Myocardial infarction (CASE PRESENTATION )

Myocardial infarction (heart attack )

1. 2nd Myocardial infarction ( heart attack ) CASE PRESEN T A TION ON PRESENTED BY :- MR. ROMAN BAJRANG BASIC BS.C NURSING 2 ND YEAR RELIANCE INSTITUTE OF NURSING 1

2. BIODATA OF THE PATIENT INTRODUCTION :- My patient name is Ram bahadur basyal age 65 year he is admited in male word of with the complan of central chest pain , shoulder pain ,vomiting , shortness . Name : Ram Bahadur Basyal father / hasband Name: Age: 65 years Sex: Male Adress : IPD.NO: 170210 OOD .NO: 100357 Bed no. : 05 Word no. : Male word Hospital : 2 Edited by :- MR. ROMAN BAJRANG

3. Reliance institute of nursing L imtar dhamtari occupation : farmer Education: 8 th Religion: Hindu Marital status: Married Dr. consultant : Dr. dignosed : Date of admission: Admission of time: Discharge of date : Diagnosis: Myocardial Infarction ( heart attacke ) Chief complain: My patient chief complail is central chest pain , shoulder pain ,vomiting , shortness . 3

4. Present health history :- Medical history :- My patient no any present medical history . Surgical history :- There is no any significant history of present surgery. 4

5. Past health history:- Medical history :- My patient no any past medical history . Surgical history :- There is no any significant history of past surgery. 5

6. OPD Notes:- My patient mr. Ram Bahadur Basyal from he is 65 year admitted in male word he is complain in opd in the complain of central chest pain , shoulder pain ,vomiting , shortness . Examination :- Temprature :- 98 f Pulse:- 70b/m Respiration:-24b/m Blood pressure:-120/80mm/hg Highet :-45kg. Wegh :- 5.1 inch 6

7. Family history Name Age / Sex Relation Education Occupation Marital status Health status 1 . Ram Bahadur Basyal 65/m self 8 th farmer yes unhealthy 2.Rukhmani 55 / f wife 5 th House wife yes healthy 3. Ajay 4.rameshwar 35/m 30 /m Son Son 12 th BA Selmen Electricion No No Healthy healthy 7

8. Family tree :- 8

9. Socio economic history:- Type of house: Pakka type No. of rooms: 4 rooms Kitchen : separate Type of drainage: open drainage Type of toilet used: water seal Sources of water: Hand pump and tap Type of fuel: wood and gas Adequate lighting: present Facilities available in surrounding: medical shops, schools available Monthly income: Rs 37000 Bread winner : Self, Son 9 Edited by :- MR. ROMAN BAJRANG

10. Personal history :- Smoking : Smoker, smoke 12 sticks per day from 20 years Alcohol: Alcoholic Food habbit: Mixed diet , 2-3 times a day Food allergy : not known Drug allergy: Not Known Bowel and Bladder: Regular Sleeping pattern: Disturbed due to hospitalization Hobbies: He likes to watch TV, listen radio 10 Edited by :- MR. ROMAN BAJRANG

11. Education & occupation :- My patient is pass he is farmer family he is well maintain . 12 Edited by :- MR. ROMAN BAJRANG

12. Enviroment :- Physical :- my patient is family physical enviroment is good be cause her family may good co – operation maintain . Social:- Interpersonal :- Cultural:- 13

13. Life style :- Sleeping patten :- distered sleep pattern . Elimination:- not good . Any bad habbit :- no any bad habbit . Diet:- non vegeterin . Stress :- no t 1 4 Edited by :- MR. ROMAN BAJRANG

14. Physical examination :- General appearance :- nurishment :- well nourishment Body bulid :- thin Health :- unhealthy Activity :- active Skin condition :- Colour :- white Texture :- dryness Temerature :- warm Lesions :-no wound . Hight :- 45kg 15

15. Head & face :- Hade – normal Sculp - normal Face – normal Eye:- Eye lashes – normal Eye brows – normal Eye bulls - normal Eye lids – normal Ear:- Ear – normal Hearing- normal 16

16. Nose:- septum - normal Mucosa – normal Mouth & pharynx :- normal Neck:- normal Abdomen:- normal 17

17. Investigation   S.N Name of Investigation Normal valve Patient value Remarks 1 Hemoglobin male – 14 to 17 gm /dl 10.2mg/dl female -12 to 15 gm/dl Anemia 2. Total RBC count male – 14 to 17 gm /dl 3.74 million/ female -12 to 15 gm/dl cu mm Anemia 3. Neutrophils 1,5000-8,000 82% (1.5-8.0 ) n/ mcl Neutrophilia 4. lymphocytes 1,000-4,800 15% leukopenia 1 8 Reliance institute of nursing L imtar dhamtari

18. 5. Total bilirubin 0-1 mg/dl 0.69 g/dl Jaundice 6. Conjugated bilirubin 0-0.35 mg /dl 1.61mg/dl Indicate hepatobi l ia ry 7. Unconjuga t ed bilirubin 0.2- 0.65 mg/dl 2.0 mg/dl Indicate blood or liver problem 8. SGPT/ALT 10-40 iu /l 85 i u /l Liver injury 9. Alkaline phosphate 40-112 u/l 3.4 u/l Problem with gall bladder 19 Reliance institute of nursing L imtar dhamtari

19. Medication S.N Name of Drug Dose /Route Action Side effect Nursing responsibility 1. Inj. Tazopip 4.5g m I/V It used to treat varius types of bacterial infection . Antibiotic To check the dose . 2. Inj. Luponex 40m g Subcutaneo us This can help reduce damage caused by clots in your blood vessels . Low molecular weight heparin group to check the exper date . 3. Tab. clonaz 0.25 M g P/O It is used to prevent and control seizures . Benzodiazepine To check the medicen 20 Reliance institute of nursing L imtar dhamtari

20. 4. Tab. Ecospirin 150 mg It has antiplatelt action and prevent the formation of blood clots . Antiplatelet agent To check the medicen 5. Tab. Clopidet 75 mg Preventing platelets . NSAIDS To check the medicen . 6. 7 . Tab. Lipicure Tab . Pantocid 20mg 40m g Cholesterol preventing . Stomach & esophagus problems . Lipid lowering agent . Diarrhea . Stomach pain . Nausea . Headache . To check the medicen . To check the medicen . 21

21. Diagnosis :- heart attack DEFI N A TION 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. - Wikipedia 22

22. The death of heart muscle due to the loss of blood supply. The loss of blood supply is usually caused by a complete blockage of a coronary artery, one of the arteries that supplies blood to the heart muscle. Death of the heart muscle, in turn, causes chest pain and electrical instability of the heart muscle tissue. - Medical net 23 Edited by :- MR. ROMAN BAJRANG

23. ETIOLOGY S.N In book In my patient 1. Smoking Smoking habit present 2. Stress Stress 3. Exposure to air pollution Exposure to air pollution 4. Alcohol Consumption Alcohol consumption 5. Diabetes mellitus Diabetes mellitus type II 6. Coronary artery diseases, High blood pressure Absent 7. High level of blood cholesterol Absent 24 Reliance institute of nursing L imtar dhamtari

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25. CLINICAL FEATURES S.N Name of the book In my patient 1. Chest and shoulder pain present 2. Shortness of breathe present 3. Diaphoresis present 4. Decreased urinary output present 5. Weakness , fatigue present 6. Vomiting present 26 Reliance institute of nursing L imtar dhamtari

26. 7. Lack of consciousness Absent 8. Sleep disturbance present 9. ECG elevation ECG elevation ( ST segment elevated) 10. Tachypnea present 27

27. DIAGNOSTIC EVALUATION S.N in book In my Patient’s 1. History collection present 2. Physical examination present 3. Electrocardiogram present 4. Lab test i.e Blood test, Troponin I , II., HDL, LDL present 5. Chest X-ray present 28

28. MEDICAL MANAGMENT Open IV access High flow oxygen ECG monitoring IV analgesia: 5-10 mg morphine Thrombolytic therapy (streptokinase,alteplase) Antiplatelete therapy :- aspirin 75-300mg, clopidegrel 75 mg Anticoagulants ( heparin) Beta blockers ( propanolol , esmolol, labetolol) 29 Reliance institute of nursing L imtar dhamtari

29. M = morphine O = oxygen N = nitrates A = aspirin T = thrombolytic agent A = anti- coagulants S = stool softener 301 Edited by :- MR. ROMAN BAJRANG

30. NURSING MANAGMENT Provide emotional support 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. 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 31 Reliance institute of nursing L imtar dhamtari

31. NURSING CARE PLAN 32 Reliance institute of nursing L imtar dhamtari

32. Nursing Diagnosis 33

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37. COMPLIC A TION Angina Re-infarction Infarct extension Heart failure Cardiogenic shock Mitral valave dysfunction 38

38. PROGNOSIS 39 Edited by :- MR. ROMAN BAJRANG

39. Health Education PERSONAL HYGIENE DIET MEDICATION FOLLOW UP 40 Reliance institute of nursing L imtar dhamtari

40. Thank You! 41 Reliance institute of nursing L imtar dhamtari