Myocardial Infarction: Case Study

Running head: MYOCARDIAL INFARCTION: CASE STUDY
Myocardial Infarction: Case Study
Name of student:
Name of university:
Author Note:

1MYOCARDIAL INFARCTION: CASE STUDY
Elements of deterioration
The patient, Mr. Lee was admitted with myocardial infarction with associated symptoms
of shortness of breath, lightheadedness and angina or chest pain. Early interventions and
diagnosis of the condition was done through performing electrocardiogram, which enabled initial
management of the cardiac discomfort. The patient was given nitroglycerin in sublingual form in
successive dosages along with morphine. This drug treatment, intended to improve the condition,
however, further resulted in deterioration of the patient’s condition with reduction of blood rate,
hypotension and reduced preload of myocardial oxygen demand followed by lethargy. A review
of the patient’s clinical condition confirmed that increased heart rate (HR 133), decreased blood
pressure (BP 87/53) and reduced level of myocardial oxygen saturation (SPO2 88%) are mainly
the elements of deterioration in the patient’s condition. According to NSW Health Between the
Flags, indication of these elements of deterioration require a clinical review by nursing officials
to assess the root of deterioration of clinical treatment (Hughes et al., 2014). Based on clinical
review in the given case study, an increased requirement of myocardial oxygen is required to
improve the hypoxic condition. The nursing assessment of the Mr. Lee needs to be performed to
identify whether the deterioration has occurred due to drug overdose or any new clinical
symptom. If these clinical review and identification of deteriorating causes do not result in
improved patient condition in the following one hour, then a rapid response team would be
required to handle the situation (Chen et al., 2014). In the given case study of Mr. Lee, frequent
assessment by nurses is essential for the following one hour post clinical review.
ISBAR communication
I (Identity) Health nurse attending Mr. Lee post drug

2MYOCARDIAL INFARCTION: CASE STUDY
treatment in Coronary care unit.
S (Situation) The patient, Mr. Jae Kwang Lee, a 65-year
old man has admitted with severity of
conditions; He reported that he felt an
increasing chest heaviness which moved to
his left arm. He was constantly rubbing both
his chest and arm, trying to get some relief
from the discomfort. On further questioning,
shortness of breath and mild dizziness were
also reported with lightheadedness. He was
immediately admitted in the emergency
section and electrocardiogram was performed
which confirmed that he had been suffering
from myocardial infarction. He had been
given nitroglycerin in sublingual form
followed by morphine administration as the
first line of treatment. Nitroglycerin showed
no effect after administration, whereas
morphine showed a number of responses.
ECG before drug treatment confirmed blood
pressure of 108/73 and a myocardial oxygen
demand of 95%.
B (Background) Mr. Lee reported that he had been having a