IDENTIFICATION DATA

Name : Mrs .I .Krishna Rao

Age : 50 years
Sex : Male
Address : At/PO/- khilingirai
P.S-Gunupur
Dist-Raygada
Qualification : High school
Occupation : Farmer
Marital Status : married
Religion : Hindu
Registration Number : 1700056410
Name of the Hospital : MKCG, MCH
Ward : Cardiac Ward
Date of admission : 19/1/17
Diagnosis : Myocardial Infarction
Provisional diagnosis :  Severe chest pain
 Restlessness
 Dyspnoea
 Loss of appetite
 Fatigue and weakness
Name of doctor : [Link]
Date of data collection : 20/6/118
CHIEF COMPLAINT;-

 Swelling of face
 Decrease urine output
 Weight gain
 Fatigue
 Weakness

SOCIO-ECONOMIC STATUS

Mr. I. Krishna Rao belongs to a middle class ,nuclear family. The breadwinner of the
family is [Link] [Link] family monthly income is 10,000/- per month.
Theylives in own house with adequate light,water supply,toilet bathroom and
electrical supply. He have good relationship with neighbours .
FAMILY HISTORY:-

SL. NAME OF AGE/ RELATI EDUCAT OCCUP MARITA HEALTH

NO FAMILY SEX ONSHIP ION ATION L STATUS
MEMBER WITH STATUS
.
PATIEN
T

1 Mr. [Link] 50Y Client Higher Farmer married Apparently

Rao RS/ secondar healthy
M y
2 Mrs. I. 45yr Wife High House Married Apparently
Brundabati Rao s/ F school wife healthy
3 Mr. [Link] 20yr Son Degree Depende Married Apparently
Kr. Rao s/ M -nt healthy

4 Mr. I. Takulu 15yr Son Higher Dependa Unmarri Apparently

Rao s/ M secondar -nt ed healthy
y

FAMILY GENOGRAM

Mrs. I. Brundabati Rao

I. Krishna Rao (45yrs)

(50 year)

Mr. [Link] Kr. Rao Mr. I. Takulu Rao

( 20yrs) ( 15yrs)

Key terms:-

:-Male

:-Female

:-Client
FAMILY HISTORY OF ILLNESS

The client’s family members are free from all types of communicable and hereditary
disease.

PERSONALHISTORY:-

[Link] takes non-vegetarian .He used to take meals 3 times a day, But due
to disease condition he is not taking adequate meal now. She used to drink 6-7
glasses of water per day. Client having habits of taking alcohol [Link]
usually have regular bowel and bladder pattern Sleeping pattern is normal but due to
chest pain not getting adequate sleep. His relationship with family members is good

PAST MEDICAL HISTORY

Patient having diabetes and hypertension since 3year but no history of similar
episode chest pain and not taking any medication for that and no documentation of
treatment found.

SURGICAL HISTORY;-

There is no significancesurgical history present.

PRESENT MEDICAL HISTORY:-

Four years back Mr. Rao was apparently healthy but after a heavy meal he
developed nausea and vomiting,central and right sided chest pain started mild to
moderate in nature. The pain is radiating to both arms and towards the back ,after
sometimes it subsides. Now the client is admitted in M.K.C.G medical hospital .she
undergone the investigation of chest x-ray, ECHO, blood test such as CBC,urea,
createnine ,lipid profileand electrolyte. Client is now under treatment with
medication Tab. Ecosprin 150mg, Tab clopitab 75mg, Tab telmisartan 40mg,Tab
clonazepam 0.5mg.
PHYSICAl EXAMINATION

GENERAL APPEARANCE:-

Level of consciousness : Oriented to time, place, person

Body built : muscular
General grooming : Well groomed
Speech : understandable
Height : 154cm
Weight : 50kg
VITAL SIGN :-

SL. VITAL SIGN VALUE

NO.
1 Temperature 98.20F
2 Pulse 110 beats/ min

3 Respiration 20 breaths/
min
4 Blood pressure 100/110
mmHg

SKIN:-

Color of skin : Fair

Skin turgor : Elastic
Texture and integrity : Rough, no impaired skin
HEAD AND FACE:-

Shape : Round
Texture of hair : Curly
Scalp : Free from dandruff
Facial puffiness : Not present
Distribution of hair : Equally distributed
EYES:-

Eye brows Bilaterally symmetrical

Eye lashes : Equally distributed
Eye lids : Bitarally equal
Eye balls : Bilaterally equal
Conjuctiva : No infection
Sclera : Whitish
Cornea and iris : Clear
Pupils : Reactive to light
Lens : Clear
Fundus : Normal
Uses of glasses : Not using glasses
Vision : 6/6
EARS:-

Pinnae : Bilaterally symmetrical

Tympanic : No perforation
membrane
Hearing : Normal hearing present
Level in rotation to : Normally coordinated
eye
Hearing acuity : Good
Any discharge : No discharge present
Hearning aid : Not using any hearning aid
Vertigo : No vertigo
Canal Clear
Tinnitus : No tinnitus
NOSE:-

Size and shape : Long nose

Nostrils : Clear
Symmetry : Symmetrical
Deformity : No deformity
Flaring : No nasal flaring
Discharge : No discharge
Nasal septam : Patent
Epistaxis : No nasal bleeding
Sinuses : Not tendered , no pain
 MOUTH AND PHARYNX:-

Lips : Pink
Odour of mouth : Foul smelling
Teeth : Yellowish
Dental hygine : Clean
Tongue : Well flexed
Throat and pharynx : No infection
Uvula : Present in midline
Gum and mucous membrane : Healthy
Palate : Intact
Tonsils : Not enlarged
Temporomandibular joint : Normally range of motion
maintained
NECK;-

Lymph nodes : Not palpable

Thyroid gland : No swelling
Range of motion : Not possible
RESPIRATORY SYSTEM:-

Shape and symmetry : Bilaterally symmetrical

Respiratory rate : 26 breaths/ min
Thoracic cage shape : Normal shape
Lung auscultation : Wheezing
Normal breath sound : Normal visceral sound
Respiratory pattern : Not chest indrawing present
Dyspnea on exertion : Present

BREAST AND AXILLAE ;-

Breast : Bilaterally symmetrical

Nipple : No any discharge
Axillae : Lymphnodes not palpable
Lumps : Not palpable
CARDIOVASCULAR SYSTEM:-

Heart sound : S2 and S2 heard

Carotid pulse : Palpable,77 beats /min
Apical pulse : 75 beats /min
Peripheral pulse : 78 beats /min
Blood pressure : 150/100mmhg

ABDOMINAL EXAMINATION :-

Skin : Flushed
Contour : Flat
Digestion : Poor
Bowel sound : Audible
Percussion : Dull sound present
Palpation : No tenderness found
Abdominal distension : Not present

MUSCULOSKELETAL SYSTEM;-

Back : No any abnormalities

Vertebral column aligment : Abscence of kyphosis,scoliosis
Range of motion : Fully all directional
Upper extremities : Normal range of motion present
Lower extremities : Normal range of motion present
GENITOURINARY AND RECTUM :-

Rectum : Absence of fissure and hemorroids

Genetalia : Well developed
Any discharge or
abnormalities : Not found

Bad ador : Absent

NEUROLOGICAL EXAMINATION :-

Gait : Steady
Cranial nerves : Well responsive
Reflexes : Present
Coordination : Well coordinated

MENTAL STATUS EXAMINATION :-

Level of alerness : Dull

Orientation : Well oriented to time , place , person
Memory : Intact (immediate ,recent, remote )
Language & speech : Audible and understandable
Responsivess : Well response to the question
Knowedge : Intact
Insight : Patient is well known baout disease condition ,score-
5

INTRODUCTION

A heart attack is a medical emergency condition . If someone get prompt medical

treatment you canlimit damage to your heart. Even if waiting 10minutes can be fatal
myocardial infaarction is the technical name for a heart attack.A heart attacks occurs
when any artery supplying to heart become blocked and the heart does not get
enough blood and [Link] oxygen , cells in that area of heart die (called
infarction.) Most heart attacks are caused by blood clots,high blood fats ,life
[Link] a heart healthy diet and 30 min ofexercise 5 days , a week can reduce the
risk of heart attack.

DEFINITION

A myocardial infarction occurs as a result of sustained ischemia ,causing irreversible

myocardial cell death (necrosis), 80% to 90% of acute MI are secondary to thrombus
formation.

(According to Lewis’s medical sursical nursing )

 According to medical dictionary “Myocardial infarction is death of the cells of an
area of the heart muscle (myocardium) as a result of oxygen deprivation ,which in
turn is caused by obstruction of the blood supply commonly referred to as a “heart
attack”.

Medical definition of myocardial infarction is the term focuses on the

myocardium(the heart muscle) and the changes that occur in it due to sudden
deprivation of circulating blood .The main change is necrosis (death) of myocardial
tissue.

RELATED ANATOMY AND PHYSIOLOGY

The heart is a roughly cone shaped hollow muscular organ .It is about 10cm long and
is about the size of the owener’s [Link] weighsabout 250 g in women and is heavier in
men.

The heart lies in thoracic cavity in the [Link] lies obliquely a little more to
the left than the right and present a base above and apex [Link] apex is about
9cm to the left the midline at the level of 5 th intercostal spaces,i.e a little below the
[Link] extended to the level of the 2nd rib.

STRUCTURE OF THE HEART

The heart has four chambers, two upper atria, the receiving chambers, and two
lower ventricles, the discharging chambers. The atria open into the ventricles via the
atrioventricular valves, present in the atrioventricular septum.  There is an ear-shaped
structure in the upper right atrium called the right atrial appendage, or auricle, and
another in the upper left atrium, the left atrial appendage.  The ventricles are
separated from each other by the interventricular septum.

Heart composed of layer of tissue that are pericardium,myocardium,and

endocardium.

Pericardium

The pericardium is the outer most layer and is made up of two [Link] outer sacs
consist of fibrous tissue and inner of a contineous double layer of serous membrane.

Myocardium

Myocardium is the middle layer composed of specialised cardiac muscle found only
in the [Link] is not under voluntary control but it is striated ,like skeletal muscle.

Endocardium

This lies the chambers and valves of the heart .It is a thin ,smooth ,gilatening
membrane that permits smooth blood supply inside [Link] is the inner lining of heart
.BLOOD SUPPLY TO THE HEART

Arterial supply

Arterial supply by right and left coronary [Link] is the branch of aortic [Link]
supply 5% of blood pumprd from the heart.

Venous drainage

Most venous blood is collrcted by numbers of cardiac vein that join to form the
coronary sinus and is opens into right atrium.

ETIOLOGY :-

In patient In book picture

High blood pressure Hypertension
Dibetes Dibetes
Elevated cholesterol Elevated cholesterol
Smoking Smoking
Alcohol consumption Accumulation of homocystein
- Inflammation
RISK FACTORS :-

In patient picture In book picture

Age Age
Gender Smoking
Smoking Gender
High LDL Lack of exercise
Diabetes High cholesterol
Hypertension Being over weight
Stress Family history of MI
Hypertension
History of mental illness

PATHOPHYSIOLOGY :-

Atherosclerosis Arterial spasm atherosclerosis+ plaque spilit

+ thrombus

Obstruction sudden obstruction obstruction

( Reversible ) ( irreversible )

Ischemia

Hypoxia

Reduced o2 demand angina

Thrombolysis unstable angina

Permanent thrombus
 Necrosis

Myocardial infarction

CLINICAL MANIFESTATION

In patient picture In book picture

Squeezing pain Squeezing pain,heaviness ,tightness,pressure
in centre of chest
Pressure in centre of chest Pain that radiate to
back, left arm, jaw and
neck.
Pain that radiate to back,left arm, neck Nausea and vomiting
and jaw
Shortness of breath Diziness and weakness
Nausea and vomiting Irregular heart beats
Weakness Sweeting feeling of doom
Unusual fatigue

INVESTIGATION :-

In client picture In book picture

Chest x-ray Chest x-ray
ECG ECG
ECHO ECHO
Blood test such as CBC, urea Blood test such as CBC, urea createnine
createnine ,electrolyte ,electrolyte, lipid profile ,RBS
Coronary angiography
Cardiac biomarkers
TREATMENT :-

SL NAME OF DOS ROUTE FREQUE SIDE EFFECT

N DRUGS AGE NCY
O
1 [Link] 150m Oral OD  Abdominal pain
g  Heart burn
 Constipation
 Skin rash
2 [Link] 75mg Oral OD  Hematuria
 Headache
 Difficultyin
breathing
3 Tab 40mg Oral OD-HS  Confusion
.Atorvastatin  Muscle problem
 Weakness
4 Tab. Carvedilol 3.125 Oral BD  Dizziness ,diarrhoea
mg  Reduced blood flow
5 TabTelmisartan 40mg Oral OD  Back pain,sore throat
Hheadache
 Flu-symptoms

6 Inj Clexane 0.6mg S\C BD  Bleeding gums

 Increase menstrual
flow
 Fever ,irritability
7 Tab 0.5mg Oral OD-HS  Hypoglycemia
Clonazepam  Allergic reaction
[Link] 10U BBF  Drowsiness
8 mixtard 30:70 S/C 8U Before  Salivation
dinner  Loss of coordination
 sweating

9 Tab Ranozex 500m Oral BD  Nausea

g  Vomiting
 Weakness
 Costipation
 NURSING DIAGNOSIS :-

According to maslaw’s hierarchy of needs the priorities of nursing diagnosis -

1. Acute pain related to myocardial infarction as evidenced by restlessness,&

verbalization.
2. Risk for ineffective tissue perfusion related to decrease cardiac output as
evidenced by monitoring blood pressure.
3. Imbalanced nutrition less than body requirement related to pain as evidenced
by
refusing to eat food.
4. Disturbed in sleeping pattern related to stressful hospital environment as
evidenced by client verbalization
5. Deficit knowledge related to therapeutic treatment regimen as evidenced by
asking frequent question

NURSING PROCESS ANDAPPLICATION OF NURSING THEORY

Application of Roy adaptation modes :-

Sr .Callista Roy,a prominent nurse theorist, writer, lecturer ,born at Loss Angeles on
1939.

Her concepts of adaptation says

Adaptation : goal of nursing

Person : adaptive system

Environment :stimuli

Health: outcome of adaptation

Nursing :promoting adaptation and health.

INPUT THROUGHPUT OUTPUT
Physiological functions, Self
Stimuli concept
Coping
,Rolefunction,Interdepe- Adaptive and
Adaptation level mechanism
ndence ineffective
Regulator response
(myocardial
cognator
infarction)
1. Physiological mode – Pain
 Nursing diagnosis - Acute pain related to myocardial infarction as
evidenced by restlessness,& verbalization.
 Adoptive system –inadequate
2. Physiological mode –Oxygenation
 Nursing diagnosis- Risk for ineffective tissue perfusion related to
decrease cardiac output as evidenced by monitoring saturation level.
3. Physiological mode- Nutrition
 Nursing diagnosis- Imbalanced nutrition less than body requirement
related to pain as evidenced by refusing to eat food.
4. Physiological mode-activity and rest
 Nursing diagnosis:- Disturbed in sleeping pattern related to stressful
hospital environment as evidenced by client verbalization.
5. Physiological mode :-Neurological function(knowledge deficit)
 Nursing diagnosis- Deficit knowledge related to therapeutic
treatment regimen as evidenced by asking frequent question.
SL.N ASSESSMENT DIAGNOSIS GOAL IMPLEMENTATION RATIONALE EVALUATION
O
1 Subjective Acute pain related The  Assessed the pain level of patient  To know the After 2 hrs,
data:- to myocardial pain by the use of numerical pain scale. pain level of patient
Patient infarction as level The pain score is 8/10. patient. verbalized relief
complaints evidenced by will be  Assessed the location, type, of [Link] pain
severe chest restlessness, relieve. duration of pain. score is 4/10.
pain. verbalization.
Objective data:-  Placed patient in semi fowler’s
Restlessness position and advised for complete  It enhances
Dyspnoea bed rest. the comfort
of the patient
 Monitored effectiveness of o2
therapy  To prevent
further
ischemia
 Administered medication as advised
by doctor.  To decrease
pain by
reducing the
 Reassurance given to patient and reuptake of
family members regarding the serotonin at
relieve of pain. the nerve
ending

 To relieve
anxiety
02 Subjective Risk for To  Monitored vital signs .  To determine Stable sign
data:- ineffective tissue maintain baseline of cardiac
Patient perfusion related the stable  Monitored for cardiac dysrhythmia changes. perfusion
 complains chest to decrease sign of including disturbances of both  To identify was
tightness and cardiac output as effective rhythm and condition. significance of maintained
pressure feeling evidenced by cardiac  Kept the patient on bed rest with a dysrhythmia. after some
at centre of monitoring perfusion. quiet environment.  Stress extent.
chest. saturation level .  Monitored respiratory status for activates
Objective data:- symptoms of heart failure. sympathetic
Decreased activity and
blood pressure  Administered o2 as ordered increase o2
Dysarrythmia . demands.
 To maintain
saturation
level.
 It increases
myocardial o2
supply.
03 Subjective Imbalanced To maintain  Assessed the nutritional status the  To know the Client
data :-client says nutrition less than nutritional client . nutritional nutritional
“I am body requirement status of  Advised to take nutrition by status. status is
not interested to related to pain as the client frequent small feedings.  To decrease maintained
take food as evidenced by  Administered analgesics half an pain. after some
before .” refusing to eat hour before each meal.  To minimize extent .
Objective data :- food.  Provided oral care before and after bad breaths
Loss of appetite meals.  To maintained
 Given balanced diet rich in nutritional
proteins,carbohydrate, vitamins status.
and minerals

SL NO ASSESSMENT NURSING GOAL IMPLEMENTATION RATIONALE EVALUATION

DIAGNOSIS
04 SUBJECTIVE Disturbed in To maintain  Assessed sleep pattern  It provides base line Client sleeping
DATA:- sleeping pattern the normal and difficulty in sleep. data. patter is
Clients related to sleeping  Provided Calm and quiet maintained
complaints the stressful hospital pattern. environment.  To feel comfort after some
he is not able to environment as  Provided comfort extent.
sleep evidenced by measures such as  It helps in muscle
OBJECTIVE client comfortable bed, noise relaxation.
DATA:- verbalization free room, massage,
Dullness comfortable position.
Verbalisation  Administered medications
for sleep as per physicians  It enhances sleep.
order.
 Given reassurance and
helped the client in taking
some decisions regarding
care.

SL NO ASSESSMENT NURSING GOAL IMPLEMENTATION RATIONALE EVALUATION

DIAGNOSIS
G
05 Subjective data :- Deficit To describe  Assessed the client’s current level of  Obtain client’s VERBALIZED
Patients knowledge disease knowledge. teaching
complains that related to condition needs .
she is not aware therapeutic and  Explained the pathophysiology of
about disease treatment regarding disease and treatment regimen  Increase level
condition. regimen as the of
Objective data :- evidenced by therapeutic  Discussed about life style modification understandin
Look anxious asking frequent treatment to prevent further complication. g
Frequent asking question. regimen.
question .  Instructed the client to notify  To get
physician if any abnormalities found. cooperation
from patient .

 Explained the need for follow up care .

 It prevent
 Instructed the client to take further
medication as prescribed by the complications.
doctor .Not to stop any medication
without permission of cardiologist.
 Helps to know
regarding
health status.

Because cardiac
medication are
very essential .
HEALTH EDUCATION

Health education is given as per the need of the client which are as follows :-

Medication

 Take all the heart medication as prescribed by the doctor .

 Instructed the client not stop medication without consulting cardiologist.
 Instructed the client to notify physician if any abnormalities occurs such as gum
bleeding.

Nutrition
 Advised the client to take adequate light diet ,which heart healthy diet
 Get enough calories ,protein, vitamins, and minerals to prevent poor nutrition.
 Avoid sea food, excessive fat and spicy food.
 Do routine check up of lipid profile .

Exercise

 Maintain every day activity of daily living as possible.

 Do exercises 30 minutes every day .
 Encouraged to follow the energy conservation principles to get relief from fatigue.

Lifestyle modification

 Manage stress cordial with others.

 Get full vaccination.
 Deep breathing exercise.
 Maintain hygiene.
 Encouraged the client to avoid smoking and alcohol consumption.

Follow up care

 Encouraged the client to go cardiac rehabilitation centre as directed.

 Take permission from physician before taking any other medication.
 Do not take any decision regarding disease condition without consulting your
treating doctor.

FINAL IMPRESSION AND SUSPECTED ILLNESS

From the evidence as subjective and objective data ,I suspected that client is suffering from
myocardial infarction. Client is having chest pain that is radiating to back ,arms ,neck. Client
having history of diabetes ,hypertension, alcoholism and high cholesterol levels, which
supports me to suspect client having MI.
CONCLUSION

From this study i got conclusion that patient is from a low socio economic status ,having
habits of alcohol came to hospital with the chief complaints of chest pain and diagnosed as
MI. Myocardial infarction is also a heart attack where muscle get irreversible necrosis. It
caused due to smoking ,high cholesterol etc. Through this study .I improved my knowledge
about the myocardial infarction ,its causes ,sign and symptoms, treatment which needed for
application in nursing field.

BIBLIOGRAPHY

 Hinkle L. Janice, Cheever [Link], Brunner and , Suddarth’s Text book of Medical
Surgical Nursing” 13th edition , New Delhi, published by Walters Kluwer( India )
[Link].,Pp -741-749.
 Chintamani, Lewis’s Medical Surgical Nursing, 7thedition, Gorgon, A division of
Reed Elsevier India Pvt. Ltd. ,Pp-805-814
 Chug SN ,Textbook of Medical Surgical Nursing,1st edition, New Delhi, Avichal
publishing company, Pp- 318-321.
SUBMITTED TO :- SUBMITTED BY:-
[Link] Bai Miss Pratima Topno

Lecturer (MSN) [Link]. nursing 1st year

CON, Berhampur CON, Berhampur

SUBMITTED ON