Bandana did a case presentation on Myocardial Infarction which was conducted in CMS-TH, Nepal.

1. CASE PRESENTATION
ON
MYOCARDIAL
INFARCTION
Bandana Budhathoki
Bsc Nursing 4th year
Roll no. 06

2. PATIENT PROFILE
Name : Ram Bahadur Basyal
Age/Sex: 49 years/Male
Education: Illiterate
Religion: Hindu
Marital status: Married
Date of admission: 2017-05-07
IP.NO: 1702100357
Diagnosis: Myocardial Infarction ( anteroseptal)

3. CHIEF COMPLAINTS
Central chest pain * 1 day
Shoulder pain * 1 day
Vomiting * 1 episode
Shortness of breathe * 1 day
HISTORY COLLECTION
a) Present illness
Mr. Ram bahadur basyal was apparently well 1 day back ,
then he gradually developed the central chest pain radiating
to the shoulder. He had an episode of vomiting non projectile
in nature, no any blood composition. He also developed the
history of shortness of breathe.

4.  Past illness
Mr. Ram Bahadur Basyal had a history of Diabetic Mellitus
Type II and had been controlling it through exercise and
diabetic diet.
Present Surgery
There is no any significant history of present surgery.
Past Surgery
There is no any significant history of past surgery.
Family history
- Nuclear family
- 7 members in family
- Health: All members are healthy except cilent himself

5. 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

6. 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

7. INVESTIGATION
S.N Investigation Patient value Remarks
1 Hemoglobin 10.2mg/dl Anemia
2. Total RBC count 3.74 million/ cu mm Anemia
3. Neutrophils 82% Neutrophilia
4. lymphocytes 15% leukopenia

8. S.N Investigation Patient value Remarks
5. Total bilirubin 0.69 g/dl Jaundice
6. Conjugated bilirubin 1.61mg/dl Indicate
hepatobiliary
7. Unconjugated
bilirubin
2.0 mg/dl Indicate blood
or liver
problem
8. SGPT/ALT 85 ou/l Liver injury
9. Alkaline phosphate 3.4u/l Problem with
gall bladder

9. Echo :
 Moderate MR
 Dilated LV
 Mild TR
ECG:
 ST segment elevation

10. MEDICATION
S.N Name of Drug Dose Route Frequency Classification
1. Inj. Tazopip 4.5g
m
I/V TDS Antibiotic
2. Inj. Luponex 40m
g
Subcu
taneo
us
BD Low molecular
weight heparin
group
3. Tab. clonaz 0.25
mg
P/O HS Benzodiazepine

11. S.N Name of Drug Dose Route Frequency Classification
4. Tab. Ecospirin 150
mg
P/O BD Antiplatelet agent
5. Tab. Clopidet 75
mg
P/O BD NSAIDS
6. Tab. Lipicure 20m
g
P/O HS Lipid lowering
agent
7. Tab. Pantocid 40m
g
P/O BD Proton pump
inhibitor

12. PHYSICAL EXAMINATION
Findings
i. Dull , ill looking.
ii. Lean and thin body.
iii. Physical hygiene not maintained well.
iv. Self care deficit.
v. Oxygen supplementation 3L/m through nasal prong
vi. Neck vein visible
vii. Edema present at cannula site over right dorsal palm

13. DISEASE CONDITION

14. ANTEROSEPTAL MYOCARDIAL
INFARTION

15. 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.
- Wikipedia

17. ETIOLOGICAL FACTORS
S.N Book’s picture Patient’s picture
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

19. CLINICAL FEATURES
S.N Book’s picture Patient’s picture
1. Chest and shoulder pain Chest and shoulder pain
2. Shortness of breathe Shortness of breathe
3. Diaphoresis Diaphoresis
4. Decreased urinary output Decreased urinary output
5. Weakness , fatigue Weakness , fatigue
6. Vomiting Vomiting

20. S.N Book’s picture Patient’s picture
7. Lack of consciousness Absent
8. Sleep disturbance Sleep disturbance
9. ECG elevation ECG elevation
( ST segment elevated)
10. Tachypnea Tachypnea

21. DIAGNOSTIC EVALUATION
S.N Book’s picture Patient’s picture
1. History collection History collection
2. Physical examination Physical examination
3. Electrocardiogram Electrocardiogram
4. Lab test i.e Blood test,
Troponin I , II., HDL, LDL
Lab test i.e Blood test :- CBC, Hb
5. Chest X-ray Chest X-ray

22. 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)

23. • M= morphine
• O = oxygen
• N = nitrates
• A = aspirin
• T = thrombolytic agent
• A = anti- coagulants
• S = stool softener

24. 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

25. COMPLICATION
• Angina
• Re-infarction
• Infarct extension
• Heart failure
• Cardiogenic shock
• Mitral valave dysfunction

26. NURSING DIAGNOSIS
1. Acute pain related to tissue ischemia as evidenced by patient
reporting of chest pain, facial grimacing.
2. Decreased cardiac output related to changes in myocardial
contractility.
3. Impaired gas exchanges related to interruption of blood flow to
pulmonary alveoli.
4. Imbalanced nutrition less than the body requirements related to
inadequate intake, anorexia.
5. Activity intolerance related to imbalance between myocardial
oxygen supply and needs
6. Anxiety related to hospitalization and fear of death
7. Risk of ineffective tissue perfusion related to reduction of blood
flow

27. HEALTH EDUCATION ON:
• About disease condition “ Myocardial Infarction”
• Rest and sleep

28. PROGRESS REPORT
Day 1 Day 2
•Patient general condition looks
ill
•Vital sign were unstable ( fever
100.6 F)
•Shortness of breathe
•SpO2 was maintained via face
mask of 3L/m
•Kept on liquid diet
•Patient general condition looks
satisfactory
•Vital sign were unstable (Spo2
fluctuating)
•Shortness of breathe
•SpO2 was maintained via face
mask of 3L/m
•Kept on liquid diet

29. PROGRESS REPORT
Day 3 Day 4
•Patient general condition looks
fair
•Vital sign were stable
•SpO2 was maintained via
room air
•Kept on soft diet
•Patient general condition looks
fair
•Vital sign were stable
•SpO2 was maintained via
room air
•Kept on soft diet

30. PROGRESS REPORT
Day 5
•Patient general condition looks
fair
•Vital sign were stable
•SpO2 was maintained via
room air
•Kept on Normal diet
•Mobilization was done

31. SUMMARY
A patient named Ram bahadur Basyal 59 years of male was
admitted in college of medical sciences- TH on 2017-05-07 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.

32. 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/medical-management-
myocardial-infarction