause
 Spasm of the artery: Your blood vessels have a muscle lining that allows
them to become wider or narrower as needed. Those muscles can
sometimes twitch or spasm, cutting off blood flow to heart muscle.
 Rare medical conditions: An example of this would be any disease that
causes unusual narrowing of blood vessels.
 Trauma: This includes tears or ruptures in the coronary arteries.
 Obstruction that came from elsewhere in the body: A blood clot or air
bubble (embolism) that gets trapped in a coronary artery.
 Electrolyte imbalances: Having too much or too little of key minerals like
potassium in your blood can cause a heart attack.
 Eating disorders: Over time, an eating disorder can cause damage to your
heart and ultimately result in a heart attack.
SIGNS AND SYMPTOMS
 Discomfort, pressure, heaviness, tightness, squeezing, or pain in your
chest or arm or below your breastbone
 Discomfort that goes into your back, jaw, throat, or arm
 Fullness, indigestion, or a choking feeling (it may feel like heartburn)
 Sweating, upset stomach, vomiting, or dizziness
 Severe weakness, anxiety, fatigue, or shortness of breath
 Fast or uneven heartbeat
 Unusual fatigue
 Shortness of breath
 Nausea or vomiting
 Dizziness or lightheadedness
 Discomfort in your gut. It may feel like indigestion.
 Discomfort in the neck, shoulder, or upper back

RISK FACTORS
 Age. Men age 45 or older and women age 55 or older are more likely to have a heart attack
than are younger men and women.
 Tobacco. This includes smoking and long-term exposure to secondhand smoke.
 High blood pressure. Over time, high blood pressure can damage arteries that lead to your
heart. High blood pressure that occurs with other conditions, such as obesity, high cholesterol
or diabetes, increases your risk even more.
 High blood cholesterol or triglyceride levels. A high level of low-density lipoprotein (LDL)
cholesterol ("bad" cholesterol) is most likely to narrow arteries. A high level of triglycerides, a
type of blood fat related to your diet, also increases your risk of a heart attack. However, a
high level of high-density lipoprotein (HDL) cholesterol ("good" cholesterol) may lower your
risk.
 Obesity. Obesity is linked with high blood cholesterol levels, high triglyceride levels, high
blood pressure and diabetes. Losing just 10% of your body weight can lower this risk.
 Diabetes. Not producing enough of a hormone secreted by your pancreas (insulin) or not
responding to insulin properly causes your body's blood sugar levels to rise, increasing your
risk of a heart attack.
 Metabolic syndrome. This syndrome occurs when you have obesity, high blood pressure
and high blood sugar. Having metabolic syndrome makes you twice as likely to develop heart
disease than if you don't have it.
 Family history of heart attacks. If your siblings, parents or grandparents have had early
heart attacks (by age 55 for males and by age 65 for females), you might be at increased risk.
 Lack of physical activity. Being inactive contributes to high blood cholesterol levels and
obesity. People who exercise regularly have better heart health, including lower blood
pressure.
 Stress. You might respond to stress in ways that can increase your risk of a heart attack.
  Illicit drug use. Using stimulant drugs, such as cocaine or amphetamines, can trigger a
spasm of your coronary arteries that can cause a heart attack.
 A history of preeclampsia. This condition causes high blood pressure during pregnancy and
increases the lifetime risk of heart disease.
 An autoimmune condition. Having a condition such as rheumatoid arthritis or lupus can
increase your risk of a heart attack.

COMPLICATIONS
 Abnormal heart rhythms (arrhythmias). Electrical "short circuits" can develop, resulting in
abnormal heart rhythms, some of which can be serious, and may lead to death.
 Heart failure. A heart attack might damage so much heart tissue that the remaining heart
muscle can't pump enough blood out of your heart. Heart failure can be temporary, or it can be a
chronic condition resulting from extensive and permanent damage to your heart.
 Sudden cardiac arrest. Without warning, your heart stops due to an electrical disturbance that
causes an abnormal heart rhythm (arrhythmia). Heart attacks increase the risk of sudden
cardiac arrest, which can cause death without immediate treatment.
 PREVENTION
 Medications. Taking medications can reduce your risk of a subsequent heart attack and help
your damaged heart function better.
 Lifestyle factors.  Maintain a healthy weight with a heart-healthy diet, don't smoke, exercise
regularly, manage stress and control conditions that can lead to a heart attack, such as high
blood pressure, high cholesterol and diabetes
.

NURSING MANAGMENT
• Balancing of myocardial oxygen supply as per demand
• Medication administration as per order
• Continuous monitoring of cardiac function
• Continuous ECG monitoring, hemodynamic monitoring
• Monitoring and recording input/ output.
• Provide emotional support
• Nutritional support
• Bed rest for couple of days, reduce stress factors
• Provide heath education
• Asses the patient level of pain, location, duration.
• Prevention of the complication

CONCLUSION
A patient named shyam shankar 40 years of male was admitted in BHAGWATI
HOSPITAL with chief complains of chest pain radiating towards shoulder,
shortness of breathe and vomiting. He was admitted on CCU for proper
treatment and care. He was undergone the medication i.e Tab. Ecospirin, Tab.
Clopid, Inj.Ondem. His general condition was much improved through out the
treatment procedure being hospitalized.
 BIBLIOGRAPHY
 Brunner and suddharth “ A Textbook of medical surgical
nursing”, 3th edition; page no. 1032-1034

 Kumar and clarks “ Clinical Medicine”, 7th edition; page no.

732-735

Net sources:
• www.healthline.com/health/acute-myocardial-infarction

• https://www.floridahospital.com/medicalmanagementmyocardial-
infarction