Case Study of Mr. Papas

This case study explores the risk factors, pathophysiology, homeostasis mechanisms, and nursing treatments for myocardial infarction in the case of Mr. Papas. It discusses the role of smoking, sedentary lifestyle, and exercise in the development of the condition. The study also highlights the importance of health literacy and provides recommendations for substance abuse counseling and lifestyle changes. Additionally, it explains the pathophysiology of myocardial infarction, including plaque rupture and thrombosis. The case study concludes with nursing treatments, such as reperfusion therapy and antiplatelet and antithrombotic therapy.

Running head: CASE STUDY OF Mr. PAPAS
CASE STUDY OF Mr. PAPAS
Name of the student:
Name of the university:
Author note:

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CASE STUDY OF Mr. PAPAS
Risk factors and health promotion:
Myocardial infarction can be described as the disorder where blood flow to the heart gets
reduced or even may get stopped that results in occurrence of damage in the heart muscles. One
of the risk factor of the disorder which promotes the vulnerability of an individual to develop the
disorder is smoking of tobacco. It has been found that chemicals that are present in the cigarette
smokes contribute to swelling of the cells that are present in the lining of the blood vessels
(Anderson et al., 2017). They are seen to become inflamed which actually causes narrowing of
the blood vessels and this results in development of various types of heart ailments. Studies have
found that cigarette smoking results in development of plaques in the arteries which obstructs the
flow of the blood in the blood vessels. Moreover, the arteries are seen to lose their flexibility and
the opening of the arteries also become narrow resulting in situations called atherosclerosis.
Blood faces obstacles to flow through these damaged blood vessels and hence blood flow to the
heart gets obstructed. Many researchers are also of the opinion that smoking causes the blood to
be thicker making them more prone to develop clots inside the veins and arteries which also
block the blood flow to the heart. In this way, myocardial infarctions take place from smoking
(Reed et al., 2017). Mr Papas is seen to smoke around 15 cigarettes which might have been one
of the main risk factor that had resulted in myocardial infarction in the patient. Another risk
factor that contributes to myocardial infarction is sedentary lifestyle as well as lack of physical
activities and exercises in the life. It has been found in studies that exercise contributes in
keeping the heart healthy and helps to maintain the blood pressure level in the individuals
thereby preventing occurrence of heart disorders. Exercises also contribute to healthy body
weight and prevent the development of obesity that increases the chance of developing AMI. It
was seen Mr. Papas was an It professional who mainly used to work indoors and always seemed

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to be so busy that he could rarely undertake any physical activities as well as exercises (Li et al.,
2015). The sedentary lifestyle of the patient might have been one of the contributor or the risk
factor that had made him vulnerable to develop AMI. It is extremely important for the nursing
professionals to develop health literacy of the patient. Developing his health literacy would help
him to understand how his lifestyle choices and health behaviors are contributing to the disorder
that he had developed. He has already been of the opinion that his lifestyle choices had been the
main reason of the development of AMI. The nursing professionals may refer Mr. Papas to a
substance abuse counselor who can undertake cognitive behavioral therapy and help him to
unlearn the behavior of smoking. She can also refer her to anti-smoking workshops held by many
healthcare agencies in the community which Mr. Papas can attend to for overcoming his
smoking issues. The nurse should also educate him about the importance of exercises and other
physical activities for prevention of the recurrence of the disorder (Ibanez et al., 2017). The nurse
can also develop an exercise regime that aligns with his age and present health condition without
creating extra stress on him. Mr. papas should be also educated about the importance of regular
screening which can help him to understand whether he is out of danger or not for developing
any chronic disorders. A diet chart should also be given to him so that chances of developing
obesity or becoming overweight reduces and in turn chances of heart disorders.
Pathophysiology:
Often atherosclerosis procedure results in development of “vulnerable plaque” which
become responsible for acute coronary syndromes and ultimately, coronary artery thrombosis
become the end point. These are the situations that are found to be mimicking STEMI and
distinguishing them becomes very difficult. A substance known as the tissue factor remains
located within the necrotic core of the plaques. When such substances get exploded in the blood

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stream, tissue factors are seen to activate the clotting cascades thereby resulting in the occurrence
of the thrombosis (Niccoli et al., 2015). Studies opine that tissue factors might get exposed when
the fibrous cap which is seen to cover the plaque gets ulcerated or disrupted and this disruption
of the fibrous cap results in the plaque erosion or plaque rupture. Surprisingly plaque rupture is
seen to occur at the site of the modest coronary stenosis and therefore even if stress testing
becomes normal, the risk of the acute coronary syndrome still remains present. STEMI mainly
results from the coronary thrombosis after plaque rupture takes place and less often from fixed
obstruction (Mehta et al., 2016). Unstable angina is found to have much lower incidence of the
coronary thrombosis as compared to NSTEMI or STEMI and is often seen to take place from
fixed atherosclerotic stenosis. Studies opine that plaque rupture most commonly and are some
cases plaque erosion result in coronary occlusion which is the main predominant mechanism of
STEMI and NSTEMI.
A ST elevation myocardial infarction mainly occurs as a result of the thrombus formation
and this aspect results in the complete occlusion of the major epicardial coronary vessel. STEMI
is considered to be one of the most severe forms of acute syndromes and is found to be life-
threatening. This is a time-sensitive emergency that must be immediately treated with the help if
coronary revsacularisation as well as through percutaneous coronary interventions. Unlike that of
the non ST segment elevation as well as through unstable angina, STEMI mainly shows a
significant ST elevation in the 12 lead ECG (Cequier et al., 2017). A Non-ST segment elevation
is found to be different from ST segment elevation on particular aspects. In the former one,
angina symptoms at rest that mainly contribute to myocardial necrosis can be identified by the
elevated cardiac biomarkers showing no ST segment elevation on the 12-lead electrocardiogram.
But, the latter mainly comprises of angina symptoms at rest that contributes myocardial necrosis

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and can be also identified by elevated level of cardiac biomarkers with the elevation of ST
segment on the 12-lead electrocardiogram.
Homeostasis mechanisms:
Symptoms showing Radiation of pain in the different regions like shoulders and left arm:
During the time of acute myocardial infarction, the pain is seen to start in the chest and
then the pain gradually spreads to the other arenas. In fact, the professionals are seen to show
signs of the heart attack where the pain and discomfort are found to left, right or both the arms or
even in shoulders, neck, back, and also in elbow, stomach and lower jaw. It has been found that
women are seen to experience the pain in both the arms because of this disorder whereas the men
are seen to experience the pain mainly in the left arms (White et al., 2015). Researchers have
found that during the time of myocardial infarction, the heart is seen to experience the pain
sensations and thereby send the pain signals to the brain and the spinal cord in the same
pathways where many other nerve are also seen to be present. In such a case, it is found that the
nerves in the arms are absolutely stable but s the information coming from the heart might travel
through the same vicinity to that of the arms, shoulders, brain and others, it might make the brain
confused. The brain might get confused about the nerve signals coming from signals of the heart
as it lies in close proximity of the signals coming from arms and shoulders (ER et al., 2016). This
is termed as the referred pain. This is often found to be the characters of myocardial infarction
and Papas showing similar symptoms of pain radiating through arms and shoulders showed that
he is also affected by acute myocardial infarction.

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CASE STUDY OF Mr. PAPAS
Pallor:
Paleness or pallor can be explained as the abnormal lightness of the skin color when
comparison is done with that of the normal complexion of the human skin. When the blood flow
reduces, not enough oxygen is sent to the skin surfaces which result in development of paleness.
This situation might take place all over the body or it might also be localized. It has been found
that during the times of myocardial infarction, blood also fails to reach the heart muscles and so
the heart muscles cannot get the oxygen to function and this causes heart attack (Parrodi, 2016).
In such situation, the heart is also seen to fail the pump enough blood to the different parts of the
body that they get from the lungs. Thus oxygen containing blood is not pumped by the heart
successfully and hence, the skin extremities fail to receive the blood and so oxygen cannot reach
the skin and these results in development of the paleness.
Clamminess:
Clammy skin can be described as the skin condition which remains wet because of
excessive sweating. It has been found that heart attacks often accompany cold sweats thereby
giving healthcare professionals the cues that the patient needs immediate treatment. During the
time of myocardial infarctions, the pumping ability of the heart is seen to get reduced as the heart
of the affected individuals do not get enough oxygen which it requires to function effectively.
As the heart fails to send enough oxygen to the different parts of the body, the body starts feeling
lack of oxygen (Mannverk et al., 2019). Therefore, the heart is seen to take up extra efforts in
order to pump blood which require excessive amounts of ATP. When ATP burns excessively,
more energy is produced. In such a situation, the body heat is seen to increase as well and the
body homeostasis is seen to try its best to normalize the body heat. This mainly contributes in

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making the homeostasis system to bring down the body heat under control and therefore, they
initiate the perspiration process to release the body heat in forms of sweats though evaporation.
Hence, clamminess can be found in case of patients having AMI.
Nursing treatments:
The initial treatment should include the nurses to provide a 325 mg of nom-enteric coated
aspirin that would need to be chewed. The nurse should administer clopidogrel at a loading dose
of 300 to 600 mg to the patient. Id Mr. Papas is provided to be taken to the PCI, then he should
be given a 600 mg loading dose. Reperfusion therapy is one of the most important interventions
that are considered to be the cornerstone of the STEMI management. It should be provided
within 12 hours from the start of the symptoms (Parodi et al., 2015). Studies are of the opinion
that the most efficacious reperfusion therapy is the available of the timely primary PCI.
Percutaneous coronary intervention should be undertaken by the nurses with the motive of
opening the clogged arteries within one and half hour from the time, the patient gets admitted to
the emergency ward. Nursing professionals need to locate the clot in the patient and then place
stent so that the blood flow can initiate once again to all the heart muscles (Engstorm et al.,
2015). If the healthcare organization where Mr. Papas is admitted does not have PCI services,
then the nursing professionals should immediately administer fibrinolytic therapy (Cosentino et
al., 2017). Here, the nursing professionals attending Mr. Papas would aim in providing clot-
bursting medications in the patient with the aim of resolving the clots and these needs to be done
within 30 minutes from the time of the arrival in the emergency room. This approach helps in
breaking the barriers created by the blood clots and cause restoration of the blood flow. The
nursing professionals need to provide fibrinolytic agents like that of th streptokinase. Recently
evidences of giving Tenecteplase has been found to be more advantageous as it is fibrin-specific

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as well as can be given as the bolus and would have the lower incidence of the hypersensitivity
reactions. This medication can be given at the dose of 0.5 mg/kg body weight of Mr. Papas.
Antiplatelet treatment with that of the Glycoprotein IIb/IIIa antagonists can be also selectively
used in the patients who undergo PCI treatment primarily (Levine et al., 2016). Anticoagulant
therapy with that of UFH or bivalirudin can be used in the catheterization laboratory at the
specific type of the procedure when large thrombus burden had been found in the patient or if
the patient had developed inadequate thienopyridine loading. The next set of approach would be
to undertake the anti-thrombotic therapy. After the administration of the fibrin-specific and non
fibrin specific fibrinolytic agents, many of the literatures had supported the use of the
antithrombotic agents. This would help in the reduction of the reinfarction as well as the
recurrence of the ischemia. Studies opine that low molecular weight heparins (LMWH) may be
better than unfractionated heparin (UFH) and hence, the nurse can follow this evidence in cure of
Mr. Papas as well. One of the studies have stated that patients who undergo primary PCI need to
have periprocedural UFH26 or bivalirudin as Fondaparinux (without added UFH) may increase
the risks of catheter thrombosis (Deftereos et al., 2015). Oral beta-blockers should also be
administered. ACE inhibitors can help in improving the survival of the patients who have faced
reduction of the left ventricular ejection fraction (LVEF ≤40%) and for those who have faced
heart failures after STEMI. These drugs are seen to decrease the production of the angiotensin
II and as a result he blood vessels are seen to dilate and blood pressure gets reduced (Ebarsole et
al., 2017).
Activities of daily living:
In case of Mr. Papas, the activity of daily living that would be affected is the breathing.
The heart will be weaker after recovery and the pumping mechanism would also require time to

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come back into the normal mode in case of healthy hearts. Circulation system controlled by the
heart would not be highly efficient during this time and hence, not all the body cells would be
getting enough oxygen that could conduct respiration. Such organs might be found to be devoid
of oxygen and this would make the body feel fatigued. The working abilities of the individual
would be affected and in such situation, the nursing professionals should advise him to take
enough bed rest and not undertake any rigorous activities that might make the body feel more
need of oxygen (Backhaus et al., 208). The lung would also be devoid of oxygen for undertaking
its own actions and the breathing might be also affected as the cells in the lung would be feeling
fatigued as well. As the patient would be requested to undertake rests, he would not be able to
conduct another activity of daily living like that of washing and maintaining hygiene. The
nursing professional in such situation should try to allocate a social aide for him so as to manage
his symptoms after he is discharged home (Goldsweig et al., 2018). The social worker would
help him continue the activities of daily life like that of dressing and providing him support in
mobilizing as he is weak and may face a fall. The social aide would also be helping him to
undertake free hand exercises and accompany in brisk walking as he might feel bored from the
bed rest for the upcoming weeks. Mr. Papas should be also very careful about his body
temperature and should not go anywhere where he might face heat waves. Heat waves may affect
his body temperature which might have impacts on his health condition and studies state that
when temperature rises in the hot weather, the body tries to balance the heat also by increasing
the flow of the heart and also by the process of sweating (Scholz et al., 2018). This can make Mr.
Papas feel dehydrated and this can put more pressure on the heart. Hence, the patient needs to be
very careful.

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